The Cleveland Clinic is a multispecialty academic medical center located in Cleveland, Ohio, United States. The Cleveland Clinic is regarded as one of the top four hospitals in the United States by U.S. News & World Report. The clinic performs around 650 cycles per year and currently has three EmbryoScope® time-lapse systems in their laboratory. We have asked Dr. Nina Desai, Director IVF Laboratory, a couple of questions about the center's use of the EmbryoScope® time-lapse system.
When did you first become interested in studying embryo development with time-lapse?
Our first look at time-lapse imaging was back in 2002, as we tested vitrification as a cryopreservation method for 8-cell embryos. We monitored warmed embryos and their pattern of development to blastocyst. This early work with time-lapse and for the first time being able to observe the embryo during the entire process of compaction, blastulation and hatching was exciting. At the time there really were not any commercially available systems that could be incorporated in to a clinical IVF laboratory. Nonetheless the endless possibilities of what time-lapse could offer in understanding embryonic development tweaked our interests. Over the years we watched as time-lapse technology evolved.
When and why did you decide to acquire an EmbryoScope time-lapse system?
With the movement towards blastocyst stage culture and a push for single embryo transfers we realized that an additional non-invasive technology for assessing embryos was needed. For years our laboratory had focused a lot of attention on sequential scoring of embryo cleavage, compaction and blastulation patterns. We felt that time-lapse imaging and the ability to precisely identify specific developmental endpoints might provide additional parameters to select embryos most likely to implant. We acquired our first EmbryoScope time-lapse system in March of 2012 after a careful survey of competing time-lapse technologies. The sophistication of the EmbryoScope time-lapse system design as both an incubator as well as a device for time-lapse imaging made the choice easy for us. The device was also the only system at the time with FDA clearance and published pregnancy outcome data.
What moved you to start using the EmbryoScope time-lapse system exclusively?
We loved being able to visualize embryos throughout the growing phase. Clearly, with conventional once a day observations we were missing a lot of data and cleavage anomalies that could prove valuable in narrowing down our selection of embryos for fresh transfer. Our initial experience with culture in the EmbryosScope time-lapse system showed high rates of blastocyst formation and excellent clinical pregnancy rates in our day 5 transfer patients. Most importantly we were able to push more patients to blastocyst stage transfer due to the superior culture environment. Not having to remove dishes from the incubator at specific times each day for grading or to exchange culture media was an added benefit. Within two months of our first purchase we knew we were going to need another two EmbryScopes to accommodate all patient embryos.
How many research articles and abstracts have you presented on time-lapse embryo development?
To date we have presented a total of 11 abstracts at ASRM, ESHRE and other venues. Our first manuscript detailing initial embryo morphokinetic data and pregnancy outcomes in patients having a day 5 transfer was just recently published (RBE, 2014 http://www.rbej.com/content/12/1/54 ). This study laid the ground work for developing an embryo selection model specific for our laboratory that incorporates both traditional morphology as well as kinetic data. Validating the clinical use of morphokinetics for embryo selection is the subject of a prospective randomized controlled trial we initiated in spring of this year.
Have you learned anything new about embryo development using this system?
We have developed a basic model for embryo selection that excludes embryos with particular cleavage anomalies and encourages selection of embryos whose development fall within specific kinetic ranges. We are constantly refining this model as we accumulate more implantation data. The data suggests an improvement with time-lapse but this still needs to be corroborated. Another topic of interest to us increased rate of multinucleation observed with time-lapse imaging and its impact on pregnancy outcomes.
How has EmbryoScope time-lapse system influenced your communication with patients?
EmbryoScope has been quite helpful in counseling patients who have failed to become pregnant. We have more information to share with them about their embryos. Also, for the patient being able to visualize what we tell them about their embryos fragmenting or lagging behind is quite useful. For patients becoming pregnant having a video of the earliest moments of their baby’s growth is amazing and very much appreciated.