The Hewitt Fertility Centre, located in Liverpool on the UK’s North West coast, is one of the country’s largest assisted conception centres providing over 3000 cycles of treatment per annum. The centre is owned by the National Health Service (NHS) and is unusual in that as well as being the largest provider of NHS-funded treatment in the UK, it also provides treatment ‘privately’ to those patients not eligible for state-funding (with ‘profits’ being re-invested into the service). The Hewitt Fertility Centre now routinely provides time-lapse imaging to all of its patients (free of charge) and uses eight EmbryoScope systems to help achieve this. Dr Stephen Troup, Scientific Director explains below something of the centres approach to time-lapse imaging and the use of its EmbryoScope time-lapse systems.
"All embryologists would no doubt agree that we have been striving for many years for a way of observing embryos without disturbing them. Also, in the UK, the Human Fertilisation and Embryology Authority (HFEA) who regulate assisted conception, currently require centres to achieve a multiple birth rate of <10% (ours is currently 7.7%) and, as such, over 70% of our patients now have elective single embryo transfer (mainly on day 5). Of course, this puts even more pressure on our embryologists to select the embryo with the highest implantation potential - so the EmbryoScope system couldn’t have come along at a better time.
Our interest in time-lapse imaging started over 10 years ago when the first prototype of a time-lapse system was introduced by another company, which did not continue with the project. Although the system was capable of producing good quality time-lapse images, it constantly overheated and was therefore not clinically acceptable! But the technology has, of course, improved hugely and we acquired our first EmbryoScope system in April 2011 and a second shortly thereafter.
Three advantages of the EmbryoScope time-lapse systems were immediately obvious. These being i) at last we had a culture system which is extremely stable and far superior to our conventional incubators, ii) the ability to de-select embryos which showed abnormal cleavage patterns (which would have gone previously undetected) and iii) the ability to record a huge amount of morphokinetic information about each embryo. As funding within the hospital became available, we were then placed in the (pleasantly) difficult situation of deciding whether time-lapse imaging was indeed a ‘game-changer’. Following critical evaluation of the literature and much discussion with many colleagues around the world, we decided to invest wholeheartedly acquiring a further six EmbryoScope systems and providing time-lapse imaging routinely to all patients at no additional charge.
But morphokinetic analysis is still very much in its infancy and forms the focus of our embryology research at the moment. One of our team is studying for a PhD using EmbryoScope morphokinetics in an attempt to elucidate effective embryo selection algorithms and presented some of her findings at ESHRE 2014 in Munich. Due partly to its high patient throughput the Hewitt Fertility Centre is well placed to contribute to this research forum and we have already cultured over 25,000 embryos in the EmbryoScope time-lapse systems.
Although we might not know exactly why yet, I am delighted that since the introduction of EmbryoScope, we have seen our embryo implantation rates increase by approximately 10% (to nearly 50% per embryo transferred in patients aged <35) together with a reduction in the number of ‘biochemical only pregnancies’ (presented at Boston ASRM) and I must congratulate the IVI group on the recent publication of their RCT which provides much-needed evidence of the beneficial effects of using the EmbryoScope system in terms of improving pregnancy rates and reducing the incidence of early pregnancy loss.
Finally, I must admit that we do also have a couple of other time-lapse systems in our IVF laboratory at the moment and I’m frequently asked which system I think is the best. The correct answer is that the different systems do different things and the choice of system will depend on the individual requirements or the laboratory. However, the fact that 90% of our cycles use EmbryoScope systems, is perhaps testament to my current opinion!"