How useful is an embryoscope?

One of the newer technological gimmicks which has got a lot of attention recently is the embryoscope. A number of IVF clinics are now tom-tomming their acquisition of this newest toy in the IVF lab - and claiming that this helps to improve success rates !

The embryoscope is basically a videomicroscope which allows the embryologist to take multiple images of each embryo over a period of time , using time lapse videography . It is thus possible to review exactly how the embryo has developed over the period of 3 to 5 days which it spends in vitro in the incubator.

The great thing about the embryoscope is that it provides some gorgeous pictures ! It's very useful in training new embryologists , so they can learn exactly how and when embryo cleavage occurs in the IVF lab . Logically , such a devise makes a lot of sense. It gives us more precise information on how each embryo is growing , and therefore holds out the promise that it will allow us to select the best embryos - the one which are dividing more rapidly , and are therefore presumably of better quality.

The utility of the embryoscope in clinical practice still remains to be proven . If there are many embryos , all of which look equally good at a particular point in time, then reviewing the images provided by the embryoscope may provide more information about how each embryo has reached that point. The embryologist can look retrospectively , to see how each embryo has developed , so that he may then be able to select which embryo is better. However, for most experienced embryologists, their ability to select the best embryo , based on conventional morphological criteria such as the number of cells , their equality; and the presence of fragmentation , means that the additional incremental information which is provided by the embryo scope is of very little clinical utility for most patients .

It is usually patients who are poor responders who are likely to create far more problems for IVF clinics, because they have a poor success rate. However, because they have few embryos, the utility of the embryoscope becomes extremely limited in their case, because there are few embryos to choose from . One the other hand, when patients have lots of good quality embryos , the chances of success are extremely good, whether or not an embryoscope is used. This means that while the embryoscope can be a useful research tool in certain settings , whether it actually helps IVF clinics improve pregnancy rates for their patients still remains to be proven.

Unfortunately, as is true with any technological advance , because it is being marketed extremely aggressively, lots of IVF clinics will buy these; and then promote their use by advertising that they have the latest technology, which other clinics ( their competitors !) do not have. It's quite easy to fool some of the people some of the time - and some patients do get taken in by some of this marketing hype. However, using the embryoscope is extremely expensive - and is very unlikely to provide cost-effective use in clinical practice today.

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.