Tuesday, December 4, 2012

In-Vitro Video Cameras

Cleveland Clinic uses EmbryoScope technology to keep a close watch on developing embryos

Published: Tuesday, November 27, 2012, 8:15 AM     Updated: Tuesday, November 27, 2012, 8:16 AM
EMBRYO_13837691.JPG The photo of this embryo was taken by a camera built into an EmbryoScope, a specially made incubator that is in a dozen fertility centers across the United States. The Cleveland Clinic has two of the machines, which takes automated and continuous time-lapse video of fertilized embryos to track their development without having to move them.
CLEVELAND, Ohio -- Modern technology has given people with fertility problems hope that they can become parents.
Even so, less than 40 percent of in vitro fertilization and other assisted reproductive technology cycles result in a pregnancy.
The Cleveland Clinic Fertility Center in Beachwood is one of only 12 sites in the United States using new technology designed to help select embryos that have the best chance of developing into a successful pregnancy and birth. The EmbryoScope is an incubator with a built-in camera that takes automated and continuous time-lapse video of fertilized embryos stored there until they are transferred into a woman's uterus.
Massachusetts-based Unisense FertiliTech A/S, developed the technology, which has been used in the United States for research since 2009, and overseas even longer.
The Food and Drug Administration granted the EmbryoScope clearance in December 2011, opening the door for fertility centers to use it in their IVF labs.
DESAI_12539421.JPG Nina Desai
The Clinic jumped at the chance to buy the incubator, which Nina Desai, director of the Clinic's IVF laboratory, calls "revolutionary." Desai liked it so much that she bought another one three months later. The units cost $120,000 apiece, she said.
EmbryoScope shoots video at set time intervals of every 20 minutes so lab embryologists can go back and view the development of an embryo (an egg that has been fertilized by a sperm). The lab also can capture and review still photos of all of the images taken while the embryos are developing inside a special culture dish.
Time-lapse imaging is nothing new, but this is a significant advancement, Desai said.
In the past, video could capture the development of a single embryo in a culture dish, under a microscope.
"Initially the technology was very cumbersome," Desai said.
With the Clinic's two EmbryoScopes, up to 72 embryos from as many as a dozen patients can be monitored at once, and the embroyos never have to be moved out of the incubator.
The technology, Desai said, has made the process of selecting viable embryos for transfer much easier.
With one round of IVF costing as much as $12,000, picking a viable embryo the first time can result in a significant cost-savings. Having more data available to choose the best-developed embryos also will cut down the chances of extra ones being implanted as "insurance," resulting in multiple births.
That information includes cell division patterns and the characteristics that distinguish embryos that implant from those that don't.
"For patients with a lot of embryos, it gives us a little bit better ability to select," Desai said. "If you're imaging embryos every 20 minutes, you're getting a wealth of information."
An embryo is typically transferred on either Day 2 or Day 3 after fertilization, when it has reached up to the 8-cell stage, or at Day 5 or Day 6, when it is more developed.
More than 60 women at the Clinic have successfully gotten pregnant; the first birth (a set of twins) is due in January. And while they can't be in the lab to watch the embryos develop in real time, patients are given a DVD of the video (with either all of the embryos or just the ones selected) usually after a successful transfer.
Today, EmbryoScope is in use at more than 185 fertility clinics worldwide. Around 8,000 babies have been born from embryos that have been monitored in an EmbryoScope. But those numbers, based on a estimated 30 percent pregnancy rate, is a rough estimate at best, said FertiliTech's Marianne Vivian.
"We don't track miscarriages and we don't take into account medical tourism, [the practice of someone traveling to another country for medical care]" she said.
The Clinic is using EmbryoScope to monitor the embryos of women ages 38 and under with at least eight embryos from which to choose. Desai is collecting the data for a study on selection criteria that she hopes to publish in the future.

My opinion:  I think it's a bit much to pay $120,000 for a video camera.  I understand that this camera is sharp, and that it captures multiple embryos, but there is probably a less expensive way to do this.  Is medical technology one of the reasons why health care costs have skyrocketed?  I also believe that there is a question of ethics at hand.  In the movie Gattaca, parents may select the qualities of their future children by simply meeting with a geneticist.  Though this situation is far different, it does involve choosing one embryo over the others.  It will be interesting to see the guidelines are for selection - how much can one tell about the baby's genes from its embryo by the sixth day?

No comments:

Post a Comment