Research QuestionProgress in artificial intelligence (AI) and advanced image analysis offers unique opportunities to develop novel embryo assessment approaches. In this study, we tested the hypothesis that such technologies can extract and harness novel information derived from cytoplasmic movements of the early human embryo to predict development to blastocyst.DesignIn a proof-of principle study, an artificial neural network (ANN) approach was undertaken to assess retrospectively 230 human preimplantation embryos. After ICSI, embryos were subjected to time-lapse monitoring for 44 hours. For comparison as a standard embryo assessment methodology, a single senior embryologist assessed each embryo to predict development to blastocyst stage (BL) based on a single picture frame taken at 42 hours of development. In the experimental approach, in embryos that developed to blastocyst or destined to arrest (NoBL), cytoplasm movement velocity (CMV) was recorded by time-lapse monitoring during the first 44 hours of culture and analysed with a Particle Image Velocimetry (PIV) algorithm to extract quantitative information. Three main AI approaches, the k-Nearest Neighbor (k-NN), the Long-Short Term Memory Neural Network (LSTM-NN) and the hybrid ensemble classifier (HyEC) were employed to classify the two embryo classes.ResultsBlind operator assessment classified each embryo in terms of ability of development to blastocyst, reaching a 75.4% accuracy, 76.5% sensitivity, 74.3% specificity, 74.3% precision and 75.4% F1 score. After integration of results from AI models together with the blind operator classification, the performance metrics improved significantly, with a 82.6% accuracy, 79.4% sensitivity, 85.7% specificity, 84.4% precision and 81.8% F1 score.ConclusionsThe present study suggests the possibility to predict human blastocyst development at early cleavage stages by detection of CMV and AI analysis. This indicates the importance of the dynamics of the cytoplasm as a novel and valuable source of data to assess embryo viability.