New practical recommendations for the use of time-lapse technology in ART

ESHRE 2020 Montjean

New ESHRE recommendations on the use of time-lapse technology were reviewed by French embryologist Debbie Montjean.

Published 07 July 2020

New recommendations from ESHRE concentrate on the practicalities of introducing a time-lapse system into IVF labs, not on its use solely to improve delivery rates.

A decade after its dramatic introduction to the IVF sector, the question still remains whether time-lapse technology (TLT) is able to improve success rates in IVF. Will TLT ever fulfil its great expectations for outcome or are we holding it accountable to the wrong benchmark?

Despite such hopes and its widespread uptake, a lack of good practice guidelines for TLT in IVF has persisted. Now, the wait is over. Debbie Montjean, a member of the ESHRE’s SIG Embryology and one of 11 international contributors, presented details of the long awaited recommendations for TLT at this year’s virtual annual meeting. The collaborative effort has now produced a set of good-practice recommendations for the introduction and application of TLT, a comprehensive literature review and detailed time points for annotating development, whilst finely balancing both the pros and cons of this technology.(1)

The published recommendations, as Montjean emphasised, are not set out as a blueprint for improving embryo selection or delivery rates, but provide extensive support to IVF laboratories embarking on investment in TLT and standardisation and structure to those with the systems already in place. In addition, the publication emphasises the need for consistent nomenclature and annotations of morphokinetics, guidelines which were previously published but further summarised within this publication.(2)

For newcomers to the technology the recommendations are divided into a user-friendly 11-step guide to the best approach to introduction and application. The publication comprehensively reviews all versions of TLT currently available, comparing an extensive range of user requirement specifications in hardware, software and the on-going costs of technical support and maintenance.

Acknowledging the initial excitement when TLT was first introduced, with ‘obvious implications for the efficiency of ART treatment’, the authors propose that these expectations are yet to be met; indeed, the integration of TLT within the ART laboratory has not yet increased IVF success rates as once hoped. Yet, added Montjean, ‘clinical outcomes aren’t the only advantage to justify use’. Significant importance to other laboratory activities should not be ignored, she said. Undisturbed and stable culture conditions combined with improvements in laboratory workflow, flexibility and efficiency are substantial benefits. Moreover, TLT has undoubtedly revealed further biological markers and development anomalies which are otherwise undetected in traditional culture and static embryo assessments. Thus, the recommendations summarise 20 atypical features in human embryo cleavage development, 13 of which are exclusively observed using TLT and the remaining seven ‘better’ observed when assisted by TLT. Such observations of subtle embryo anomalies and early mitosis can assist in blastocyst prediction with higher sensitivity and accuracy. Montjean ended her online presentation noting that ‘time-lapse will at least help you to prioritise embryos and ultimately shorten your time to pregnancy’.

Until now the absence of good practice guidelines for TLT and a lack of standardisation might be a reason for the inconsistent results among global users of the technology. But the authors here recognise that TLT is here to stay in the IVF lab; perhaps a standardisation of practice may unify the data and point towards an improvement in IVF success rates.

1. ESHRE Working group on Time-Lapse technology. Good practice recommendations for the use of time-Lapse technology. Hum Reprod Open 2020; doi: 10.1093/hropen/hoaa008.
2. Ciray HN, Campbell A, Agerholm AE, et al. Proposed guidelines on the nomenclature and annotation of dynamic human embryo monitoring by a time lapse user group. Human Reprod 2014; 29: 2650-2660.

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