The higher the score, the better the clinical outcome: retrospective evaluation of automatic embryo grading as a support tool for embryo selection in IVF laboratories

Abstract

STUDY QUESTION Is the automatic embryo grading function of specific time-lapse systems clinically useful as a decision support tool for IVF laboratories? SUMMARY ANSWER Blastocyst grading according to the automatic scoring system is directly associated with the likelihood of implantation and live birth, at least in treatments without preimplantation genetic testing for aneuploidy (PGT-A). WHAT IS KNOWN ALREADY Several embryo selection algorithms have been described since the introduction of time-lapse technology in IVF laboratories, but no one algorithm has yet been sufficiently consolidated for universal use. Multicentric models based on automated grading systems offer promise for standardization of embryo selection. STUDY DESIGN, SIZE, DURATION A retrospective cohort study was performed including 1678 patients who underwent IVF treatments between 2018 and 2020 and whose embryos (n = 12 468) were cultured in time-lapse systems. PARTICIPANTS/MATERIALS, SETTING, METHODS After obtaining the required parameters (division time to 2, 3, 4 and 5 cells; time of blastocyst formation; inner cell mass quality; and trophectoderm quality), the automatic embryo score was calculated using the software included in the appropriate workstation. First, embryo score was compared with conventional morphological quality and the subsequent clinical outcomes of 1952 single blastocyst transfers. Second, we quantified the contribution of the automatic embryo score and conventional morphological grade to implantation and live birth outcome with multivariate logistic regression analysis in different patient populations. MAIN RESULTS AND THE ROLE OF CHANCE A higher embryo score was associated with a better clinical outcome of IVF treatment. The mean of the automatic embryo score varied significantly (P < 0.001) among embryos with different morphological categories, between euploid and aneuploid embryos, between embryos resulting in positive versus negative pregnancy, between implanted and non-implanted embryos, and between embryos resulting in positive and negative live birth. Embryo score was related to the odds of implantation and live birth in the oocyte donation program (odds ratio (OR)=1.29; 95% CI [1.19–1.39]; P < 0.001 for implantation and OR = 1.26; 95% CI [1.16–1.36]; P < 0.001 for live birth) and in conventional treatments with autologous oocytes (OR = 1.38; 95% CI [1.24–1.54]; P < 0.001 for implantation and OR = 1.47; 95% CI [1.30–1.65]; P < 0.001 for live birth). There was no significant association of embryo score with implantation or live birth in treatments involving PGT-A. LIMITATIONS, REASONS FOR CAUTION This study is limited by its retrospective nature. Further prospective randomized trials are required to confirm the clinical impact of these findings. The single-center design should be taken into account when considering the universal application of the model. WIDER IMPLICATIONS OF THE FINDINGS Evidence of the clinical efficiency of automated embryo scoring for ranking embryos with different morphological grade and potential in order to achieve higher implantation and live birth rates may make it a decision support tool for embryologists when selecting blastocysts for embryo transfer. STUDY FUNDING/COMPETING INTEREST(S) This research has been funded by a grant from the Ministry of Science, Innovation and Universities FIS (PI21/00283) awarded to M.M. There are no competing interests to declare. TRIAL REGISTRATION NUMBER N/A.

Assessment of artificial intelligence model and manual morphokinetic annotation system as embryo grading methods for successful live birth prediction: a retrospective monocentric study

“…Further evidence of the clinical efficiency of automated embryo scoring in achieving higher live birth rates has been recently disclosed. The KIDScore D5™ algorithm was shown to correlate with higher live birth rates compared to conventional morphology assessment; thus, it was proposed to function as a valuable, supportive prediction tool with the final decision being made by the assisted reproduction expert [ 34 ].…”

Assessment of artificial intelligence model and manual morphokinetic annotation system as embryo grading methods for successful live birth prediction: a retrospective monocentric study

“…Further evidence of the clinical e ciency of automated embryo scoring in achieving higher live birth rates has been recently disclosed. The KIDScore D5™ algorithm was shown to correlate with higher live birth rates compared to conventional morphology assessment; thus, it was proposed to function as a valuable, supportive prediction tool with the nal decision being made by the assisted reproduction expert [34].…”

The correlation between morphological parameters and the incidence of de novo chromosomal abnormalities in 3238 biopsied blastocysts

“…In laboratories, morphological evaluation has been the main strategy applied to choose the embryos to transfer. Most reports demonstrate that the implantation, clinical pregnancy and live birth rates in the day-5 blastocyst group are significantly higher than those in the day-6 blastocyst group[ 12 , 26 , 34 ] and that morphologic parameters (degree of expansion, ICM grade, and TE grade) are significantly positively correlated with the outcomes after blastocyst transfer[ 27 , 29 ]. Some studies suggested that the transfer of euploid blastocysts tested by PGT-A can lead to higher rates of clinical pregnancy, live birth, and implantation than those of non-PGT-A tested blastocysts [ 35 , 36 ].…”