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

Autores de IIS La Fe

• Lorena Bori Arnal

  Autor

• Fernando Meseguer Estornell

  Autor

• Mª De Los Ángeles Valera Cerdá

  Autor

• José Remohí Giménez

  Autor

• 

  Marcos Meseguer Escrivá

  Autor

Participantes ajenos a IIS La Fe

• Galan, Arancha

Grupos

• Biomarcadores, Medicina Genómica, Estadística y Análisis masivo de datos en Reproducción humana asistida

  

  Investigador Principal

  Marcos Meseguer Escrivá

• Endocrinología Reproductiva e Infertilidad

  Leader

  José Remohí Giménez

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 (P121 /00283) awarded to M.M. There are no competing interests to declare.

© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Keywords

• KIDScore D5 (TM); automatic embryo scoring; implantation; live birth; time-lapse; preimplantation genetic testing for aneuploidy; embryo morphology; automatism