title: Time-lapse embryo imaging for improving reproductive outcomes: systematic review and meta-analysis.
abstract: OBJECTIVE
  To identify, appraise and summarize the available evidence regarding the effectiveness and safety of time-lapse embryo monitoring on the main outcomes of assisted reproductive techniques.
  
  
  METHODS
  In this systematic review and meta-analysis, we included only randomized controlled trials (RCTs) comparing time-lapse embryo imaging with standard embryo monitoring. Our primary outcomes were live births (efficacy) and congenital abnormalities (safety). The secondary outcomes were clinical pregnancy, ongoing pregnancy and miscarriage.
  
  
  RESULTS
  Two RCTs were considered eligible, and their data were extracted and included in a meta-analysis. In both studies embryos were transferred at the blastocyst stage. No studies reported rates of live birth or congenital abnormalities. Our estimates were not sufficiently precise to identify whether time-lapse monitoring provided a small benefit, no effect or minor harm on rates of clinical pregnancy (relative risk (RR), 1.05 (95% CI, 0.80-1.38)) or ongoing pregnancy (RR, 1.05 (95% CI, 0.76-1.45)), based on two studies involving 138 women with moderate-quality evidence. Considering the available data, we were unable to determine whether the intervention poses substantial benefit, no effect or substantial harm in the risk of miscarriage (RR, 0.95 (95% CI, 0.30-2.99)), based on two studies involving 76 clinical pregnancies with low-quality evidence.
  
  
  CONCLUSIONS
  Time-lapse embryo imaging is unlikely to have a large effect on the chance of achieving clinical and/or ongoing pregnancy when transferring embryos at the blastocyst stage. More studies are required to improve the quality of the current evidence and also to examine whether this intervention is useful when transferring embryos at the cleavage stage.
authors.affiliation: Division of Child Health, Obstetrics & Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK.
authors.forename: L T
authors.initials: LT
authors.lastname: Polanski
authors.forename: M A
authors.initials: MA
authors.lastname: Coelho Neto
authors.forename: C O
authors.initials: CO
authors.lastname: Nastri
authors.forename: P A
authors.initials: PA
authors.lastname: Navarro
authors.forename: R A
authors.initials: RA
authors.lastname: Ferriani
authors.forename: N
authors.initials: N
authors.lastname: Raine-Fenning
authors.forename: W P
authors.initials: WP
authors.lastname: Martins
mesh_terms: D000293:Adolescent; D000328:Adult; D002970:Cleavage Stage, Ovum / Q000637:transplantation; D004624:Embryo Transfer / Q000379:methods; D005260:Female; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D027724:Reproductive Techniques, Assisted; D059008:Time-Lapse Imaging / Q000379:methods*; D055815:Young Adult
keywords: ICSI; IVF; assisted reproductive techniques; review; time-lapse imaging