TILT: Time-Lapse Imaging Trial: A pragmatic, Multi-Centre, Three-Arm Randomised Controlled Trial to Assess the Clinical Effectiveness and Safety of Time-Lapse Imaging in in-Vitro Fertilisation Treatment.

• Background: Subfertility is a common problem for which in-vitro fertilisation (IVF) treatment is commonly recommended. Success rates following IVF are suboptimal and have remained static over the last few years. This imposes a considerable financial burden on overstretched healthcare resources. Time-lapse imaging (TLI) of developing embryos in IVF treatment is hypothesised to improve the success rates of treatment. This may be either by providing undisturbed culture conditions and/or improving the predictive accuracy for optimal embryo selection from a cohort of available embryos. However, current best evidence for its effectiveness is inconclusive. • Methods: The time-lapse imaging trial is a pragmatic, multi-centre, three-arm parallel group randomised controlled trial using re-randomisation. The primary objective of the trial is to determine if the use of TLI or undisturbed culture in IVF treatment results in a higher live birth rate when compared to current standard methods of embryo incubation and assessment. Secondary outcomes include measures of clinical efficacy and safety. The trial will randomise 1575 participants to detect an increase in live birth from 26.5% to 35.25%.• Discussion: In the absence of high quality evidence, there is no current national guidance, recommendation or policy for the use of TLI. The use of TLI is not consistently incorporated into standard IVF care. A large, pragmatic, multicentre, trial will provide much needed definitive evidence regarding the effectiveness of TLI. If proven to be effective, its incorporation into standard care would translate into significant clinical and economic benefits. If not, it would allow allocation of resources to more effective interventions.• Trial registration: ISRCTN registry, ISRCTN17792989, 18/04/2018, prospectively registered.