Large RCT Finds Time-Lapse Imaging for Embryo Selection in IVF Does Not Improve Live Birth Rates

A randomized controlled trial (RCT) in the UK and Hong Kong examined in vitro fertilization (IVF) outcomes, revealing that time-lapse imaging (TLI) does not enhance treatment success. Published in The Lancet, the study offers critical evidence against the effectiveness of TLI in fertility treatments.

Current TLI Assessment Techniques Controversial to Fertility Viability

Time-lapse imaging, a technique in IVF, captures thousands of images of embryos during their development, offering a continuous view of each embryo’s growth. Fertility practitioners sometimes use TLI for pre-implantation screening, believing it can help identify the best embryos for implantation based on development rate and cell characteristics.

With TLI, embryos remain in their incubators, thereby reducing fluctuations in temperature, humidity, pH, and gas concentrations that could impact their development. Conversely, standard assessment techniques involve removing embryos from the incubators to select those with the best implantation potential.

Globally, one in six adults experiences subfertility. According to the Human Fertilization and Embryology Authority (HFEA), the UK conducted over 100,000 IVF treatments in 2022–23.

Time-Lapse Imaging Does Not Improve IVF/ICSI Live Birth Rates

Dr. Priya Bhide from the Women’s Health Research Unit at Queen Mary University of London led the double-blind trial, which recruited over 1,500 participants undergoing IVF at seven centers in the United Kingdom and Hong Kong.

Researchers randomly assigned participants to one of three trial arms: one group underwent TLI-based embryo selection, another received standard static assessment with undisturbed culture, and the third underwent conventional assessment using a light microscope and standard embryo culture in incubators. Moreover, baseline demographic and clinical characteristics were similar across all three groups.

Live birth rates for embryos were 33.7% in the TLI arm, 36.6% in the undisturbed culture arm, and 33.0% in the control arm. Clinical pregnancy rates were 42.2% for the TLI group, 43.4% for the undisturbed culture group, and 40.9% for the control group. Furthermore, none of the secondary outcomes for clinical effectiveness and safety showed significant differences between the trial arms.

Advanced Technology Does Not Guarantee Better Clinical Outcomes; Equipment Budgeting Should be Reassessed

Essentially, the study found no significant improvement in live birth rates for women using TLI during IVF and ICSI treatments. Despite TLI being an advanced technology, it did not make a difference in the actual success rates of these fertility treatments. This result is crucial for everyone involved as it shows that sophisticated technology does not always lead to better results in real-life clinical settings.

Dr. Bhide, the study lead and a Clinical Reader at the Women’s Health Research Unit, Center for Public Health and Policy in the Wolfson Institute of Population Health, shared, “Our trial suggests that TLI does not improve the odds of live birth in women having IVF and ICSI treatments. This shows that the theoretical benefits of advanced technology do not always translate into improved clinical outcomes. This is important information for all stakeholders; patients, health care professionals, funders, and policymakers.”

Dr. David Chan, lab director at the Prince of Wales Hospital, The Chinese University of Hong Kong, stated, “Our trial provides evidence to support that TLI machines may not be essential equipment in the IVF lab, especially for IVF laboratories with limited resources. Laboratories may use the findings from this study to re-evaluate how they allocate their budget for equipment.”

Dr. Chan highlighted that the study suggests TLI machines may not be essential for IVF labs, particularly those with tight budgets. He recommends that these labs rethink their spending on equipment. Instead of spending heavily on TLI machines, which didn’t show significant benefits, labs should invest in equipment that directly enhances live birth rates. This approach could help reduce the overall costs of IVF treatments and make them more affordable for patients, especially in resource-constrained settings.

Author

Bernice Lottering