Abstract
Research question
What is the intra- and inter-centre reliability in embryo grading performed according
to the Istanbul Consensus across several IVF clinics?
Design
Forty Day 3 embryos and 40 blastocysts were photographed on three focal planes. Senior
and junior embryologists from 65 clinics were invited to grade them according to the
Istanbul Consensus (Study Phase I). All participants then attended interactive training
where a panel of experts graded the same embryos (Study Phase II). Finally, a second
set of pictures was sent to both embryologists and experts for a blinded evaluation
(Study Phase III). Intra-centre reliability was reported for Study Phase I as Cohen's
kappa between senior and junior embryologists; inter-centre reliability was instead
calculated between senior/junior embryologists and experts in Study Phase I versus
III to outline improvements after training (i.e. upgrade of Cohen's kappa category
according to Landis and Koch).
Results
Thirty-six embryologists from 18 centres participated (28% participation rate). The
intra-centre reliability was (i) substantial (0.63) for blastomere symmetry (range
–0.02 to 1.0), (ii) substantial (0.72) for fragmentation (range 0.29–1.0), (iii) substantial
(0.66) for blastocyst expansion (range 0.19–1.0), (iv) moderate (0.59) for inner cell
mass quality (range 0.07–0.92), (v) moderate (0.56) for trophectoderm quality (range
0.01–0.97). The inter-centre reliability showed an overall improvement from Study
Phase I to III, from fair (0.21–0.4) to moderate (0.41–0.6) for all parameters under
analysis, except for blastomere fragmentation among senior embryologists, which was
already moderate before training.
Conclusions
Intra-centre reliability was generally moderate/substantial, while inter-centre reliability
was just fair. The interactive training improved it to moderate, hence this workflow
was deemed helpful. The establishment of external quality assessment services (e.g.
UK NEQAS) and the avant-garde of artificial intelligence might further improve the
reliability of this key practice for embryo selection.
Keywords
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Biography
Danilo Cimadomo, MSc, PhD, is a molecular biologist, Science and Research Manager of GeneraLife IVF, member of the Executive Committee of SIERR, and Basic Science Officer of the ESHRE Special Interest Group Implantation and Early Pregnancy. He has authored over 80 peer-reviewed manuscripts concerning embryology, embryo selection and PGT.
Article info
Publication history
Published online: October 06, 2021
Accepted:
September 26,
2021
Received in revised form:
September 1,
2021
Received:
April 7,
2021
Declaration: The authors report no financial or commercial conflicts of interest.Identification
Copyright
© 2021 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.
