Publication:

Morphokinetic trajectory analysis for conservative embryo deselection in two-embryo transfer cycle: A pilot time-lapse imaging study

Background Time-lapse imaging enhances conventional morphological assessment by providing continuous developmental monitoring and novel morphokinetic parameters; however, its potential application as a conservative embryo deselection strategy remains inadequately explored. Therefore, this pilot study aimed to evaluate the feasibility of time-lapse morphokinetic analysis for identifying embryos with the lowest developmental viability in the in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycle.

Methods A retrospective, observational, single-center, case-control, pilot study was conducted over a 3-month period at a tertiary care center in India. Morphokinetic parameters were compared between embryos associated with successful twin live births and failed pregnancies using generalized estimating equation models with a Gaussian distribution. A reference morphokinetic trajectory was derived from successful embryos using empirical 5th and 95th percentile limits for each developmental parameter.

Results Twenty-nine IVF/ICSI cycles contributed 58 embryos, including 32 embryos from 16 cycles resulting in successful twin live birth and 26 embryos from 13 cycles resulting in pregnancy failure. Women in the successful outcome group were younger and had higher anti-Mullerian hormone concentrations than those with failed pregnancies. Embryos from successful cycles exhibited significantly greater morphokinetic progression and a more consistent developmental trajectory than embryos from failed cycles. About 81.3% of embryos from successful cycles remained within the reference developmental window, compared with only 34.6%of embryos from failed cycles.

Conclusions The study suggests that time-lapse morphokinetic trajectory analysis may provide a feasible framework for a conservative embryo deselection by identifying embryos with markedly deviant developmental kinetics. These findings are hypothesis-generating and require validation in larger, independent cohorts before clinical implementation.