Fertility breakthroughs and the future of embryology
At the end of British Science Week, we’re thinking about our scientists’ fertility breakthroughs and the future of embryology.
A recently published, world-first study by CARE scientists shows that CAREmaps – our pioneering time-lapse embryo imaging system – is significantly more accurate at selecting the best embryos than traditional methods. Sam Duffy, Senior Clinical Embryologist at CARE Manchester and one of the authors of the study, talks us through CAREmaps, fertility breakthroughs, and her thoughts on the future of embryology.
So, Sam: What exactly is CAREmaps?
CAREmaps is our unique time-lapse embryo imaging system that allows us to predict which embryos have the most potential. It works by taking photos of an embryo every ten minutes, so showing us the entire cell division process from the very moment of fertilisation through to when the embryo is ready for implantation or cryopreservation. Our embryologists are then able to use our own CAREmaps specific selection algorithm, based on known live birth data, to give each embryo a unique score.
Our Manchester clinic was actually the first in the UK to use the embryoscope clinically, but now I would say we use CAREmaps in roughly 70% of all cycles at CARE nationwide. I might be biased as – with my colleagues – I was the first to present CARE Manchester data on embryo time-lapse imaging and our morphokinetic algorithms, but I would say it has completely transformed IVF treatment and success, not just here but throughout the world.
Why is CAREmaps better than standard embryo observation, then?
Firstly, because the embryo is under constant surveillance. Before, you might only be able to look at an embryo once a day, and then have to update your team – and the patients – based on just a snapshot, literally just a second’s glance. Now, with CAREmaps, we are now able to virtually eliminate the risks of missing certain key developmental events, such as the appearance of normal fertilisation and the start of blastulation.
Of course, you’ve also got the continuous culture. Previously, embryos would have to be removed from the incubator at least once a day, in order to observe their development, but with CAREmaps, you never have to take embryos out of the incubator; you only disturb then when they’re ready for transfer. That means the embryo is in its optimal environment at all times.
Also, what’s nice for the patients is that they get to see the embryo development too! We were the first clinic in the UK to show patients a time lapse video of their embryo’s development, which is really the first video of their baby, right from the moment when egg and sperm become the embryo. It’s really quite amazing.
Finally, on the day to day, it’s quicker! CAREmaps gives us a lot of flexibility in the lab, which means we can help more patients in the time we have.
So, you work with CAREmaps every day – what would you consider the most exciting part of the technology?
As an embryologist, it has to be the increased knowledge we now have on embryo development patterns and the potential to use this to ultimately increase a patient’s chance of having a live birth. Using CAREmaps, we’ve been able to identify aspects of embryo development that we never knew existed. For example, we’ve been able to observe anomalies such as reverse cleavage and the merging of cells – both occurrences that can only be seen by using time lapse and factors that we now know can impact on an embryo’s potential to implant.
And we can be sure about what we’re seeing too, because of the amount of data… I couldn’t even say how many images we have! We have so many that we have to store the data in specialist computer drives.
Of course, now we also have the data from live births as well as the embryo images, which means we can discuss our findings and observations with even more certainty than before.
Okay, so embryologists really love CAREmaps – which other treatments do you think have helped bring over 40,000 CARE babies into the world?
Hmm… To be honest, there have been so many advancements in IVF and other techniques that it’s hard to choose! There’s PGT-A (pre-implantation genetic testing for aneuploidy), which is a genetic screening test that gives us information about an embryo’s genetic health. It allows us to select the embryo with the best chance of achieving a successful pregnancy, and also reduces the chance of miscarriage.
We also have the improvements in enhanced freezing: freezing eggs or embryos for use in later life. 30 years ago, cryopreservation wasn’t a very successful treatment, as ice crystals often formed inside the cells, damaging their structure and DNA, and causing them to perish. Now, success rates have increased astronomically thanks to the advent of vitrification: “fast freezing” of embryos and eggs storing them at temperatures of -196⁰C. I would say that 98 or even 99% of embryos now survive the freeze-thaw process here at CARE and the success rate of fertility treatment using frozen embryos is now the same – if not better! – than using fresh embryos, depending on your circumstances.
When you put all these advancements together, you can really see why there’s now over 40,000 CARE babies in the world. The science just keeps on getting better and better.
So, although CAREmaps is exclusive to CARE, other clinics use techniques like enhanced freezing and PGT-A. What makes CARE Fertility stand out from other fertility experts?
Once again, I would have to say the data! With CARE being a network of clinics, the amount of data we gain from our own research and projects is absolutely fabulous. If you’re going to find significance, if you’re going to find a breakthrough, it’s going to be using CARE data.
Also, you’ve got to mention the people in CARE. We have so much experience, such a wealth of knowledge across the group. You’re really not going to find such experience in any other clinic in the UK. If you add up all the years of experience just in CARE Manchester’s embryology department, it would blow your mind – imagine that multiplied by 21 clinics across the UK!
What do you think the next breakthrough will be in embryo research?
I have to go back to CAREmaps, mainly to look at embryo health. Currently, we can check embryo health with techniques like PGT-A, which can be great for people with multiple embryos. But, for some patients with maybe only a couple of embryos, where the embryo quality might not be good enough – well, those techniques are maybe less helpful.
We hope that we can use more live birth data to further enhance the predictability of the current CAREmaps algorithms. That means, in the future, we may not need to use an invasive technique to check embryo health; we’ll be able to predict their health with a very high degree of accuracy just by looking at the images. Wouldn’t that be great?