Abstract
Time-lapse imaging (TLI) has emerged as a transformative technology in in vitro fertilization (IVF). This is because it offers continuous, non-invasive embryo assessment through morphokinetic profiling. It demonstrates key advantages such as reduced embryologist subjectivity, detection of dynamic anomalies, and improved implantation rates in niche populations. However, its clinical utility remains debated. Large trials and meta-analyses reveal no universal improvement in live birth rates compared to conventional methods. Key challenges underlying the outcome include algorithm generalizability, lab-specific protocol variability, and high costs. Nevertheless, TLI shows promise in specific contexts. For instance, Preimplantation Genetic Testing for Aneuploidies (PGT-A) cycles where it reduces unnecessary biopsies by predicting euploidy. However, even in this, its benefits are marginal in unselected populations. This review synthesizes evidence to highlight that TLI's value is context-dependent, not universal. As such, adoption must be cautious to avoid resource misallocation without significant IVF outcome improvements. In future, personalized protocols, integration with non-invasive biomarkers, and multicenter collaboration are crucial to optimize TLI's potential in assisted reproduction.