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Embryo selection at CARE

Why is embryo selection important?

At CARE, we believe that family is for everyone, which is why we place such a high level of importance on embryo selection.  To give you your best personal chance of success, we want to ensure that we choose your best embryo.

To ensure that the best embryos are chosen, we need to know how viable they are. Traditionally, embryologists would assess embryo quality by looking down a microscope and evaluating the embryo based on their number of cells, how smooth and even those cells are, and whether or not there was any sign of fragmentation (cell debris). This method is effective, but now, we have more sophisticated tools to choose the best embryo for transfer and increase the chances of success thanks to technological advancements.

Using a tool such as time-lapse imaging, where a photo is taken of an embryo every five to ten minutes, we can gather a vast amount of data. Using this data, we can assess how the embryo looks, how they move and their behaviours. A live feed of time-lapse imagining enables us to continuously assess these sets of information throughout the embryo’s journey.

 

How are embryos selected?

Embryos are visually assessed by our experienced embryologists using an EmbryoScope. An EmbryoScope is an incubator that not only has the right conditions for a healthy embryo to develop, it also allows the embryologist to monitor embryo cell divisions while the embryo remains within the incubator. It has a special time-lapse system with a camera that continuously captures images and records them as the embryo develops. This can then be used with our unique CAREmaps algorithm analysis to increase success rates.

CAREmaps has helped improve the process of embryo grading, which is a key part of an emberyologist’s job. Previously, an embryologist would remove dishes from incubators to view embryos under a microscope each day. This would expose the embryos, albeit not for very long, to substandard conditions. For many, the need to balance checking how the embryos are progressing versus not exposing the embryos to cold conditions for too long remains tricky. This usually means that instead of checking embryos every day, they are instead checked only 2-3 times. At CARE, we now have time-lapse technology that allows us to monitor the embryos 24 hours a day.

 

Preimplantation Genetic Testing (PGT)

CARE can also offer you Preimplantation Genetic Testing (PGT). PGT enables us to screen for any genetic abnormalities before an embryo is implanted through IVF. We offer PGT-A, PGT-M and PGT-SR.

PGT-A is preimplantation genetic testing for aneuploidy (the presence of an abnormal number of chromosomes in a cell, for example 45 or 47 instead of the usual 46.) PGT-A allows us to give you information about your embryo’s genetic health, thus allowing us to help select the best embryo for transfer, helping to improve your chances of achieving a successful pregnancy.

PGT-M, formerly known as Preimplantation Genetic Diagnosis, is recommended for those aware that they are at an increased risk of passing on a specific genetic condition. PGT-M will usually be performed before pregnancy and can reduce the risk of having a child affected by a genetic condition.

PGT-SR, also known as preimplantation genetic testing for chromosomal structural rearrangements can be performed to help improve the chance of establishing a healthy pregnancy. PGT-SR aims to ensure that pregnancy can occur without chromosomal imbalance occurring due to inherited structural rearrangement. Such rearrangements can be inherited or can happen spontaneously. PGT-SR can help identify embryos with the correct amount of chromosomal material likely to lead to a successful pregnancy.

 

An embryo developing from one cell into a blastocyst ready for transfer

 

What is CAREmaps, and how does it work?

To make sure the right embryos are chosen, we’ve created a database containing all our data on embryo development from the past twenty years. By comparing new embryos to embryo data on the database, our amazing  embryologists can calculate precise timings for laboratory procedures and fine-tune our practices to optimise fertilisation and pregnancy tests.

CAREmaps is the name of our time-lapse imaging procedure. It has been designed to help us choose the best embryo possible without genetic testing. CAREmaps allows us to predict which embryos have the greatest potential, thus increasing your possibility of having successful IVF treatment.

 

So, how does CAREmaps actually work?

CAREmaps makes use of time-lapse technology to monitor embryos 24 hours a day. Cameras are fitted within the incubators allowing the embryologist to view an embryo’s development at any point without needing to remove them from the incubator. We are able to use the data gathered from videos of the embryos to assess which embryo has the highest capacity of creating a baby. We are also able to give patients more information about each of their embryo’s chances of success.

In our recent publication ‘Optimisation of the timing of fertilisation assessment for oocytes cultured in standard incubation: lessons learnt from timelapse imaging of 78,348 embryos’ we used the data from our CAREmaps system to help us determine when the optimum time to perform the all-important check for fertilisation is. This check tells us if the egg has created an embryo or not.

For fertilisation to be confirmed, we need to see two circular structures in the egg, which are only visible for a small window of time. If the eggs are cultured in CAREmaps, then we can perform this check at any time. However, if they are in a standard incubator, we must be able to time these checks to make sure the observation is as useful and accurate as possible.

Currently, our guidance suggests a 2-hour window in which to perform this check. From our research, we would suggest a stricter 1-hour window to make sure that most eggs with visible signs of fertilisation can be seen at the time of observation.

 

Benefits of CAREmaps

Some of the benefits of CAREmaps include:

  1. Higher birth rates than standard methods, as CAREmaps gives better embryo selection, allowing embryologists to see which embryos have the best chance of producing a baby.
  2. More detailed information than standard incubation methods, cell division timings and embryo development patterns are recorded using time-lapse images. These images help indicate embryo quality and potential, which we discuss with you.
  3. Uninterrupted culture is where eggs are removed from the ovaries and combined with partner or donor sperm in an artificial forum to create a fertilised egg, with embryos developing without disturbance. With CAREmaps being a non-invasive process, embryologists can view detailed photographs and movies of the developing embryos without removing them from the incubator.
  4. A video download of your transferred embryos is available for you to keep.

To find out more about CAREmaps please click here.

 

World-leading science and exceptional patient care is at the forefront of what we do. If you have any questions, contact the CARE team to find out more.

With love from CARE x

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