Limitations of a time-lapse blastocyst prediction model: a large multicentre outcome analysis

Kirkegaard, Kirstine; Campbell, Alison; Agerholm, Inge; Bentin-Ley, Ursula; Gabrielsen, Anette; Kirk, John H.; Sayed, Shabana; Ingerslev, Hans Jakob

doi:10.1016/j.rbmo.2014.04.011

Cited by 62 publications

(44 citation statements)

References 4 publications

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“…In addition, analytical variations resulting from differences in study design, study size, clinical end-points, frequency and/or duration of image acquisition, and the definition and number of morphokinetic variables may account for the lack of agreement (reviewed by Chen et al, 2013;Kaser and Racowsky, 2014). These multiple sources of variation may account for the overlapping ranges reported across studies for viable and non-viable outcomes and explain why proposed morphokineticbased models of embryo selection have not been transferable to other clinics (Campbell et al, 2013a;Conaghan et al, 2013;Kirkegaard et al, 2014;Meseguer et al, 2011). It would seem that generating universally applicable reference ranges is more complicated than first anticipated, and that establishing a universal algorithm for selection of the best embryos may not be feasible.…”

Section: Article In Pressmentioning

confidence: 99%

Quality control and standardization of embryo morphology scoring and viability markers

Lundin

Ahlström

2015

Reproductive BioMedicine Online

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A so-called 'good-quality embryo' may be defined as an embryo that has the potential to implant into the uterine endometrium and give rise to the birth of a healthy child. A standardized and objective scoring of embryo 'quality' is therefore crucial in the classification and selection of embryos. However, embryo scoring is still being performed mainly via ocular evaluation, which often results in different interpretations of embryo quality. The addition of viability markers, such as measuring gene expression or the uptake/release of metabolites, proteins or RNA/DNA molecules in the culture media, would increase the possibility of standardized measurements. However, no single biomarker has yet been introduced into standard clinical practice, mainly due to the complexity of the techniques and the influence of biological variations and differences in culture conditions. In this paper different methods for the scoring of embryos and the possibility of standardizing and implementing quality control systems are discussed.

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Section: Article In Pressmentioning

confidence: 99%

Quality control and standardization of embryo morphology scoring and viability markers

Lundin

Ahlström

2015

Reproductive BioMedicine Online

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“…The timing of key parameters from time-lapse monitoring for predictions of blastocyst formation [11][12][13] aneuploidy, [14,15], and, in some cases, implantation [16][17][18] have been investigated. Various models based on specific developmental milestones and phenotypes have been built [9].…”

Section: Available Time-lapse Systems and Potential Benefitsmentioning

confidence: 99%

A critical appraisal of time-lapse imaging for embryo selection: where are we and where do we need to go?

Racowsky

Kovács

Martins

2015

J Assist Reprod Genet

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Purpose The aim of this study was to undertake a critical appraisal of the available evidence for the use of time-lapse imaging for embryo selection in clinical IVF. Methods A literature search in PubMed, Scopus, Cochrane Central, ClinicalTrials.gov, Current Controlled Trials, and WHO International Clinical Trials Registry Platform was performed to identify randomized controlled trials that investigated the effect of time-lapse embryo selection and/or the timelapse incubation system on ongoing pregnancy rate. We then performed a systematic review and assessed the relative risks (RRs) and 95 % confidence intervals (CIs) for ongoing pregnancy rates and the risk of bias of the eligible studies. Results We identified four eligible randomized studies, three of which investigated the effect of both time-lapse incubation system and selection on ongoing pregnancy rate; the pooled result revealed a benefit of this intervention (relative risk (RR) 1.20; 95 % CI 1.05-1.37). However, the evidence was judged to be of low quality due to study limitations; a beneficial effect was observed in only one study deemed to be at high risk of bias. The single study assessing the effect of only the timelapse incubation system revealed a non-significant negative effect (RR 0.71; 95 % CI 0.49-1.03). Conclusions The findings from this systematic review of the current evidence do not support routine use of time-lapse technology in clinical IVF. We therefore believe that the use of time-lapse imaging for embryo selection should remain experimental and that couples should not be subject to a surcharge for having their embryos cultured in a time-lapse imaging system. Future studies evaluating this technology in welldesigned trials should be performed.

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“…Based on their results, the authors did not recommend routine application of the original model but proposed each clinic to develop their own predictive algorithm. Another study, conducted by Kirkegaard et al (2014), tested the Conaghan model. The Conaghan model (Conaghan et al, 2013) predicts blastocyst formation using two early kinetic markers, CC 2 and S 2 .…”

Section: External Validationmentioning

confidence: 99%

Time-lapse embryoscopy

Kovács

2016

Journal of Reproductive Biotechnology and Fertility

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Time-lapse (TL) embryo monitoring is the latest technology that is proposed for embryo evaluation and selection for transfer. TL technology enables us to collect significantly more information about the in vitro development of the embryos that can be obtained through the daily-once evaluation under the light microscope. In addition, the embryos do not need to be removed from the culture environment for this. The extra morphokinetic information and the undisturbed culture conditions could both be beneficial for the cultured embryo cohort. Many morphokinetic parameters have been tested in relation to variety of laboratory (e.g. blastocyst development) and clinical (implantation and live-birth rate) outcomes. Most of these studies are retrospective in nature and suffer from methodological problems (heterogeneous patient population, culture conditions not standardized, and small sample size). Several groups attempted to build algorithms, however, have not yet been confirmed externally as attempts so far could not reproduce the expected predictive abilities. Therefore, these algorithms cannot be universally accepted. The latest algorithm proposed for embryo selection was developed based on data from 24 clinics using local stimulation and laboratory procedures. It groups embryos into five categories (KIDScore) based on in and out of range kinetic events. The algorithm was tested in subsets of patients using various fertilization methods or culture conditions and its predictive ability remained the same. The authors, therefore, feel comfortable to recommend it for routine use in any laboratory using TL technology. There is, however, still limited prospective, randomized trial data testing the algorithms. This article reviews TL technology, retrospective and prospective reports on various morphokinetic parameters, and the benefits and shortcomings of currently available algorithms.

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Limitations of a time-lapse blastocyst prediction model: a large multicentre outcome analysis

Cited by 62 publications

References 4 publications

Quality control and standardization of embryo morphology scoring and viability markers

Quality control and standardization of embryo morphology scoring and viability markers

A critical appraisal of time-lapse imaging for embryo selection: where are we and where do we need to go?

Time-lapse embryoscopy

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