By fertility experts from Spain.
Estefanía Abanto Gonzalvo, MD, Gynecologist & Obstetrician, is answering patients’ questions about Timelapse embryo incubator and new technologies available at IVF lab in IVF Bilbao clinic.
To answer this question we have to begin talking about the IVF process or the IVF treatment. As most of you know, IVF treatment begins with the stimulation of the patient’s ovaries to get their oocytes. The gynecologist controls this stimulation by ultrasounds and when we see that the ovarian follicles are full enough with oocytes for the retrieval. In the retrieval, we get those oocytes and then the work of the embryologists at the IVF lab begins. This is the first step – they accumulate the oocytes and fertilize them with the selected sperm. They do it this inside special cabins. Here, for example, we have closed cabins that make this process safer. Then the fertilized oocytes are kept inside the embryo incubators. An embryo incubator is a place where the embryos are kept during the days that they are in our laboratory.
When the embryologists keep the embryos in culture in the laboratory this culture must fulfill some conditions. The temperature of it must always be safe, at a constant temperature of 37 Celsius degrees. The culture media must have a determined osmolarity and pH. The humidity must be high – to create this they oil with the culture media to avoid the evaporation of this medium. An embryo incubator has two simulate the maternal environment of the uterus and that’s the reason why it must fulfill these conditions. All kinds of incubators in our days fulfill these conditions but we can talk about many different types of incubators. When using the traditional ones, to be able to assess the development of the embryo embryologists must open the door of this incubator, take the plate where the embryo is, remove it and access the embryo. On the other hand, we have the Time-lapse system where we use a traditional incubator but we don’t do the step of opening the door, moving the plate with the embryo which can destroy the ideal conditions that is needed for the development. With the Time-lapse system, as we are going to see now, it doesn’t happen.
As I have said it’s a kind of incubator but the main characteristic of it is that it has a camera recording the embryo, taking pictures of the embryo every 15 minutes in different focal planes. This is really important because this allows the embryologist to have complete information on the development of the embryo and not only its assessment in a specific moment as it happens with a traditional incubator. With this information, the embryologist can really know the real potential of implantation of every embryo. On the other hand, it also allows the embryo to grow better because we are keeping those conditions that we have talked about before always the same. The temperature, the humidity – we never break that environment and that allows the embryo to grow better. Also, this kind of incubator nowadays includes software that uses the information taking into account the division speed of the embryo, the size of the embryo and using some algorithms and artificial intelligence, makes the prediction of the real potential of each embryo.
If we take into account that the information that the TLS system gives us about the real implantation potential of every embryo and that this kind of incubator allow the embryo to grow better, the pregnancy rates in an IVF treatment in which we use TLS system are higher. For example, our group has recently presented research at IVI Valencia which included more than 8,000 cycles IVF cycles with the transfer of more than 9,000 embryos. In that research, we could see that the implantation rate using the TLS system was 6% higher than when we didn’t use it. There are different kinds of TLS systems. In that research we didn’t they didn’t see any difference in pregnancy rates using a different kind of TLS systems. The main one that we use here is the EmbryoScope – because it’s the one in which development we took part, we were the first group using it and achieving the first pregnancies with it. Also, there has been interesting research that is trying to correlate the morphokinetic of the embryo that they can see with these systems with euploidy of the embryo. So in the future maybe I think that we will be able to know if an embryo is euploid or not without a biopsy but only by using this kind of device.
In an IVF treatment, this is a really easy question and a really easy answer. Always, with no doubt. As I have said before using this kind of incubator makes the pregnancy rates higher. The embryologists have more information about the embryo and the embryo grows better. In the future with the use of artificial intelligence, this will be better. This kind of incubator will become essential. For us, they are essential nowadays. We are lucky to be able to offer all our patients the use of them. So we should always use them, always.
IVI clinics have both traditional and Time-lapse system incubators but mainly we use the TLS system and the EmbryoScope. This is most important for us.
This is a question that our biologist would answer. Nowadays, they use single uniform media.
When the ovarian reserve is really low, we think that treatment with donor eggs would be the best for you and of course. We will have to take into account other conditions, the sperm quality and so on but, of course, using TLS could be also beneficial, of course when being sure that the uterus and the endometrium activity is OK.
We have EmbryoScope and it’s mainly used at IVI clinics generally.
Yes, I do. Our experience, as I have told you before, here at IVI clinics is greater with the EmbryoScope and, of course, when you have experience using any laboratory technology, you get more experience and your results are better. So this is the one that we use because our embryologists really work well with it. In the research that our group made with IVI Valencia the results with different types of TLS are the same. Here we use the EmbryoScope because it’s the one with which we have more experience. I think it’s better because thanks to it we have better results.
My advice would be to check with the embryologist of your clinic because they have more information about them than only the classification. It’s not enough information only the classifications and my advice is talking to the embryologist of your clinic to inform you about the evolution and the division of these embryos to be able to choose.
This is a nice question because this could be another advantage of this kind of system. The camera recordings of each embryo are kept at the clinic and normally here we give to the patient on a flash drive so she can see watch them at home. When the baby is older, he or she would be able to see the images from when they were an embryo. It’s a really nice system.
The length of the period is not a problem. When we say to make a controlled ultrasound on a day two or three of the period, it doesn’t mean that you still must bleed till then. So if your period lasts only one day – no problem. The next day you can do the ultrasound with no problem. That’s a better moment because the endometrium is not thick and so we can see in the ultrasound if uterus if has any problem or if fibroids are going to be a problem with the transfer later.
We need more information and without seeing those embryos is difficult. The development on day 3 can be different from day 5 or 6. I always advise my patients to talk to the embryologist because finally he or she is the one that has to make the decision and has more info. It’s still too little information to be able to make a decision. I do repeat the same – I think that best would be to talk to your embryologist who will explain better the development of those embryos.