title: Does the addition of time-lapse morphokinetics in the selection of embryos for transfer improve pregnancy rates? A randomized controlled trial.
abstract: OBJECTIVE
  To determine if the addition of continuous morphokinetic data improves reproductive outcomes when all embryos are cultured in a closed system.
  
  
  METHODS
  Prospective, randomized, controlled study.
  
  
  METHODS
  Single academic center.
  
  
  METHODS
  A total of 235 patients undergoing fresh autologous IVF cycles with at least four embryos, cultured in the Embryoscope: 116 patients randomized to conventional once-daily morphologic embryo screening (CS) and 119 to additional time-lapse kinetic monitoring (TLM) for selection.
  
  
  METHODS
  TLM versus CS.
  
  
  METHODS
  Intrauterine clinical pregnancy (CPR) and implantation (IR) rates.
  
  
  RESULTS
  CPR and IR were similar overall (TLM vs. CS, respectively: CPR 68% vs. 63%; IR 51% vs. 45%) and with blastocyst transfers (CPR 74% vs. 67%; IR 56% vs. 51%). CPR with day 5 transfer was threefold higher than day 3 transfer, but group (TLM vs. CS) was not a significant predictor of clinical pregnancy or implantation. Significantly more multinucleation was detected when CS embryos were retrospectively reviewed with the use of TLM (7.0% vs. 35.3%), and multinucleation was independently associated with decreased rates of implantation. Time to the start of blastulation of <100 hours after insemination and the morphokinetic scoring system used in the TLM group were independently associated with implantation.
  
  
  CONCLUSIONS
  The addition of time-lapse morphokinetic data did not significantly improve clinical reproductive outcomes in all patients and in those with blastocyst transfers. Absence of multinucleation, timing of blastulation, and morphokinetic score were found to be associated with blastocyst implantation rates.
  
  
  BACKGROUND
  NCT02081859.
authors.affiliation: Department of Reproductive Endocrinology and Infertility, Cleveland Clinic, Beachwood, Ohio. Electronic address: linnea.goodman@gmail.com.
authors.forename: Linnea R
authors.initials: LR
authors.lastname: Goodman
authors.affiliation: Department of Reproductive Endocrinology and Infertility, Cleveland Clinic, Beachwood, Ohio.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Goldberg
authors.affiliation: Department of Reproductive Endocrinology and Infertility, Cleveland Clinic, Beachwood, Ohio.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Falcone
authors.affiliation: Department of Reproductive Endocrinology and Infertility, Cleveland Clinic, Beachwood, Ohio.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Austin
authors.affiliation: Department of Reproductive Endocrinology and Infertility, Cleveland Clinic, Beachwood, Ohio.
authors.forename: Nina
authors.initials: N
authors.lastname: Desai
mesh_terms: D000293:Adolescent; D000328:Adult; D001755:Blastocyst / Q000502:physiology*; D046149:Embryo Culture Techniques; D010064:Embryo Implantation; D004624:Embryo Transfer / Q000009:adverse effects; D005260:Female; D005298:Fertility; D005307:Fertilization in Vitro / Q000009:adverse effects; D006801:Humans; D007246:Infertility / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D007700:Kinetics; D016015:Logistic Models; D009024:Morphogenesis; D016017:Odds Ratio; D009820:Ohio; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D059008:Time-Lapse Imaging; D016896:Treatment Outcome; D055815:Young Adult
keywords: Time-lapse monitoring; blastocyst; embryo selection; implantation; morphokinetics; multinucleation