New technologies in IVF: What to use and when?

Time-lapse incubation (Embryoscope)

Embryoscope, is an interesting latest IVF technology as it is a special time-lapse incubator which consists of a camera. It allows uninterrupted viewing of the embryo development without removing it out from the incubator and hence avoids exposing it to outside conditions. After every 10 mins, the embryoscope takes pictures of the embryo and then a small time-lapse movie is made which then allows the embryologist to monitor the cell divisions and growth of each embryo. As a result, the best embryos are selected by the embryologist for transfer.

 (https://www.fertilitydost.com/articles/article-details/10-latest-IVF-technologies-to-increase–)

Advantages of Embryoscope

  • Transparency in the growth of embryos as the time-lapse picture can be seen. Therefore all cell division time points can be monitored and used in in-house algorithms to prioritize and select embryos. 
  • Help embryologists identify anomalies, such as unusual cleavage patterns or severe fragmentation or pronucleate abnormalities that may otherwise be missed.
  • Uninterrupted culture as embryos are not removed from the Embryoscope for daily quality checks since their development is constantly monitored by the incubator itself.

Disadvantages of Embryoscope

  • Increases the cost of IVF in many clinics worldwide (but very affordable in Turkey)

Preimplantation Genetic Testing (by Next Generation Sequencing, NGS)

PGT-A (Preimplantation Genetic Testing for Aneuploidies) is a genetic study of the embryos produced during IVF Treatment in Turkey cycle. This test screens the embryos for any kind of chromosomal abnormalities before transferring them into the uterus. PGT-A selects genetically normal embryos with a normal number of chromosomes with a normal structure. 

Advantages of PGT

It allows a clear selection of embryos (as analyzing cleavage patterns in Embryoscope is totally subjective since it very much depends on the laboratory conditions and embryologist’s experience). 

It should be noted that many aneuploid embryos do divide as they should give rise to high quality embryos. Therefore PGT is strongly advised in case of:

    • Advanced maternal age (as aneuploidy in embryos is totally correlated with maternal age) 
    • Repeated implantation failures
    • Repeated spontaneous abortions
    • History of abnormal fetal karyotype 

Disadvantages of PGT

  • A biopsy representing a very small part of the 5th day embryo, named as blastocyst, has to be taken in order to do the test. Although very simple in unexperienced hands, this procedure can be lethal to the embryo. 
  • To give time to the genetic test, blastocysts are frozen by a technique called vitrification, which is very straightforward but harmful in unexperienced hands.
  • PGT is an expensive test, therefore it may be useful to use it in combination with Embryoscope to prioritize embryos when there are many. 

Artificial Intelligence (AI)

(https://www.forbes.com/sites/ganeskesari/2022/06/30/heres-how-ai-is-helping-make-babies-by-revolutionizing-ivf/?sh=42b56d187330)

Today, embryo classification is done by embryologists who manually inspect pictures for size, area, shape, proportion, and symmetry. AI utilizes computer vision algorithms to augment this process and predict the likely effectiveness of implantations. AI algorithms are trained from very large datasets  drawn from a diverse patient demographic giving the AI models the power to analyze minute features that are often undetectable by even the most experienced embryologists.

Advantages of AI:

  • Integrated with time-lapse imaging (TLI) systems providing continuous predictions from fertilization to the blastocyst stage. 
  • Embryological information coupled with implantation probability facilitating embryologists to make data-driven decisions for every embryo cultured in the Embryoscope.

Disadvantages of AI:

  • Despite improved results in embryo selection, studies have yet to demonstrate concrete improvements in live birth rates.
  • High cost depending on the IVF clinic.

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