JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):249
Poster Presentation
29^th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263832

P-237. Time-Lapse Imaging versus Conventional Morphology for Embryo Selection: A Review of Recent Evidence

Luma Soares Fagundes¹, Ana Márcia De Miranda Cota², Júlia Pereira de Matos¹, Maria Clara Silva Rabello¹

¹ Faculdade Ciências Médicas de Minas Gerais - Minas Gerais – Brasil
² Hospital Mater Dei Santo Agostinho - Belo Horizonte - MG, Brasil

Objective: To evaluate whether the use of time-lapse imaging (TLI) incubators improves the accuracy of embryo selection compared to conventional morphological assessment, based on literature published in the past five years.
Methods: This study is based on a review of scientific articles published between 2020 and 2025. The descriptors "Time-Lapse Imaging", "Time-Lapse Systems", "Morphokinetics", "Embryo Selection", "Embryo Culture Techniques", "Embryo Quality", "In Vitro Fertilization", and "Assisted Reproductive Techniques" were searched in PubMed, combined with the Boolean operators "AND" and "OR" as appropriate. Initially, 185 articles were retrieved. After applying filters for the last five years and free full-text access, 133 studies were excluded. The remaining 38 articles were screened by title, abstract, and full text, resulting in 14 studies meeting the eligibility criteria and being included in this review.
Results: The success of assisted reproductive technologies (ART) depends on several factors, particularly embryo culture conditions and evaluation methods. Traditionally, assessment is performed by periodic microscopic observation, requiring embryo removal from the incubator and exposing them to environmental fluctuations. Advances in technology have led to the development of multi-chamber incubators and, more recently, TLI systems, which enable continuous image capture without embryo manipulation, allowing the assessment of morphokinetic parameters and the detection of events not observable with conventional methods. Despite these technical advantages, clear evidence that TLI improves embryo selection accuracy over conventional incubators is lacking. Among the included studies, 9 (64%) reported no advantage of TLI for clinical outcomes, 4 (29%) identified conditional benefits in specific subgroups or when combined with algorithms/artificial intelligence (AI), and 1 (7%) recognized potential but without consensus. The three included randomized controlled trials (RCTs) found no significant differences between TLI and conventional morphology in implantation, clinical pregnancy, or live birth rates, concluding that TLI does not provide greater clinical accuracy when used alone. Two meta-analyses acknowledged technical benefits such as more stable culture and reduced manipulation but found no consistent translation into clinical improvement. One systematic review reported mixed evidence, with potential benefits primarily in blastocyst-stage culture and when combined with AI, but without definitive consensus. Observational studies showed that TLI-based algorithms may improve predictive capacity for implantation and, in some cases, live birth, especially in patients ≤ 35 years old or when preimplantation genetic testing for aneuploidy (PGT-A) is not performed. Four studies indicated that when PGT-A has already determined euploidy, the additional benefit of TLI is minimal or absent. Nonetheless, certain contexts, such as embryos without PGT-A or selection supported by morphokinetics-based AI, suggest improved predictive metrics for implantation and viability, although the clinical impact remains uncertain.
Conclusion: TLI incubators enable continuous monitoring and provide additional morphokinetic data, reducing manipulation and standardizing embryo evaluation. However, most studies, including RCTs and meta-analyses, show no consistent improvement in embryo selection accuracy or clinical outcomes. Potential benefits appear in embryos without PGT-A or when combined with algorithms/AI, whereas in previously selected euploid embryos, the added value is minimal. Therefore, TLI offers complementary information, but when used in isolation, there is no evidence of significant improvement in reproductive outcomes. Further well-designed, large-scale randomized controlled trials are warranted to clarify its clinical utility and identify contexts in which TLI may offer a measurable advantage.