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A critical appraisal of time-lapse imaging for embryo selection: where are we and where do we need to go?

  • Assisted Reproduction Technologies
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The aim of this study was to undertake a critical appraisal of the available evidence for the use of time-lapse imaging for embryo selection in clinical IVF.


A literature search in PubMed, Scopus, Cochrane Central,, Current Controlled Trials, and WHO International Clinical Trials Registry Platform was performed to identify randomized controlled trials that investigated the effect of time-lapse embryo selection and/or the time-lapse incubation system on ongoing pregnancy rate. We then performed a systematic review and assessed the relative risks (RRs) and 95 % confidence intervals (CIs) for ongoing pregnancy rates and the risk of bias of the eligible studies.


We identified four eligible randomized studies, three of which investigated the effect of both time-lapse incubation system and selection on ongoing pregnancy rate; the pooled result revealed a benefit of this intervention (relative risk (RR) 1.20; 95 % CI 1.05–1.37). However, the evidence was judged to be of low quality due to study limitations; a beneficial effect was observed in only one study deemed to be at high risk of bias. The single study assessing the effect of only the time-lapse incubation system revealed a non-significant negative effect (RR 0.71; 95 % CI 0.49–1.03).


The findings from this systematic review of the current evidence do not support routine use of time-lapse technology in clinical IVF. We therefore believe that the use of time-lapse imaging for embryo selection should remain experimental and that couples should not be subject to a surcharge for having their embryos cultured in a time-lapse imaging system. Future studies evaluating this technology in well-designed trials should be performed.

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Conflict of interest

The authors declare that they have no conflict of interest.

Declaration of authors’ roles

All three authors participated equally in the content, editing, and finalizing of the manuscript.



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Correspondence to Catherine Racowsky.

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Capsule A critical appraisal of the current evidence for using time-lapse imaging in clinical IVF.

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Racowsky, C., Kovacs, P. & Martins, W.P. A critical appraisal of time-lapse imaging for embryo selection: where are we and where do we need to go?. J Assist Reprod Genet 32, 1025–1030 (2015).

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