Real-time monitoring is not indispensable for a successful routine ART program. Its potential benefits are not supported with convincing evidence based on currently available data. Risks related to its application should be seriously considered and eliminated. However, it is a very useful research tool. - Grace Fertility Centre " "

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Real-time monitoring is not indispensable for a successful routine ART program. Its potential benefits are not supported with convincing evidence based on currently available data. Risks related to its application should be seriously considered and eliminated. However, it is a very useful research tool.

What are the principles behind this idea?
1. In an effort to identify the best embryo(s) for transfer for further improvement of IVF success, a recent approach is to apply real-time light microscopic monitoring of embryo development using time lapse photography.
2. This idea is not new as it was applied to study the early embryos in rabbits as early as 1929.
3. The principles are the same for the different available devices (e.g., the “EmbryoScope”) – either to build an incubator (for embryo development) around a commercially available microscope, or place a microscope specifically modified into a commercially available incubator.


What are the requirements for a time-lapse system for routine application in a standard infertility/IVF program?
1. Allow individual identification of embryos and changes of culture medium and safe arrangement without mixing up embryos
2. Record pictures with reasonable frequency and clarity of key milestones of early embryo development, the actual state of all embryos and previous events for analysis and archiving without disturbing safe incubation of the embryos.
3. Provide easy to use software for automatic analysis and real-time monitoring free of potential harm.


What are some of the potential sources of concerns?
1. Frequent exposure of the early embryos to visible light
2. Subtle physical, chemical, and/or biological disturbances related to some of these factors inherent in a time-lapsed embryo monitoring system:
a. the complicated mechanical arrangements and advanced electronics of the system, the automatic forwarding and focusing of the microscopic parts, and their maintenance might generate additional heat (e.g., from the motors), electro smog or volatile compounds from the lubricants used
b. loading of culture dishes can be more demanding
c. constant movement of culture dishes might generate shear stress and compromise embryo development
d. these factors may lead to potential inconsistencies of temperature and gas atmosphere and  infection risk (e.g., difficulty to sterilize and/or maintain sterility)
3. Potential risk of malfunction or breakdown of the system


Summary:
Real-time monitoring is not indispensable for a successful routine ART program.
It's potential benefits are not supported with convincing evidence based on currently available data.
Risks related to its application should be seriously considered and eliminated.
However, it is a very useful research tool.