After egg collection comes the week of wait-and-see. You wait and see how many of your eggs fertilise, how many cleave at the right time and grow into blastocysts. They'll often be graded at this point, based on how even the cell sizes are, and what kind of fragmentation they have.
I've gotten pictures on all these days - pictures of my little embryos. It's a hard week, as often the number of eggs you start with is not the number of blastocysts you get at the end.
This last round we've decided to use an embryoscope, in the hope that it'll help our embryos get to blastocyst level.
What is an Embryoscope?
Typically your eggs and embryos are placed in a special incubator that maintains the environmental conditions necessary for embryos to grow. Every day, at set time points an embryologist will remove your embryos from the incubator to take photos and ensure they're developing on time. This has to be done quickly, because any environmental stress can potentially damage the embryos. Based on these observations, an embryologist will grade your embryos to tell which embryos are most likely to result in pregnancy and will select an embryo that develops along a set timescale. **
An embryoscope is an incubator that maintains the environmental conditions - just like a standard incubator. It has an incorporated time lapse camera system - it will take a picture every 20 minutes. This means your embryologist can monitor embryo development while the embryos are still in the incubator - they won't have to remove the embryo to examine it, making for more stable culture conditions.
It also means an embryologist can make more informed decisions, particularly with embryo selection as there is more information to consider. Time lapse observation is more thorough way to understand what is happening with the embryo. Embryo cells aren't static - they move. With a single static observation per day it's difficult to judge correctly what stage the embryo is at. For example, an embryo that has just cleaved and is pulling itself back together at the time of observation may be misjudged for extreme fragmentation. With more information, embryologists can can better tell which embryos will have a better chance at success.
Who should use an embryoscope?
An embryoscope is an expensive piece of equipment, adding to an already hefty IVF price tag. You'll want to weigh up the advantages of using an embryoscope with the cost.
- People who have lots of eggs/embryos for selection.
As using an embryoscope provides more information about an embryos development, there is a more informed chance of selecting a viable embryo for transfer. **
- People who would like more information about the embryo, when past cycles have not gone as expected.
Sometimes more information about an embryo is helpful in situations where there is repeated implantation failure, advanced maternal age or a history of recurrent miscarriage. It can help people make informed decisions about future treatment plans or sometimes bring closure.
- People who have a limited number of rounds.
IVF is such an expensive treatment and many of us can only afford a handful of rounds, if that. By ensuring a more stable culture environment you know you're doing everything you possibly can to help your embryos along.
What does the research say?
Unsurprisingly there has been loads of research around embryoscopes - they provide so much more information and have been used in a fair number of studies.
This study (Source) found that culturing embryos and selection improves reproductive outcomes. While there was no significant difference in pregnancy rate (the beta taken after the 2 week wait), the ongoing pregnancy rate (where there was a heartbeat at 12 weeks) was much better with the embryoscope than standard incubation. Implantation rates were also better with embryos selected from the embryoscope, and that early pregnancy loss was much less likely to happen.
This French report (Source) found that better embryo selection (according to embryo movement parameters and better observation of abnormal cleavages, along with greater quality control and flexibility) lead to an overall increase in success rates in IVF cycles.
This study (Source) echoes a similar message. by providing more accurate information about the embryo potential, it allows for better selection of embryos with high reproductive potential. This study (Source) goes on to suggest that by selecting embryos with good morphology and normal cleavage rates, they could, one day, provide the basis of a qualitative algorithm for embryo selection.
Should you use an embryoscope?
Essentially, there is no harm in using an embryoscope. It only offers positives - a more stable culture environment and more information about your embryos. If you can afford it, perhaps talk to your doctor about incorporating it into your cycle plan.
** Side note: While an embryo that cleaves on time, has little fragmentation and whose cells are symmetrical might look good - it still might chromosomally abnormal which will not result in a healthy pregnancy. More on chromosomal quality here. How an embryo looks is not the be all and end all, so if your embryos grade poorly please take it with a grain of salt.