Electronic embryo evaluation (EEE)—are 2 heads better than 1?

Abstract

Objective: Embryo morphologic assessment is vital for successful outcomes in all IVF programs. For smaller centers committed to minimizing multiple pregnancy risk, a single embryologist is often challenged with the task of identifying the highest quality embryos for transfer. In this study we tested an inexpensive electronic imaging system for collaborative off-site evaluation of developing embryos, and determined its impact on implantation in our center. Design: Images of developing embryos were electronically transferred by the embryologist to the off-site laboratory director for collaborative evaluation prior to embryo transfer. A consensus recommendation was provided to the patient following laboratory and clinical assessment. Based on this information, the patient and husband made the final decision regarding number of embryos to be transferred. Materials/Methods: EEE was carried out before uterine transfer in 75 consecutive fresh cycles during a 15-month period, with comparisons made to 83 fresh cycles prior to EEE. Video images were digitized using a Snappy Video Snapshot (Play Incorporated Ver. 3.0) connected to a laptop computer, with images archived onto CD-RW disks. To ensure correct identification, a character generator was positioned between the microscope camera and Snappy Video Snapshot to embed patient names and dates onto archived pictures. Images were taken on the morning of day 1 after insemination and continued each day at approximately the same time until day 6. Embryo morphological characteristics were recorded each day. Images were sent via electronic mail to the off-site laboratory director on the morning before the transfer. Embryo grading was determined by the off-site laboratory director (MT) and on-site embryologist (MP). All transfers were carried out by the same physician (RFF) with ultrasonic guidance. Results: Refer to table. Results: Tabled 1Cycles with EEE (n = 75)Cycles without EEE (n = 83)p ValueMean embryos transferred3.23.4NSClinical pregnancy rate56% (42/75)34% (28/83)0.09Ongoing/delivered40% (30/75)23% (19/83)0.25Pregnancy RateEmbryo implantation rate24% (58/238)13% (35/281)0.01Ongoing/delivered gestations20 singletons, 8 twins, 2 triplets15 singletons, 3 twins, 1 tripletNS Open table in a new tab Conclusions: EEE has resulted in statistically significant enhancement of embryo implantation in our program, with a trend towards higher pregnancy rates. As nationwide demand for assisted reproduction steadily increases, both new and smaller IVF laboratories will strive for quality assurance, necessitating the culturing of embryos with high implantation potential. This goal has been addressed in our center by incorporating EEE into the embryo selection process. In the near future, real-time video microscopy should enable off-site IVF lab directors to better assess egg and embryo quality, and to teach and critique specific lab techniques.