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Figure 1. Acephalic acardiac baby showing development of the lower part of the body.

Background: A thickened endometrium in the postmenopausal patient is a common reason for referral to gynaecology rapid access clinics under the cancer targets wait. This can often be an incidental finding in the asymptomatic patient. Investigation of this can be invasive, uncomfortable and carries significant surgical risk. Aims: This paper aims to summarise all the recent literature to see if there is any clear consensus on who should be further investigated in this select group of patients. Methods: Systematic literature review. Results: The studies varied greatly on the need for further investigation in asymptomatic women with endometrial thickness greater than 11 mm, with some deciding on careful case selection for further investigation, and others investigating every patient. The treatment of asymptomatic patients with endometrium classified as thickened, yet under 11 mm and no symptoms again varied in case selection and further investigation. Endometrial polyps were mentioned in 1 paper, suggesting that asymptomatic polyps need not be removed, which is contrary to current clinical practice. Conclusion: There is no overall opinion as to the exact treatment of women with thickened endometrium. Women should be carefully triaged and all other factors taken into account before further investigation are instigated.

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Study question Can the annotationfree embryo scoring system (iDAScore) predict the likelihood of euploidy in embryos? Summary answer Our results have shown that there is a significant positive correlation between iDAScore and blastocyst euploidy. What is known already iDAScore (Vitrolife, Sweden) is an embryo ranking model that was developed by using artificial intelligence (AI) and deep learning. It does not require any user-dependent annotation which largely eliminates the subjectivity of manual annotation by embryologists. It has also been reported to be a robust predictor in likelihood of embryo implantation. However, the correlation between iDAScore and euploidy has not been extensively studied. Therefore, this study is to determine if iDAScore can be utilized as a predictor for embryo euploidy. Study design, size, duration A total of 860 blastocysts (mean age: 30.0; age range: 19.0-35.0) were assessed with iDAScore on day-5 and/or day-6 of embryo development from January 2022 to October 2022 at Alpha IVF & Women’s Specialists. The euploidy rates were analyzed based on the stratified iDAScores (Group A:0.0-4.9; Group B: 5.0-7.4; Group C:7.5-8.9; Group D:9.0-10.0). Participants/materials, setting, methods Scores were computed by the iDAScore software at the Vitrolife Technology Hub (Vitrolife, Gothenburg, Sweden) prior to trophectoderm biopsy for Preimplantation Genetic Testing for Aneuploidies (PGT-A) (Ion Torrent, USA). The ploidy status (euploid or aneuploid) based on PGT-A results were recorded and assessed with the corresponding iDAScore. Main results and the role of chance The euploidy rates of Group A, B, C and D were 56.7% (17/30), 60.0% (105/175), 65.9% (178/270) and 74.8% (288/385) respectively. Group D shows significantly higher euploidy rate compared to Group B and Group C (p = 0.0005, p = 0.0143). A weak significance was observed between Group D and Group A (p = 0.0505). This is probably due to smaller sample size in Group A. No significant differences were displayed among Group A, Group B and Group C (p = > 0.005). Our results demonstrated an increasing trend between iDAScore and the proportion of euploid embryos. Limitations, reasons for caution Few of the blastocysts in Group A could be selected for biopsy so the sample size was only a fraction of the other groups. Further studies and larger sample sizes would allow the findings to be stated more confidently. Wider implications of the findings Although the iDAScore algorithm scores the chance of embryo implantation, we have demonstrated its potential to assist in predicting the embryo ploidy status in a non-invasive manner. This may be used to inform the decision of which and how many blastocysts to biopsy and transfer, thus reducing treatment costs. Trial registration number not applicable