Camera technology The selfie that can help me get pregnant

1. Camera technologyThe selfie that can help me get pregnant Selecting the right embryo to give you back is crucial if you are going to achieve a pregnancy after IVF/ICSI. We know that. • Looks aren't everything. An embryo can look good but not have the potential to create a pregnancy.

2. How can we assess an embryo’s potential ? Time lapse imaging of the growth of each embryo. • We examine the embryo growth very carefully for any abnormal growth events that will adversely affect its potential to create a pregnancy. • A digital video recording is obtained for each embryo by taking a photograph every 10 mins. • There are several systems that are able to do this

3. MIRI TL from ESCO Bench top incubator combined with a time lapse

4. Individual compact camera and digital inverted microscope units.

5. Embryo time lapse culture dish Each well which holds an embryo is about the side of a full stop.

6. Primo Vision

7. Primo Vision

8. A video recording of each embryo is obtained for up to 6 days growth depending on how the embryos grow. Embryo selection is either made on day 3, 5 or 6. Most abnormal growth events are observed during the first and second cleavages

9. Primo Vision

10. Embryo growth curves

11. Electronic ranking of embryo development capability

12. Key observation points currently correlated embryos least likely to create a pregnancy • One cell to 3 cell (Video) • 2 cell to 5 cell (Video) • Re absorption of blastomeres (Video) • Fragmented or arrested development ( video) • Clear Abnormal development (Video) • Extended period between 3 cell and 4 cell (Graph) • Slow growth between key stages (Graph) • Poor overall morphology

13. Morphology assessment complements time lapse imaging data Cleavage stage embryo • Clear cells (Blastomeres) of equal size. • Correct number of blastomeres for the embryo age • Presence or absence of extra cellular fragmentation Advanced stage embryo • Expanded blastocyst showing clear and well developed ICM and trophectoderm by embryo age day 5 or 6.

14. Day 3 good Prognosis embryo Optimal growth curve, no abnormal growth events during the cleavage stages and good morphology

15. Very good Prognosis embryoOne that has reached a good quality blastocyst on day 5 or day 6 with no abnormal growth events and good cleavage morphology

16. Two examples demonstrating how we select the right embryos for transfer Video 1 • Embryo Selection at day 3 of culture using time lapse • Video 2 Embryo Selection at day 5 of culture using time lapse and morphology assessment

17. Embryo Selection at day 3 of culture using time lapsePatient had 5 embryos

18. Embryo 1One cell (blastomere) splits into 3 directly.

19. Embryo 2During the first division splits off a large fragment

20. Embryo 3 One cell (blastomere) splits into 3 directly.

21. Embryo 4 Evidence of blastomere fusion

22. Embryo 5 No abnormal growth events observedTransferred embryo and positive pregnancy test.

23. Embryo Selection at day 5 of culture using time lapse and morphology assessment resulting in a positive pregnancy