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Are time-lapse incubators a necessity or just a nice-to-have?
While the clinical improvements may seem incremental, three IVF lab directors—Ms. Christine Yeh, Dr. Mina Alikani, and Prof. Alison Campbell—explain why they are essential for the future of standardized fertility care.
Tune in to hear:
How EmbryoScope helps scale IVF volumes with small teams.
Why standardization is crucial for both labs and networks.
How an IVF system at CARE Fertility saves six months of embryology time per year.
The role of AI integration in automating embryo assessments.
Key mistakes to avoid when implementing time-lapse technology.
Listen in to learn how leading labs are leveraging EmbryoScope to drive efficiency, and find out how your clinic may be eligible for a free 120-day trial through Vitrolife.
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See all the benefits that EmbryoScope’s time lapse technology can bring to your clinic, including:
Continuous uninterrupted culture
Improved embryo development
Streamlined workflow for maximum lab efficiency
No risk. See if your IVF lab is eligible to participate.
Don’t miss this exclusive opportunity—email here to see if your IVF center is eligible to participate in a 120-day Embryoscope trial to measure the impact it can have in your lab.
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Dr. Mina Alikani (00:03)
Time lapse as a tool in the embryology lab is moving from a nice to have toward a must have. And I think that that is really rooted in the desire to make what we do in the embryology lab more objective rather than
subjective, so more precise embryo assessment. We also want an AI driven embryo selection tools, which time-lapse makes possible. And of course, there's the aspect of undisturbed culture conditions that are also important. So yes, I agree that we are moving from time-lapse incubation being nice to have.
toward a must-have.
Griffin Jones (00:59)
Scalability and standardization. Are time lapse incubators a nice to have or a must have? Every time I ask this of embryologists, I get some version of the same answer. There's nuance, but it's a must have, they say. The nuance? Obviously, embryoscopes aren't a panacea, right? Some benefits might be more important than others. The clinical improvements may only be incremental right now. Even my guests on this episode say that some labs will be just fine without them. And yet, virtually every embryologist I've asked
has said time lapse incubators are a must have for the future of the standard of IVF care. Why? Thanks to my guests, three different IVF lab directors, Ms. Christine Yeh Dr. Mina Alikani, and Professor Prof. Alison Campbell, I now understand why. It's all about standardization and consequently scalability. How can you scale your fertility clinic or network if you haven't standardized your best practices across labs?
Listen to how each of my guests keep coming back to this need for standardization.
Christine Yeh shares how she uses embryoscopes to manage standards between one small team on the East Coast and another on the West Coast. She talks about how she uses embryoscopes to grow IVF volumes with a small team because you probably can't hire a bunch of extra embryologists either. She shares how she uses embryoscope to maximize the space she has in a small IVF lab because you're probably working with limited space too. Dr. Mina Alikani Alikani talks about the necessity of standardization.
as the operative shared word in the concept of standard of care. She reframes the question for all the C-suite listeners. She talks about her first uses of embryoscope, things that she had never seen before in an embryo.
Prof. Alison Campbell shares how Care Fertility invested one million pounds in a complete embryology system that also included embryoscopes and how that system saves six months of embryology time per year.
They talk about how their IVF labs scale care by reducing time for FERT checks, embryo assessments, and integrating with AI to automate annotation.
They each share mistakes they would avoid and what they would do to take advantage of an offer that VitroLife has for eligible clinics to try Embryoscope for free for four months. Listen to what these lab directors have to say and then give it a try for free for four months to see if you can replicate the success that they were each able to standardize. Contact VitroLife to see if your clinic is eligible and enjoy this conversation about the standardization of best practices in the IVF lab with Ms. Christine Yeh, Dr. Mina Alikani and Professor Prof. Alison Campbell.
Griffin Jones (03:59)
Ms. Yeh Christine, Dr. Alikani, Mina, welcome to the Inside Reproductive Health Podcast. And Professor Campbell, Alison, welcome back for your third time, I believe, on the Inside Reproductive Podcast.
Dr. Mina Alikani (04:12)
Thank you very much for having me.
Prof. Alison Campbell (04:14)
Yeah, thanks. It's great to be back.
Christine S Yeh (04:15)
Yes, thank you.
Griffin Jones (04:16)
Mina, I see different embryologists starting to have a consensus. One of our audience members said that time-lapse imaging in the IVF lab is increasingly moving from a nice to have to a must have. What do you suspect that person means? Do you share that view and why?
Dr. Mina Alikani (04:37)
I actually do share that view. think that time lapse as a tool in the embryology lab is moving from a nice to have toward a must have. And I think that that is really rooted in the desire to make what we do in the embryology lab more objective rather than
subjective, so more precise embryo assessment. We also want an AI driven embryo selection tools, which time-lapse makes possible. And of course, there's the aspect of undisturbed culture conditions that are also important. So yes, I agree that we are moving from time-lapse incubation being nice to have.
toward a must-have.
Griffin Jones (05:28)
Christine, you're nodding your head.
Christine S Yeh (05:29)
Yes, I would agree with that. I also think there is the aspect of the procedures that are going on in the laboratory and being able to take out a portion of observing the embryos and evaluating them out of the physical laboratory allows that space to be used for other techniques. The world of fertility is just growing and laboratories are getting busier and busier. It's a big overhead in general, each square footage of your lab compared to other areas of the clinic. So
being able to remotely do, remotely meaning outside of the laboratory perform some of those techniques that we would typically need a microscope station for just makes it possible to do more in that same space and for the embryologists to have more area to work in.
Griffin Jones (06:15)
I want to go into each of these buckets as we talk more today, the clinical outcome side, the workload improvement side. Alison, do you feel that it is neck and neck between those two of what's tipping the balance towards time lapse becoming the standard or is right now, is it more about one of those buckets than the other?
Christine S Yeh (06:19)
Mm-hmm.
Prof. Alison Campbell (06:35)
I think there are so many benefits as we've heard, but I think in terms of nice to have, best to have, think it's a much better system. And I think the main benefit, if I had to choose one bucket, would probably be embryo selection, assessment and selection together. Because as we know, we've heard the human is so subjective.
And this information that we get from the time-lapse systems allows much more objectivity and much more information. You can't compare the quantity of information you get from a snapshot, morphological, microscopic evaluation, and the time-lapse system, a series of images collected over five, six days.
Dr. Mina Alikani (07:19)
I definitely agree with Alison on this, how she described it. And I do want to kind of look at your question in a slightly different way, which will probably make the answer much more obvious. And that is, do we want to move toward more subjective?
assessments or do we want to move toward objectivity? And then the answer is quite straightforward. We don't want subjectivity. We want objectivity and we want a certain level of standardization so that, so that we can actually be
Griffin Jones (07:49)
We don't want subjectivity, we want objectivity, want a certain level of standardization so that we can actually be
Dr. Mina Alikani (08:05)
able to predict outcomes more reliably, regardless of where we are in the world, which laboratory we're practicing in.
Griffin Jones (08:05)
able to predict outcomes more regardless of where we are in the world, which laboratory we are practicing in.
Dr. Mina Alikani (08:15)
And that, in the end, is to the benefit of the patients.
Griffin Jones (08:16)
In the end, it's to the end that's the question.
Christine S Yeh (08:17)
Mm-hmm.
Griffin Jones (08:20)
Explain to me how subjective it can be right now between embryologists versus the objectivity that AI and other tools by way of time lapse provide. Objectivity for someone who's not an embryologist, for the business people listening, why is that significant?
Prof. Alison Campbell (08:41)
we know as embryologists when we look down the microscope at a blastocyst at a late stage embryo it has a couple of main features, maybe three main features. It has a diameter, it has two cell types, the inner cell mass and the trophectoderm, but they can look broadly different. The diameter can change, it does.
And we don't have a measuring tool down on microscope while we're looking. So you've got nothing really apart from your experience and what you've seen before to calibrate it on is just a really momentary assessment. And it's just so subjective because the lighting might be subtly different. There are other embryos might be around in the same field of view that could influence your opinion. You may have met the patient in the morning just.
So many human factors and different elements that could subtly but significantly change your opinion. And also if you were to look at the same embryo half an hour later or half an hour before, or even five minutes, it can look substantially different. It doesn't very often look substantially different, but sometimes it does. So you may give it a completely different grading. And this grading consists of three letters or numbers.
And based on that, big decisions are made. Is this embryo going to be transferred? Is it going to be cryopreserved? And then down the line the following year, maybe if it has been cryopreserved, is it going to be warmed and transferred now or shall I choose a different one? So it's such a simplistic assessment and momentary assessment that has major impacts on what's going to happen to that patient.
and even future decisions for that patient. So if you've assessed a group of embryos, you've given them these simplistic scores, which do relate to clinical outcomes somewhat. They're not absolutely useless, but they're very simplistic. But if you've done that, then that information could and will dictate what happens to that patient, and it could make or break whether they will have the baby they want. Many patients give up.
Griffin Jones (10:30)
which do relate to clinical outcomes somewhat. They're not absolutely useless, they're very simplistic. If you've done that, then that information could and will dictate what happens to that patient and it could make or break whether they will have it. Maybe they want many patients to
Prof. Alison Campbell (10:51)
because they've not had a success first time with cryopreserved embryos still in the tank. So this is heartbreaking. Had we chosen a different embryo potentially based on our quick assessment, they may have the baby and they may go on to have another one from the same cohort. it's, yeah, it's a, don't want to put too much pressure on the embryologists, but it's a very important piece of their work.
Christine S Yeh (11:15)
Just to add on to what Alison was saying as well and to bring it, Mina had made a comment about standardization between laboratories. And I think bringing time lapse into more laboratories standardizes the tools that people have to evaluate. So in certain laboratories, they might only have a stereoscope to do their observations of their embryos, which the embryo
features are not going to show up as much. can't see as much detail whereas other laboratories will have an inverta-scope which you can get a higher magnification. You can see more granularity in the cells. So their grading is going or could be vastly different. You think of looking at a picture that's extremely pixelated and trying to make a grade on that versus one that's high definition. I mean we look at TVs. What we can see on the actor's faces are completely different nowadays because the resolution is so much better.
So if we're looking at different technologies in different laboratories, evaluation of the same exact embryo is going to be different simply because of the resolution that you can see. So if you put time-lapse incubators in each one, one, there would be the ability to share pictures of that embryo. So even if grading schemes are slightly different from laboratory to laboratory, the new laboratory that receives those embryos, if we're talking about transfer of embryos from one lab to the next,
could look at the picture image and say, okay, do I agree with what the previous laboratory graded this on paper? Or would I choose a different embryo based on the pictures that we have and the grading scheme and the way that we decide things internally from lab to lab? So I think that standardization would also be extremely beneficial on just the technology side.
Griffin Jones (12:56)
Mina, tell me about the papers that you've been involved in with regard to research on the topic.
clinical outcomes being different with time lapse versus with traditional incubators.
Dr. Mina Alikani (13:07)
Right, so I think to some extent the jury is still out on whether time-lapse microscopy and the use of this instrument actually leads to a significant improvement in outcomes. There have been many publications on that topic and
Some will say yes, others will say no. Unfortunately, comparing these studies is actually quite difficult because they are heterogeneous in the design of the experiments or the studies and also measuring the impact. Is it live birth? Is it cumulative live birth? Is it fertilization? Is it development?
you have a whole spectrum of outcomes that have been assessed during these studies, many of which, if not most, are retrospective. is this impression that we need more proof that this instrument will lead to improved
outcomes. But you know, if I could just talk about it in a more philosophical way, and the way I normally talk to physicians to try to convince them that this is actually a good way to go, is that, you know, it really it takes more than a single technology to improve outcomes in IVF. And
At this juncture, you know, in 2025, the future really is about automation and standardization and integration of artificial intelligence in all aspects of IVF. And time-lapse is a step toward that future. In fact, that future is here already.
we are seeing it unfold, although somewhat incrementally, we are seeing it unfold. again, don't we need to question, do we need actually to question and move from subjectivity toward objectivity? And, know, in terms of looking
at outcomes. Is the technology being applied properly? You some people have it and just use it as an incubator, which is nice because it's great incubator. But it's supposed to do more. You're supposed to use the data that it generates for development of algorithms that will help you.
Griffin Jones (15:33)
Is the technology being applied properly? Some people have it and just use it as an incubator, which is nice because it's a great incubator. But it's supposed to do more. You're supposed to use the data that it generates for development of algorithms that will help you
better select your embryos.
Dr. Mina Alikani (15:59)
better select your embryos, but if they are not using
Christine S Yeh (15:59)
Mm-hmm.
Dr. Mina Alikani (16:02)
that feature, it's not going to be helpful to them, is it? And are the right expectations being set? you can't suddenly using one instrument improve your outcomes by 20 percentage points. It's just, especially, especially in labs where
good outcomes are being produced already, it's very difficult to reach that differential and fulfill that expectation. It's just not the right expectation. So you have to look at it holistically and looking at workflow, looking at environment for development of embryos,
Christine S Yeh (16:34)
Thank
Dr. Mina Alikani (16:56)
looking at the ability to select embryos more objectively and looking at outcomes to see if you can improve incrementally. So this is how I look at it. But this is not exactly how it's presented very often.
Griffin Jones (17:14)
Then why is time-lapse such an integral part of the holistic picture Christine you're opening a new IVF lab. Are we allowed to talk about that?
Christine S Yeh (17:23)
Yes. Thanks most people now. Yes.
Griffin Jones (17:24)
You're opening a new lab. You've been managing your lab in Toronto. You're opening up a new one in
Vancouver. From what I understand, you really wanted embryoscopes in that lab. One, is that the case? And two, if so, why?
Christine S Yeh (17:39)
huh.
Yes, that is the one, as Mina mentioned, it's a fabulous incubator. They're very sound. They work extremely well if you just use it as an incubator. From my experience starting the laboratory in Toronto, we opened in 2022. Most laboratories start with a small team and we don't batch cycles. So they come as they come. And one thing that's the
embryoscope or a time lapse incubator has allowed us to do is grow more naturally with less stress with a small group of embryologists. Your timing, you don't have to be as exact on timing for FERT checks in the morning. And being able to retrospectively watch how the embryos grow, one, gives you a great insight to how your culture system is doing. Especially with an early stage laboratory, when you don't have a lot of cycles, you can spend a lot of time and look at
optimization of your culture system based on the morphokinetics of your embryos based on how they're growing, what's coming, your time points. We know that embryos can make it to a blastocyst, but certain time points aren't as ideal if they're not getting to the cleavage stage at a certain point or the blastulation stage. Maybe there's things that you can tweak. So having that extra data and information to be able to analyze can really help, and I believe it helped us.
to get great success rates right off the bat. Also with an offsite laboratory, having a time lapse is very helpful to be able to support from offsite. You can have somebody remote in and evaluate embryos together. If you have a new team or new embryologists, it's a great training tool because you don't need to leave your embryos out longer. You don't need to be switching people at the eyepieces.
of your microscope to look at an embryo, you can look at it for five minutes and really dissect everything that you're analyzing and teach the people that are eventually going to be doing that as well. And having the ability to do that off site is instrumental. And then also we're really pushing for wanting to integrate seamlessly an AI system. Again, that's here and it's available and that's something that
myself and my team at TWIG is very passionate about and being able to do so seamlessly with a time-lapse incubator is necessary. And if we went with a bench top incubator or box incubators, that integration is much more difficult and we're right on the precipice of it. So why go with something that is going to be harder to advance into the future? Does that make sense?
Griffin Jones (20:14)
I keep hearing about FERT checks and saving time not having to do FERT checks at a certain time and how important that is to embryologists and they really like embryoscope for that reason. A business person might not understand what the implications of that are. you tell me specifically why do embryologists keep saying that as a benefit? How does that impact the rest of the management of the lab?
Christine S Yeh (20:39)
So the timing of looking if eggs have been fertilized or not is very specific. There are what we call pronuclei that show up for a very small window of time. And that's how we know if the sperm has fertilized the egg. If you're looking at an Ixie case or where you inject the sperm directly into the egg, typically a fertilization check you would do between 16 to 20 hours.
post-fertilization or post-IXI because this is the most likely time point that you're going to see those two pronuclei, which is the morphological features that an embryologist evaluates to know if that egg was fertilized. So if you have a very early morning retrieval and you do your IXI at eight o'clock in the morning, that fertilization check is going to be happening at four, five, six o'clock in the morning.
getting embryologists into the lab at that time can be difficult. And if you miss those signs of fertilization, because there's two pronuclei, eventually they disappear. And then every egg looks the same. So if you don't see those pronuclei, then you might deem an egg unfertilized when actually you just missed it. In the case of conventional IVF, this window is a little bit more in flux because we don't know the exact
time that that sperm entered the egg to fertilize that egg. So there could be a heightened chance of missing that sign of fertilization, whether you look at the egg too soon or too late. But with time-lapse, you're able to know exactly when fertilization happened, when those pronuclei appeared, how long they stayed, and when they disappeared as well. So it's very beneficial to be able to do those FERT checks and not feel as
strapped for time of I need to look at exactly this time point to make sure that I don't miss it. And Mina and Alison, please, you have much more experience than I do. Please add to this if you feel.
Prof. Alison Campbell (22:36)
Yeah, you're quite right. It gives this flexibility. So how it can impact the wider team is that the lab can be more flexible. So if we need to schedule the egg retrievals at different times, we're not restricted by this specific window that we were before. So it has benefits throughout the whole clinic.
Griffin Jones (22:55)
Did you want to add anything to that Mina?
Dr. Mina Alikani (22:58)
I agree with everything that was said. I do want to point out though that even though the use of ICSI has increased significantly over the past decade or so, we still have somewhere
between 30 and 40 % of the cases that have standard insemination and not all laboratories have switched to a 100 % XC model. So in that case, you still have to stick with the timings and observe those requirements for fertilization checks when
eggs have been inseminated via standard IVF rather than ICSI. And those eggs are not put into the time-lapse incubators until the day or a day later after insemination on day one, after fertilization has been checked already and
we know which eggs have been fertilized and which have not. So that caveat is still there.
Griffin Jones (24:32)
it seems to me that probably only 10 % of clinics maybe 20 % of clinics in the US have
time-lapse incubators. know that number is a lot different in Europe and in the UK. Is it that way in Canada as well, Christine?
Christine S Yeh (24:48)
the exact number, but I would say more and more clinics are adopting the time lapse in Canada. Whether they use it for all cycles or not is another question. I think there are some clinics who have a time lapse incubator and they use it for select cycles or select patients. But just anecdotally, I would say probably 50 % have time lapse. It's not more in Canada.
Griffin Jones (25:04)
Alison, do you?
That's many more than I would have thought. Alison, do you think we're at a tipping point in the US now that you're part of a network that has a presence in the United States and you get to see a lot of the US market? Do you think that we're going to see an upward trajectory of adoption or is something standing in the way?
Prof. Alison Campbell (25:29)
I don't see it being at a tipping point, to be quite honest. It seems to just be a really slow trickle to me in the US. In the UK, we must be more than 90 % of clinics, I would say, have at least one time-lapse device. And we've been using it at Care Fertility since 2011, so it's such a long time. In the US, it seems to me that the primary embryo selection
technique is PGTA and that the mindset generally speaking is well, this is superior in terms of embryo selection to time lapse. we don't, why would we need both? But actually we know from the data and the evidence that we can distinguish between euploid embryos. So for PGT patients who are fortunate enough to have multiple euploid embryos, then let's add the time lapse to really
Christine S Yeh (26:00)
Okay.
Prof. Alison Campbell (26:26)
aid selection between them just to get these additional marginal gains and give the patients the best possible success rate as soon as possible.
Griffin Jones (26:35)
Do you think from the network seed, Alison, that it's possible for networks to test out time lapse in certain labs? So if you have enough labs in your network, should every network have at least some of their labs with some embryoscopes or how do you think about that?
Prof. Alison Campbell (26:52)
Well, I prefer within a network to have a standardised best lab practice, so time lapse in all of the labs. But saying that, it's not always realistic. They are very expensive. So I'd rather spread them out and have at least one in each lab than some of the labs being 100 % time lapse. And that's how we are at Care Fatility. We don't have capacity for all patients to have time lapse.
So there is some selection and some patient choice there. But what we have done is use the knowledge that we've learned from the time-lapse systems over the decade or so to apply it to our standard practice. So we've learned, for example, that we really don't need to be disturbing the embryos from the standard incubator at all after Fert Check right through to the blastocyst stage. So we don't make observations like we used to in the...
interim at the cleavage stage just to see how they're getting on and try and anticipate how the blastosis will be. There is no point in doing that. And again, with the fertilization timing we've learned and we've published this and it's fed into the new Istanbul consensus guidelines coming out soon, that to assess fertilization should be bit earlier than we originally thought in order to maximize the chance of observing them in a standard system.
Christine S Yeh (28:10)
Okay.
Prof. Alison Campbell (28:13)
So it has benefited standard practice, even if you're not fortunate enough to have time-lapse yourself.
Griffin Jones (28:21)
So maybe this business case is part of what is a little bit of what I see just as an outsider is a bit of a divergence between the business side and the lab side. Because I have every embryologist on, I ask them, I ask them a handful of things. One of the questions I go to every time, time lapse a must have or a nice to have. So far everybody said must have. And that if even if they feel like, well, it could be a nice to have in these circumstances now.
We think it's a must have for the standard of care going forward. It seems to me like that consensus is firming in a way that wasn't even some years ago on the lab side. But yet at least maybe other countries have caught up on the business side. But in the US, they're still viewing that as, all right, we have to judge that investment against other investments that we're making. You sitting in the network seat, Alison, owning equity in your company.
How long does this take, if properly utilized, to return the investment? If we're buying a handful of embryoscopes, are we looking, relative to cycle volume, are we looking at a three, four year return on investment?
Prof. Alison Campbell (29:33)
Well, it depends on the business model. think what we've done is charge for using the time-lapse devices, for using the algorithms that predict outcomes. And we've had some criticism. I've had some criticism from some colleagues, scientific colleagues, because of course, ideally, we don't want to be taking more money off our patients. We want to give them the best, most cost-effective treatment, the lowest possible price.
but these devices are expensive. made investment, big financial investment and R &D investment in them. So we have to charge a fee to use it. So we can get the return on that investment through the patient fees.
Griffin Jones (30:14)
Tell me about the time savings and tell me about, I had Dr. Schenkman on the podcast a month ago, asked her the same question she said must have, and she had referenced a paper that I hadn't seen from UCSF of something like they think that they're saving the equivalent of one embryologist time per day. Anecdotally, what are you observing with regard to
saving embryologists time or reducing their workload.
Prof. Alison Campbell (30:46)
Well, I would say that if you used a time lapse device, in the typical way, let's say without any algorithms automation, just a manual annotation, which is how we all started using it. Then it will actually take you more time than not having it. So it increases the time required because.
You're looking at the embryos every day and you're annotating using the software that comes with the device. And on average, it will take two minutes per embryo and most patients, let's say, have eight to 10 embryos. So it'll take you 20 minutes, whereas typically with standard practice, no time lapse, you may just make one or two quick observations and it may not take as long as that. But more recently, we've had the introduction of automated annotation.
So the software is analyzing the development of the embryo, the morphokinetics, and generating that data, which is clearly taking much less time. So our own system, it takes two seconds. So we've gone from 20 minutes to two seconds. And that we invested, it cost us about a million. And we've talked about this before, Griffin, but that million pounds was
Really well spent, I would say, because we've got a singing and dancing system that's saving six months of embryology time across our network.
Griffin Jones (32:10)
Christine, you've got partners. Your REI partner is Dr. Rhonda Zwingerman, and then you've got business partners, Tanner and Zach to Bay Street, entrepreneur, finance, business guys. Besides being really good guys who listen to their teams, why did they go for your
Christine S Yeh (32:20)
Thank
Griffin Jones (32:30)
proposal when you said, really want embryoscopes in Vancouver. Why did they go along?
Christine S Yeh (32:35)
mean, this is extremely multifaceted and we're only going to scratch the surface of it. One is the standardization across laboratories. Alison already mentioned it. She has vast experience with running a network. It's much more difficult to run laboratories when their procedures are extremely different. That goes down to the equipment that's being used. The protocols for using a time lapse incubator versus a bench top or a boxed incubator are very different.
from, as Mina mentioned, the dishes that you use and how you prepare those, as well as the daily observations and how you have to work with that, as well as how you have to work with other equipment in your laboratory and what gets used at what time. So there's the standardization aspect. There's the aspect of us wanting to standardize the use of AI for assisted embryo evaluations.
One thing that we're evaluating, as Alison mentioned, is potentially taking out day three observations, which then would correlate to saving a lot of embryologist time, because that's one full day of observations that are not going to have to be done. Being able to use assisted calling helps to reduce that time. We do use assisted calling in our laboratory in Toronto, and it works extremely well. It's very beneficial for the patients. We also believe, myself and Alla put
Dr. Zwingerman in here as well, that the time lapse incubator is a phenomenal incubator for the embryos and where we don't have a large study showing that there is an increase in pregnancy rate due to the undisturbed culture, we do believe that there is an incremental benefit to our patients because of that. And to be able to expand that over to our new laboratory in Vancouver is necessary.
Additionally, with the embryo scope itself, the space savings in the laboratory is very helpful with growth of the laboratory and because you can fit so many samples in a smaller incubator. So it fits 15 patient samples in there, 16 samples each dish. So to maximize the space or the usage of square foot in the laboratory,
This for us was the most beneficial time-lapse incubator to have.
Griffin Jones (34:52)
That topic of scale makes me think of everything that David Sable has been talking about, everything that patient advocates have been talking about, that we are a field of medicine that has a cure for people. I'm paraphrasing Joshua Abrams, who might be paraphrasing someone else, but putting it in these terms has lasered my focus of that we have a cure for a disease that strikes people in the prime of their lives, but we don't have a delivery mechanism that
Christine S Yeh (35:03)
and
Griffin Jones (35:21)
delivers that to patients at the level of population health and I look at the investment coming in and I look at the the companies growing I look at the political climates and I don't see the status quo as acceptable for For much longer. I we are seeing people demand much broader access to IVF I believe that they will get it both through the markets and through legislation
It sounds like that the standardization provided by time lapse is a big ingredient. Can you tell me about any of this is for any of the three of you, why this is so important for scale?
Prof. Alison Campbell (36:00)
I think it's all about the data for me. If things are standardized, you can be more confident in the data that's being generated. And so we don't have all the answers. And one of the main reasons that we went for time-lapse was to get a better understanding of how the embryo develops and to help us collect data in order to make some more informed decisions. yeah, I think that for me is the main thing.
So it's scalability in order to generate the data, in order to plow it back in to continuous improvement.
Dr. Mina Alikani (36:31)
I think that's a very important point that Alison just made. I mean, we live in an information age and big data and more and more of our decisions are data driven. And so it only makes sense that we would do the same in the embryology laboratory and push
for data, more and more data and the analysis of the data, which will eventually actually help those who may not have contributed the same amount of data to this analysis. We want others to benefit from the data that Alison collects and so meticulously
Christine S Yeh (37:14)
Mm-hmm. Mm-hmm.
Dr. Mina Alikani (37:22)
A great example is actually the paper on checking fertilization and how many laboratories may be doing this one hour later than they should be checking fertilization, therefore ending up with these, you know, unfertilized embryos.
which is a complete misnomer and it's a misinterpretation of what has actually happened. So we are benefiting, the community at large is benefiting from all the data that were collected in Alison's laboratories and were in turn analyzed and the conclusion was made that is relevant to
Griffin Jones (38:09)
that is relevant
to everybody, all practitioners in the field. And that's very, very important. And I think that this discussion with the people who hold the purse about cost and benefit, you it really has to shift. It has to shift from a focus on pure...
Dr. Mina Alikani (38:11)
everybody, all practitioners in the field. And that's very, very important. And I think that this discussion with the people who hold the Paris and about cost and benefit, you it really has to shift. It has to shift from a focus on pure,
what's the profit in it? And are we getting
amazing increases in pregnancy rate in to what is it we are achieving here? And is that important to the program as an individual program, but also to the field and to all the patients as a whole? You know, and the answer to that is yes, it is to the benefit of the general population of
patients as well as clinics that are doing IVF. So the more data we have, the more power we have to make the right changes, to choose the right direction. So I don't subscribe to this very narrow
interpretation of what these add-ons, which I don't use. I don't use that terminology. I'm just using it as to illustrate my point. This very narrow ideology that if time-lapse microscopy has not been shown to lead to major increases or significant increases in pregnancy rates,
Griffin Jones (39:41)
not been shown to lead to major increases or significant increases in pregnancy rates,
Dr. Mina Alikani (39:49)
then it's an add on it's unnecessary. I just don't subscribe to that vision and that idea.
Griffin Jones (39:49)
then it's an add-on, it's unnecessary. I just don't subscribe to that vision and that idea.
Christine S Yeh (39:56)
Mm-hmm.
Dr. Mina Alikani (39:57)
know, IVF has improved since the 1980s and I don't think there's anyone except for perhaps one person who will remain unnamed. There's agreement that IVF
Dr. Mina Alikani (40:17)
has improved incredibly over the past four decades or so. And these improvements have been incremental and due in large part to the changes and innovations in the lab. And so we have to look at time-lapse and other tools in that specific context, rather than saying, well, does it improve pregnancy rate? What? It doesn't? No, we're not interested. It's an add-on. It gets a red light. It gets an orange light or, know, I just don't see it that way.
Christine S Yeh (40:56)
Mm.
Griffin Jones (41:07)
for embryoscopes for eligible labs and they'd have to check who's eligible. Well, I'll put some info in the show notes, but provided that a lab is eligible, VitroLife will give them the embryoscopes, install them, If labs are eligible for that,One, should they take advantage of that? And if the answer to that is yes, how should they take advantage of those four months?
Prof. Alison Campbell (41:33)
I would say always take advantage of a nice piece of kit being offered to your lab. It's a privilege to have time-lapse in the laboratory. It's a privilege to watch the embryos developing. yeah, I think the advice would be geek out, read the papers, talk to experts, use it properly, collect the data.
Prof. Alison Campbell (41:58)
Show your patients their beautiful embryos developing and yeah, embrace it. Why not?
Griffin Jones (42:04)
Mina and Christine, would you give people any tips of try to learn this or try to obtain this information or try to test this workflow or anything that what tips would you give to someone during that four month period?
Dr. Mina Alikani (42:21)
You know, I think that bringing time-lapse technologies into the lab is not trivial at all. It's nerve-wracking, at least it was for me. And I always show these stages of dealing with incorporating the technology. You at first you have sticker shock and then...
You are euphoric that it's there and then you are pulling your hair out because you're seeing things that you've never seen before in embryos and you're saying something is wrong here, what's happening and you need therapy and all of that. And then you pass that stage and you go into this, wow, what a tool. And I went through all of those stages and I suspect that other people will too. And if you can get help avoiding some of the more unpleasant aspects of that integration, then I think you should. If the company is offering to help you establish the technology
Christine S Yeh (43:14)
Mm-hmm.
Dr. Mina Alikani (43:25)
in your laboratory and integrate it in the right way,I would go for it. The more help you get, the easier it becomes. It's not easy. Don't expect it to be easy, but it does get there. And the more help you have before you get really involved with patient material, the better it will be.
Christine S Yeh (43:31)
Mm.
Griffin Jones (43:35)
You get the easier it becomes. It's not easy. Don't expect it to be easy. But it does get there. And the more help you have before you get really involved, the patient is the better it
People always seem to say embryoscope like Q-tip. Like we don't say cotton swab, we say Q-tip. And I there are other time lapse incubators out there.
Christine S Yeh (43:53)
Thank you.
Griffin Jones (44:02)
they might be pretty good, but it seems like there's a general preference towards embryoscope. For those of you that use embryoscope, why embryoscope as opposed to a different incubator? What was it that you were dealing with that you've preferred embryoscope for?
Prof. Alison Campbell (44:28)
Well, we chose Embryoscope really because it was the only one available at the time. And once you've got one system in, it's especially across a network and you've got your protocols and you've got the data collection and it's all working seamlessly. It's quite hard to change. Saying that, we do have GERI time-lapse incubators from Junaea as well now, because we've acquired clinics that have had them or we've decided to evaluate.
Prof. Alison Campbell (44:53)
We look at both systems and they're similar but they're also different. And the main difference I would say is the humidification in the jerry whereas the embryoscope is a dry incubator. So I don't think there's much between them. It's great that there is competition and that we do have choices and there are others also available.
Griffin Jones (45:09)
that there is competition and that we do have choices.
Christine S Yeh (45:13)
well, to your Q tip question. One, I think embryoscope is one of the first ones out there. So it caught on. Also, they hit the name very well, embryo scope, a microscope for embryos. I think it kind of tells exactly what a time lapse does in more layman's terms. So I think that is very catchy and easy to use.
in regards to our decision to use the embryo scope or to go with the embryo scope, a lot of it went down to one, the reliability of the incubators. think the Jerry also has a very reliable incubator. It's very good, very sound. think Miri as well has a time-lapse incubator. But for us, it was the square footage and how many patients we could fit into a small area. We built a laboratory in a city. We're building a new one in a new city.
Real estate is expensive and you don't have a lot of it. So we don't have the space to grow in the laboratory, or we don't have infinite space in a laboratory and overheads are already very expensive. So if we're able to fit 15 patients in a, what is it about 18 inch by 18 inch area on a bench top versus something that's one and a half times that size for the same amount of patients for us, that was the cost per square footage.
Griffin Jones (46:27)
How important is it to be able to have quality control and do quality control in one chamber for 15 dishes as opposed to having multiple different chambers?
Dr. Mina Alikani (46:37)
Yeah, I think the engineering and design of this particular time-lapse incubator are really quite impressive. that's maybe partly the reason for the name embryoscope being used.
Griffin Jones (46:46)
really surprised.
Dr. Mina Alikani (46:56)
as a sort of generic for this type of incubation systems. They were also the first, if you don't count Eva, which was a very different concept, although it sort of the same, it was the same idea, but it wasn't an independent incubator. So they were the first.
Griffin Jones (47:11)
So they were the first.
Dr. Mina Alikani (47:21)
And very often this happens that name then becomes generic. In terms of quality control, think yes, there is an advantage to having a larger number of patients in the same incubator so that you're focused on that one incubator to QC rather than 10 different incubators to QC. But I am not sure if I see that necessarily as an advantage, at least in the context of regulations in the United States. I think our problem is that those regulations are actually outdated.
Griffin Jones (48:09)
think our problem is that those regulations are actually outdated. You know, we have in the embryos scope a system that is monitoring continuously all the conditions within the incubator. Yet, we are obliged to use external instruments that may not be...
Dr. Mina Alikani (48:18)
in the embryo scope, a system that is monitoring continuously all the conditions within the incubator. Yet we are obliged to use external instruments that may not be, may
or may not be as accurate as the instrument itself, you know, to double check to see that those values
Griffin Jones (48:38)
And then you're going to have an actual instrument itself to double check to see that those values
Christine S Yeh (48:41)
Thank
Griffin Jones (48:47)
are within range. So the Ambioscope is such a sensitive piece of equipment and also in my experience, very, stable. So on this little thing.
Dr. Mina Alikani (48:47)
are within range. So, you know, the embryo scope is such a sensitive piece of equipment and also, in my experience, very, very stable. So all this fiddling, you know, trying
to measure this and measure that external to the incubator itself may actually be not only superfluous, but
It may backfire at some point. So I think there are issues, you know, the other issues that, okay, you're collecting all of the data, all the data are being collected by the instrument itself, but very often there is no connection to your EMR. you have information, enormous amounts of information.
Dr. Mina Alikani (49:40)
that are being collected separately and you have to still go into your EMR and enter data by hand on development of the embryos. So there are issues like that that need to be resolved and in some cases may have been already resolved. yeah, QC.
is an important aspect and I think that because of the stability of this system and because it continuously records the conditions of the incubator, that is helpful.
Griffin Jones (50:09)
report each individual edition.
For any or all of you, what should people consider about time lapse incubation that I haven't asked you about?
Prof. Alison Campbell (50:25)
I think we haven't talked about how you use it and how you would choose the embryos and how you can be confident that you're doing that correctly, especially if we're thinking if we've got new potential new users listening, it could be quite daunting. Do they just because it isn't it could be just plug and play. But if it is plug and play and that plug and play provides you with an automated assessment and
grading or score for each embryo, then how do you know that you can trust it? And that's quite a daunting prospect for new users. So the advice would be to validate in-house as with anything else. You can say, OK, the machine says this is the best. You either agree or not. But record when you agree, when you don't agree, what you do if you don't agree. And try and then tally up all the numbers and see.
if it's better than you and if you can embrace it wholeheartedly and use it, trust it completely to do the choice for you because that is quite a leap of faith, I would say for new users, especially if you're relying on an algorithm or a system that you've not built yourself and you don't really know how it's been built. So ask questions and yeah, take it and enjoy it. Enjoy the ride.
Christine S Yeh (51:31)
Thank
Dr. Mina Alikani (51:41)
I would say that, like I said before, it's not easy. And like Alison said, it's not quite plug and play. You need to invest the time and energy and you need to collect the data and look at how, decide how.
you're going to be selecting embryos if you don't have the automated version, which I'm not sure if in the US that embryo selection feature is available yet. So, you may not have that. And if it costs additional dollars for that, people may shy away from it. it is...
Griffin Jones (52:06)
with version which I'm not sure if in the US that NBO selection features is available yet. So, you do not have that. And if it costs additional dollars for that.
Dr. Mina Alikani (52:26)
You need to work it out. And I think Alison said it very nicely that you need to think about how you're going to validate it. You need to know how you're going to use it. You need your own protocols. It is not a, from lab to lab, it may be different. We still have not really found algorithms that are universally
applicable and so it takes work. You have to expect to work a little bit before you feel comfortable and confident about using the system for embryo selection.
Griffin Jones (53:05)
using the system for embryos
Christine S Yeh (53:07)
I'll just add in here to sum my opinion up. think the embryo scope and time-lapse incubators are a phenomenal tool to be able to elevate a lot of embryology labs. Is it essential at this time for all embryology labs to have it? No, I think the laboratories that don't have time-lapse also have great fertilization and pregnancy rates. And like we've mentioned before,
is a time-lapse incubator going to make that jump up exponentially? Not at this time, but every incremental bit helps. And I think to move forward into kind of the next frontier of IVF, the time-lapse incubator is going to be essential and it's going to be necessary to be able to seamlessly integrate AI assisted calling or assistance in the laboratory in a very smooth and trouble-free
Griffin Jones (53:44)
I to move forward into kind of the next frontier of IVF, the time-lapse incubator is going to be essential and is going to be necessary to be able to seamlessly integrate AI assisted calling or assistance in the laboratory in a very smooth and troubled
Christine S Yeh (54:04)
free manner that's not gonna take a lot of time to do that
Griffin Jones (54:04)
free manner that's not going to take a lot of time.
Christine S Yeh (54:07)
and a lot of embryology time. I think the information that we're gathering, like Mina had mentioned before, is bleeding into all laboratories and just the standard of care that we're able to give our patients and to be able to move the standard of time to pregnancy to decrease that. We're learning a ton of information from these laboratories that are able to collect this data and are able to share it. So I think...
time lapse incubators are essential to our field. I think that they're going to become more more important. And I urge the vendors to help develop payment plans for laboratories who might not be able to make that one time payment to make it possible to get it into their laboratories. Initiatives to be able to support research with AI being, or not AI, maybe AI, but with time lapse incubators to support or offset the cost.
of the incubator can be essential to get that integrated kind of into the laboratory. But if you can make that payment plan, so it's a year or two years, build it into the cost of supplies.
get more creative with the ability to get those machines into the laboratories. I think it's going to benefit everybody.
So just got to work together.
Griffin Jones (55:19)
Alison Campbell, you're becoming one of my favorite people in the field as we get to know each other more. Mina Alikani, we will someday. You will be one of my favorites too, and I am honored to have all three of you. Thank you for coming on the Inside Reproductive Health Podcast.
Dr. Mina Alikani (55:39)
Thank you very much.
Prof. Alison Campbell (55:40)
Thank you.
Christine S Yeh (55:41)
It's been such a pleasure, Alison and Mina feel honored to be able to be on this podcast with the two of you and Griffin. It's always a pleasure. So thank you so much.
