Date post: | 27-Jul-2015 |
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Health & Medicine |
Upload: | mitera-ivf |
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There are no commercial relationships or other activities that might be perceived as a potential
conflict of interest
Innovation trigger
Peak of inflated
expectations
Trough ofDisillusionment Slope of Enlightenment Plateau of
productivity
Gartner’s hype cycleVisibility
Time
Payne 1997
Plethora of TLM papers
Suggestions of algorithm for embryo competence
Aneuploidy risk model
To have or not to have TLM??
First RCT’s
In vitro culture of embryos
Conventional observation’s• Maturity • Fertilization• Fragmentation• Cleavage rate/Blastocyst rate• Multinucleation/Aneuploidy
TLM• Ability to check and score in a
dynamic manner• Follow up on normality of
cleavages• Exclude “out of range” timelines• Objective scoring• Communication
Embryo
Intervals:
• DPN to 2C: 2-3 hrs• 2C -3C: 8-12hrs• 3C-4C: <45min• 4c-5C: 13-16hrs• 5C-8C: <6hrs• 8C-BC: <72hrs
Milestones:
• DPN: 22-26hrs• t2: 24-28hrs• t3: 30-38hrs• t4: 35-41hrs• t5: 48-57hrs• t8: 50-59hrs
J. Assist Reprod Genet (2015) 32:563-570
In conjunction with similar studies, our results indicate the importance of the timing of cleavage events on embryo competence and the positive effect that embryo selection via TLM has on ICSI outcomes.
We found higher clinical, ongoing and live birth rates in participants whose embryos were monitored through TLM, as compared to those whose embryos were monitored by morphological assessment. This difference was maintained in women over 40 years.
Figure 2. Percentage of transferred embryos of Group 1 (TLM) that exhibited “in range”cellular events in patients with positive outcomes (Blue lines) and negative outcomes (Redlines).
Figure 2. Percentage of transferred embryos of Group 1 (TLM) that exhibited “in range”cellular events in patients with positive outcomes (Blue lines) and negative outcomes (Redlines).
Adapted 5C-8C: from <6hrs to < 3hrs
Time line profile
e
Time line profile
e
e
3-4 Cells
Davies (ESHRE 2012) Delayed cleavage divisions and prolonged transition between 2-4-cell stages identified as aneuploid at 8-cell by array CGHThe timing of first and second divisions were delayed in aneuploidy and more marked in those with multiple aneuploidy2-4 cell transition: Euploidy<single aneuploidy<multiple aneuploidy
Basile (2013) Increasing the probability of selecting chromosomally normal embryos by studying their kineticsClassification system based on time parameters relates to selection of euploid embryos Normal embryos A+: 36,3%, A: 33,9%;B+: 32,0%, B:19,5%;C+:14,3%, C:11,5%;D+: 10,0%, D: 9,0%
Campbell (2013) Retrospective analysis of outcomes after IVF using an aneuploidy risk model derived from time-lapse imaging without PGS Aneuploidy risk model
Abnormal cell division & aneuploidy
Indications for TLM
• Older patients with high # oocytes
• Previous unsuccessful IVF patients
• Previous successful patients (sET)
• Good prognosis patients (D2/3 not BC ET)
Confidence of transferring fewer embryos Satisfied patients with greater information given
Appeals to patients & clinicians/ commercial world
Combined conventional and TLM can increase embryo selection and pregnancy rate:
Help selection by exclusion
More sophisticated way of culturing embryos
RCT have confirmed earlier studies- now in your hands!
Less disturbance/More observations
Innovation trigger
Peak of inflated
expectations
Trough ofDisillusionment Slope of Enlightenment Plateau of
productivity
Visibility
Time
METABOLIC STUDY & TIME LAPSE, Gardner
OOCYTE MATURATION, Yi, Li
QC & KPI’S, Morbeck
MICROFLUIDS, Swain, Smith
Gartner’s hype cycle