background: Transfer of more than a single embryo in an IVF cycle comes with the finite possibility of a multiple gestation. Even a twin pregnancy confers significant risk to both mother and babies. The move to single-embryo transfer for all patients will be greatly facilitated by the ability to quantify embryo viability. Developments in time-lapse incubation systems have provided new insights into the developmental kinetics of the human preimplantation embryo. Advances in molecular methods of chromosomal analysis have created platforms for highly effective screening of biopsied embryos, while noninvasive analysis of embryo physiology reveals more about the embryo than can be determined by morphology alone. methods: Recent developments in time-lapse microscopy, molecular karyotyping and in proteomics and metabolomics have been assessed and presented here in a descriptive review. results and conclusions: New algorithms are being created for embryo selection based on their developmental kinetics in culture, and the impact of factors such as patient etiology and treatment are being clarified. Potential links between morphokinetic data and embryo kar- yotype are being elucidated. The introduction of new molecular methods of determining embryo chromosomal complement is proving to be accurate and reproducible, with the future trending toward CGH arrays or next generation sequencing as a rapid and reliable means of analysis, that should be suitable for each IVF clinic to adopt. A relationship between embryo metabolism and viability is established and is now being con- sidered together with morphokinetic data to create more robust algorithms for embryo selection. Microfluidic devices have the capacity and po- tential to be used in human IVF clinics for the routine diagnosis of embryo biomarkers.

Diagnosis of human preimplantation embryo viability

To compare the outcomes of embryos selected via time lapse monitoring (TLM) versus those selected with conventional methods of selection in subfertile women undergoing ICSI. The study population (239 women) was classified into two groups, based on the monitoring method used: Group 1 (TLM) and Group 2 (conventional monitoring). Groups were compared according to the clinical and ICSI cycle characteristics and reproductive outcomes, while transfers were performed at day 2 or 3. Subgroup analyses were performed, in women of both groups according to age and clinical parameters, and in embryos of Group 1 based on their cellular events. There was a statistically significant difference between the two study groups with regard to the outcome parameters, favoring Group 1 and especially in women >40 years of age. No differences were found in subgroup analyses in participants of both groups, regarding the stimulation protocol used, number of the oocytes retrieved and type of subfertility, while in Group 1 the percentages of “in range” cellular events were higher in certain divisions in ages 35–40, non-smokers, and the GnRH-agonist group, and in embryos that resulted in pregnancy. Morphokinetic parameters of early embryo development via TLM are related to the characteristics of subfertile patients and associated with ICSI outcomes.

Morphokinetic parameters of early embryo development via time lapse monitoring and their effect on embryo selection and ICSI outcomes: a prospective cohort study

The recent development of clinical time-lapse instruments has enabled continuous monitoring of human embryos to facilitate single embryo transfers in IVF. Time-lapse imaging (TLI) allows for a refined evaluation of known morphological parameters along with dynamic parameters and represents a new method of evaluating embryo viability morphologically. Timing of development has been correlated to blastocyst development, pregnancy outcome, and recently, chromosomal content, which suggests time-lapse imaging as a promising method for a more reliable embryo selection than morphology alone. The present challenge is that no consensus exists on which parameters are the most predictive, and only a few publications have offered clinically applicable models of embryo selection. Furthermore, due to the influence of culture conditions on development, selection models need modifications before transfer between clinics. This chapter addresses the use of TLI in the evaluation of pre-implantation embryo development and pregnancy potential in an effort to provide an overview of the feasibility and potential use of TLI in IVF treatment and single embryo transfer.

Prediction of Embryo Viability by Morphokinetic Evaluation to Facilitate Single Transfer

Session 59: embryology – development and quality

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Session 59: embryology – development and quality