Comparison of the development of human embryos cultured in either an EmbryoScope or benchtop incubator.

PURPOSE: In this current study, our main goal was to establish that EmbryoScope incubation environment is comparable to standard incubation. METHODS: The development of sibling human zygotes was compared after culture in either a benchtop incubator (SI) or an EmbryoScope time-lapse incubator (ES). Between May 2015 to April 2016, a total of 581 normally fertilized 2PN, pronuclear-stage embryos, from 47 patients were allocated to culture in either a benchtop incubator (SI) or an EmbryoScope incubator (ES). RESULTS: The development of embryos to cleavage (up to day 3) and blastocyst stages (day 5/6) was compared between the two different incubators. The proportion of good quality embryos was higher in the ES group compared to the SI on day 2 (66.8 vs. 50.5%, P = 0.014) and on day 3 (75.1 vs. 56.0%, P = 0.006). Those differences were statistically significant. A higher proportion of embryos developed to good quality blastocysts when cultured in the EmbryoScope compared to the benchtop (49.4 vs. 42.0%, P = 0.24), but this was not significant. Finally, no significant differences were noted with the proportion of blastocysts chosen for cryopreservation on day 5/6 in the two incubators. CONCLUSIONS: The findings support the view that the EmbryoScope incubator supports at least equivalent in vitro development of human embryos compared to other standard incubation methods and may promote improved development during early cleavage stages.

The establishment of a centralised referral service leads to earlier abortion.

In 1988 a centralised referral service for termination of pregnancy was established in Edinburgh. This has led to a significant reduction in the time women who have requested termination wait to see a gynaecologist (mean 4.7 days) and in the time it takes before suction termination of pregnancy is undertaken (total wait 10.2 days). In 1988 only 40% of induced abortions in Edinburgh were carried out at 9 weeks gestation or before while in 1989 that figure had risen to 60%. In 1989 less than 10% of pregnancies were terminated at or after 12 weeks gestation, compared with 21% in 1988. Reasons for delays in obtaining an abortion are multifactorial but rapid referral once a woman has made the decision to seek help will be essential if she is to avail herself of the advantages of medical termination--only available until eight weeks of pregnancy.

PIP: The establishment in Edinburgh, Scotland, in 1988 of a centralized abortion referral service resulted in a significant decline in time elapsed before pregnant women are seen by a gynecologist and before pregnancy termination is performed. The Lothian Centralized Abortion Referral Service (LARS) based at a family planning center, arranges appointments with 16 consultant gynecologists at the 3 main hospitals in Edinburgh. An analysis of the 644 referrals through LARS to the Royal Infirmary of Edinburgh in the first 6 months of 1989 revealed a mean wait of 4.7 days for an appointment with a gynecologist and a further wait of 5.6 days for a 1st-trimester procedure, for a total waiting time of 10.2 days. Women referred for a midtrimester abortion passed through the system even more quickly, with a median wait of 5.7 days for an appointment and 4.2 additional days before the abortion was performed, for a total delay time of 9.8 days. Over 85% of referrals were seen within 1 week in 1989 compared with only 24% in 1988. During 1989, 60% of abortions were performed at 9 weeks' gestation or under compared with 40% before establishment of the centralized referral service. LARS handles an estimated 97% of termination referrals up to 18 weeks of gestation in Edinburgh. The 1 week decline in time elapsed before an abortion can be arranged is expected to enable more women to undergo pregnancy termination with mifepristone when this drug receives approval for use in the UK among women who are 8 weeks pregnant or less. The only concern related to the greater efficiency associated with establishment of a centralized referral service is that the shortened referral time may lead a small proportion of women to undergo an abortion they may later regret.