Article| Volume 45, ISSUE 5, P858-866, November 2022

Comparison of embryo implantation potential between time-lapse incubators and standard incubators: a randomized controlled study


      • Time-lapse systems significantly improved the first embryo transfer implantation rate.
      • Time-lapse systems did not significantly improve the cumulative implantation rate.
      • Time-lapse systems did not significantly improve the live birth rate.


      Research question

      What are the potential clinical benefits of embryo culture and assessment in a time-lapse incubator compared with a standard incubator using static assessment?


      This large multicentre, single-blinded, randomized controlled study included 1224 participants randomly assigned (1:1) to the time-lapse or standard incubator group. In all patients one or two embryos were transferred on day 3. The primary outcome was the implantation rate in the first embryo transfer cycle. Secondary outcomes included the cumulative implantation rate, live birth rate in the first embryo transfer cycle and cumulative live birth rate.


      Among 1224 participants recruited, 1182 underwent embryo transfer. The number of successfully implanted embryos in the first transfer cycle was significantly higher in the time-lapse incubator group (time-lapse group: 52.35%, standard incubator group: 47.11%, P = 0.014). The implantation rate in the first embryo transfer cycle was still significantly higher in the time-lapse group than the standard incubator group after adjusting for age, body mass index, medical centre and embryo status (relative risk 1.11, 95% confidence interval 1.02–1.20, P = 0.020). However, the cumulative implantation rate, live birth rate in the first embryo transfer cycle and cumulative live birth rate were not statistically different between the groups.


      The implantation rate in the first embryo transfer cycle was significantly improved in the time-lapse group, but the effect of the time-lapse system on the cumulative implantation rate or cumulative live birth rate was not significant. The embryo assessment method offered by time-lapse systems rather than an undisturbed environment may play an important role in improving the implantation rate in the first embryo transfer cycle. These results are only applicable to young patients.


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      Xiaodong Zhang graduated from Southwest Medical University, Sichuan, China. He has been engaged in reproductive medicine for more than 10 years at Chongqing Health Center for Women and Children, mainly responsible for embryonic development-related research. His current research areas are embryo assessment, artificial intelligence and reproductive biology.
      Key message
      The study found that embryo incubation, evaluation and selection using a time-lapse system compared with standard culture led to significantly higher implantation rates in the first embryo transfer cycle in good-prognosis patients, while the cumulative implantation and live birth rates remained unchanged.