Abstract
BackgroundQuality control programs are necessary to maintain good clinical practice. Embryo grading has been described as one of the external quality assurance schemes. Although the evaluation of embryos is based on the assessment of morphological characteristics, considerable intra- and inter-observer variability has been described. In this multicentre study, the variability in the embryo evaluation has been evaluated using morphological characteristics on day 1, day 2 and day 3 of embryo development.MethodsFive embryologists of four different IVF centers participated in this study. Multilevel images of embryos were presented on a website at different time points to evaluate intra-and inter-observer agreement in the assessment of embryo morphology. The embryos were evaluated on day 1, day 2 and day 3 of their development and each embryologist had to decide if the embryo had to be transferred, cryopreserved or discarded.ResultsBoth intra-observer agreement and inter-observer agreement were good to excellent for the position of the pronuclei on day 1, the number of blastomeres on day 2 and day 3 and the clinical decision (transfer, cryopreservation, discard). For all other characteristics (size of pronuclei, presence of cytoplasomic halo, degree of fragmentation and size of blastomeres) the intra- and inter-observer agreement was moderate to very poor.ConclusionsMono- or multicentre quality control on embryo scoring by morphological assessment can easily be performed through the design of a simple website. In the future the website design can be adapted to generate statistical feedback upon scoring and can even include a training module.
Highlights
Quality control programs are necessary to maintain good clinical practice
The efficiency and effectiveness of these laboratories can be controlled by the application of strict norms (ISO 15189; 9001) in combination with clinical practice guidelines and internal and external quality control programs, as reported before [1]
Expert opinion has been considered as the golden standard in a multicentre study [5], this choice can be scientifically challenged since the level of experience is not necessarily linked to good inter-observer agreement in the assessment of embryonic multilevel images as we reported recently [6]
Summary
Quality control programs are necessary to maintain good clinical practice. Embryo grading has been described as one of the external quality assurance schemes. Embryo grading has been proposed as one of the external quality assurance schemes [1] and is principally based on the assessment of morphological characteristics in a fast, easy and non-invasive way [2]. A second important subject of intra- and inter-observer quality control deals with the decision on which embryo needs to be transferred, cryopreserved or discarded. This clinical decision making has been associated with moderate (Assin et al [7] and Castilla et al [8]) and high (Arce et al [9]) interobserver agreement
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