MATERIALS AND METHODS: Using a dataset of 3,469 embryos, the deep CNN model was trained and tested to primarily classify images of embryos captured at 113 hours post insemination (hpi). A non-overlapping set of 97 euploid embryo images with known implantation outcomes was then used to compare the embryo predicting accuracy of 15 highly trained embryologists from multiple centers in the US to that of the CNN. Only euploid embryos that had undergone preimplantation genetic testing for aneuploidies (PGT-A) were included to remove the bias introduced by chromosomal abnormalities.RESULTS: The CNN performed with an accuracy of 75.3% while the embryologists performed with an average accuracy of 67.4% (min-max: 64.5%-70.2%) in differentiating euploid embryos based on their implantation outcome. The CNN performed with a sensitivity and specificity of 84.2% (CI: 72.1% to 92.5%) and 62.5% (CI: 45.8% to 77.3%), respectively. The positive predictive value (PPV) and negative predictive value (NPV) of the network were 76.2% (63.8% to 86.0%) and 73.5% (55.6% to 87.1%), respectively. A one sample t-test revealed that the CNN significantly outperformed embryologists in predicting embryo implantation of euploid embryos using a static image obtained at a single time-point (113 hpi) (P<0.0001).CONCLUSIONS: The trained artificial intelligence framework outperformed trained embryologists in identifying PGT-A euploid embryos destined to implant. A large randomized controlled trial is warranted to confirm that the developed CNN can improve in-vitro fertilization outcomes by prospectively selecting embryos with higher implantation potential than those selected with the current methods.
influx of assisted reproductive technology (ART) and services promote price transparency, with detailed costs of services listed on websites. Given current market trends, we sought to determine how existing clinics perform in terms of price transparency and to what extent they provide information on available discounts and financial assistance.DESIGN: Cross-sectional analysis of Society for Assisted Reproductive Technology (SART) registry clinics.MATERIALS AND METHODS: Clinics were identified through the SART website clinic search function on 4/14/19. Military clinics and those clinics without a website were excluded. Between 4/15/19 and 4/22/19, each clinic's website was queried. Practice location (city, state) and type (private vs. academic vs. other [e.g.: managed care]) were recorded. Prices for consultation, intrauterine insemination (IUI; including monitoring and sperm preparation), in vitro fertilization (IVF; excluding pre-implantation genetic testing), frozen embryo transfer (FET), and oocyte cryopreservation (OC) were recorded. Mean costs were calculated for each reported price.RESULTS: 382 clinics were listed on the SART website and 375 met study inclusion criteria. Table 1 illustrates the number and percentage of clinics that provided costs for services, information on discounts, and available financial assistance on their websites. Only 22.8% (67/293) of private practices and 11.7% (9/77) of academic practices reported the price of one or more services.
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