Abstract
Study question
Looking at time-lapse images of own embryos during the five days of culture, as a patient’s active behaviour, may help to increase pregnancy rates?
Summary answer
The number of visual connections to live blastocyst development images of own embryos positively correlates to patient’s pregnancy rates after fresh single blastocyst transfer.
What is known already
In human reproduction, despite the evidence that infertility itself and reproductive treatments can produce anxiety and stress, the impact of emotions on pregnancy outcomes is unknown and probably underestimated. The interaction between psyche, nervous, immune and endocrine systems (PNIE) is well known and has been applied to understand and treat different pathological conditions. Patient’s active behaviour during IVF treatments appears to be a positive strategy to decrease women’s anxiety and stress, thus to increase fertility quality of life and pregnancy outcomes.
Study design, size, duration
Retrospective comparative study of 934 patients undergoing fresh IVF cycles during three years. To avoid any bias related to oocyte and embryo factors, we only included egg donation cycles in the study, and ≥3BB (Gardner score) single embryo transfers. All embryo cultures were performed in time-lapse incubator and patients could connect on-line to their embryo’s images before single blastocyst transfer. We evaluated the impact of visual connections to live embryo images on pregnancy rates.
Participants/materials, setting, methods
On day one of embryo culture, consenting patients received an individualized and secure link allowing them to connect on-line to images of their own embryos any time during the five days of culture. Patients were divided in five groups depending on the number of on-line visualisations (A = 0; B = 1–10; C = 11–20; D = 21–30; E > 30). Pregnancy and clinical pregnancy rates were compared between the five groups. Chi-square test for a large contingency table was performed to compare all groups
Main results and the role of chance
The distribution of patients in the five groups, based on number of visualizations, resulted as follows: 287 in group A; 328 in group B; 156 in group C; 80 in group D; 83 in group E.
The five groups were homogeneous and there were no statistically significant differences in recipient’s ages (A 42.8±3.9 years; B 41.9±3.9 years; C 41.8±4.5 years; D 42.8±4.1 years; E 41.9±4.4 years) and in donor’s ages (A 25.5±4.3 years; B 26.9±4.4 years; C 27.1±4.2 years; D 26.4±4.5 years; E 26.5±4.1 years) among the five groups.
We observed a progressive positive trend between the number of on-line visualisations and pregnancy rates, reaching statistical significance for group E (>30 visualizations) compared to the others groups. In group E, pregnancy rates and clinical pregnancy rates per fresh single blastocyst transfer were respectively 72.3% and 65.1%, significantly higher when compared to the others groups (p < 0.01, p < 0.001): group A 61% and 50.9%, group B 63.1% and 56.1%, group C 64.1% and 55.1%, group D 65% and 53.8%.
Limitations, reasons for caution
Time-lapse incubator is needed as well as a strong informatics setting to ensure secure and personalised on-line connection to each patient at any time during the five days of culture. Endocrine and endometrial biomarkers should be proposed and evaluated in further clinical trials to better understand these results.
Wider implications of the findings: Repeated on-line visualization of own embryos images before fresh blastocyst transfer enhances pregnancy rates in IVF cycles. We propose that repeated visual stimuli of images produces a positive emotional connection between patients and their own developing embryos, thus reducing anxiety and enhancing recipient’s endometrial receptivity.
Trial registration number
Not applicable
Cytoplasmic String Between ICM and mTE Is a Positive Predictor of Clinical Pregnancy and Live Birth Outcomes in Elective Frozen-thawed Single Blastocyst Transfer Cycles: a Time-lapse Study