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- Title
Inter-observer and intra-observer agreement between embryologists during selection of a single Day 5 embryo for transfer: a multicenter study.
- Authors
Storr, Ashleigh; Venetis, Christos A.; Cooke, Simon; Kilani, Suha; Ledger, William
- Abstract
<bold>Study Question: </bold>What is the inter-observer and intra-observer agreement between embryologists when selecting a single Day 5 embryo for transfer?<bold>Summary Answer: </bold>The inter-observer and intra-observer agreement between embryologists when selecting a single Day 5 embryo for transfer was generally good, although not optimal, even among experienced embryologists.<bold>What Is Known Already: </bold>Previous research on the morphological assessment of early stage (two pronuclei to Day 3) embryos has shown varying levels of inter-observer and intra-observer agreement. However, single blastocyst transfer is now becoming increasingly popular and there are no published data that assess inter-observer and intra-observer agreement when selecting a single embryo for Day 5 transfer.<bold>Study Design, Size, Duration: </bold>This was a prospective study involving 10 embryologists working at five different IVF clinics within a single organization between July 2013 and November 2015.<bold>Participants/materials, Setting, Methods: </bold>The top 10 embryologists were selected based on their yearly Quality Assurance Program scores for blastocyst grading and were asked to morphologically grade all Day 5 embryos and choose a single embryo for transfer in a survey of 100 cases using 2D images. A total of 1000 decisions were therefore assessed. For each case, Day 5 images were shown, followed by a Day 3 and Day 5 image of the same embryo. Subgroup analyses were also performed based on the following characteristics of embryologists: the level of clinical embryology experience in the laboratory; amount of research experience; number of days per week spent grading embryos. The agreement between these embryologists and the one that scored the embryos on the actual day of transfer was also evaluated. Inter-observer and intra-observer variability was assessed using the kappa coefficient to evaluate the extent of agreement.<bold>Main Results and the Role Of Chance: </bold>This study showed that all 10 embryologists agreed on the embryo chosen for transfer in 50 out of 100 cases. In 93 out of 100 cases, at least 6 out of the 10 embryologists agreed. The inter-observer and intra-observer agreement among embryologists when selecting a single Day 5 embryo for transfer was generally good as assessed by the kappa scores (kappa = 0.734, 95% CI: 0.665-0.791 and 0.759, 95% CI: 0.622-0.833, respectively). The subgroup analyses did not substantially alter the inter-observer and intra-observer agreement among embryologists. The agreement when Day 3 images were included alongside Day 5 images of the same embryos resulted in a change of mind at least three times by each embryologist (on average for <10% of cases) and resulted in a small decrease in inter-observer and intra-observer agreement between embryologists (kappa = 0.676, 95% CI: 0.617-0.724 and 0.752, 95% CI: 0.656-808, respectively).The assessment of the inter-observer agreement with regard to morphological grading of Day 5 embryos showed only a fair-to-moderate agreement, which was observed across all subgroup analyses. The highest overall kappa coefficient was seen for the grading of the developmental stage of an embryo (0.513; 95% CI: 0.492-0.538). The findings were similar when the individual embryologists were compared with the embryologist who made the morphological assessments of the available embryos on the actual day of transfer.<bold>Limitations, Reasons For Caution: </bold>All embryologists had already completed their training and were working under one organization with similar policies between the five clinics. Therefore, the inter-observer agreement might not be as high between embryologists working in clinics with different policies or with different levels of training.<bold>Wider Implications Of the Findings: </bold>The generally good, although not optimal uniformity between participating embryologists when selecting a Day 5 embryo for transfer, as well as, the surprisingly low agreement when morphologically grading Day 5 embryos could be improved, potentially resulting in increased pregnancy rates. Future studies need to be directed toward technologies that can help achieve this.<bold>Study Funding/competing Interests: </bold>None declared.<bold>Trial Registration Number: </bold>Not applicable.
- Subjects
EMBRYO transfer; EMBRYOLOGISTS; INTER-observer reliability; MEDICAL decision making; HEALTH programs; HEALTH surveys; BIRTH rate; COMPARATIVE studies; FERTILIZATION in vitro; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; RESEARCH; EVALUATION research; FETAL development; TREATMENT effectiveness; RESEARCH bias
- Publication
Human Reproduction, 2017, Vol 32, Issue 2, p307
- ISSN
0268-1161
- Publication type
journal article
- DOI
10.1093/humrep/dew330