Morphology Score Research Articles

An artificial intelligence algorithm for automated blastocyst morphometric parameters demonstrates a positive association with implantation potential

Blastocyst selection is primarily based on morphological scoring systems and morphokinetic data. These methods involve subjective grading and time-consuming techniques. Artificial intelligence allows for objective and quick blastocyst selection. In this study, 608 blastocysts were selected for transfer using morphokinetics and Gardner criteria. Retrospectively, morphometric parameters of blastocyst size, inner cell mass (ICM) size, ICM-to-blastocyst size ratio, and ICM shape were automatically measured by a semantic segmentation neural network model. The model was trained on 1506 videos with 102 videos for validation with no overlap between the ICM and trophectoderm models. Univariable logistic analysis found blastocyst size and ICM-to-blastocyst size ratio to be significantly associated with implantation potential. Multivariable regression analysis, adjusted for woman age, found blastocyst size to be significantly associated with implantation potential. The odds of implantation increased by 1.74 for embryos with a blastocyst size greater than the mean (147 ± 19.1 μm). The performance of the algorithm was represented by an area under the curve of 0.70 (p < 0.01). In conclusion, this study supports the association of a large blastocyst size with higher implantation potential and suggests that automatically measured blastocyst morphometrics can be used as a precise, consistent, and time-saving tool for improving blastocyst selection.

Zebrafish as a biological model for assessing water quality along tropical hydrographic river basins in Northeast Brazil.

Tropical rivers are the main destinations for tailings from urban, industrial and agricultural activities in the region studied. The present study aimed to investigate if early stages of zebrafish (Danio rerio) development is a viable biological model to assess the toxicity of surface waters of tropical rivers, and whether that toxicity could be correlated to standard water quality indexes. Embryos were exposed to samples from 55 sites from 10 hydrographic basins of rivers in Pernambuco State, northeastern Brazil. Lethality rates, sublethal toxicity based on the general morphology score (GMS) and frequencies of abnormalities were analyzed. Significant mortality was observed in samples of 7 basins. The GMS indicated significant delay in embryo-larval development in 50% of the samples. The highest toxicity was detected in basins within Recife metropolitan area, where 61% of the samples caused sublethal toxicity. Most frequent developmental abnormalities included non-inflation of the swim bladder, delayed hatching and blood stasis. The highest frequencies of blood stasis were detected in samples with highest NH3 concentrations, corroborated by a positive correlation suggesting the existence of a causal relationship. A significant correlation was detected between water quality indexes and GMS with a greater toxic effect being observed in samples collected in areas of greater urban density and greater contamination by domestic sewage. This study demonstrates that the early stages of the zebrafish is a viable ecotoxicological model to assess the toxicity of surface waters and can contribute to a better understanding between the chemical composition and the adverse effects suffered by fish early life stage fish in tropical rivers.

280 Does Delayed Physiotherapy Assessment Postoperatively Affect Mortality or Length of Stay in Patients Following Surgery for a Neck of Femur Fracture?

Abstract Aim National guidance states that patients with a neck of femur fracture (NOFF) should be assessed by a physiotherapist on the first postoperative day. This can pose problems given the finite availability of physiotherapists. This study aims to determine if delayed assessment impacts patients' postoperative mortality or length of stay in the hospital. Method A prospective case series of all NOFFs surgically treated at a major trauma centre between 2013-2022 was performed. Patients ≥65 years of age were included from a unit-based prospective database. Results A total of 3411 patients were included. 3062 were assessed by a physiotherapist on the first postoperative day (POD1), and 349 on day two and beyond (POD2+). Delayed physiotherapy was principally due to the day of operation, where the POD2+ group more likely had surgery on a Friday or Saturday, p&amp;lt;0.001. The two groups were comparable in age, gender, fracture morphology, preoperative ASA and Rockwood frailty scores, and surgical procedure. The average length of stay for POD1 was 16.9 days (SD = 21.1), and 16.0 days (SD = 12.4) for POD2+, p = 0.450. Mortality was lower in the POD2+ group at 30 days after surgery, p = 0.040. There was no difference in mortality at 1 year, p = 0.295, 2 years, p = 0.724, and overall, p = 0.826. Conclusions Delayed physiotherapy assessment does not worsen length of stay in NOFF patients. Lower early mortality in this group indicates a possible benefit in delaying physiotherapy assessment although there was no significant difference in mortality beyond 30 days. However, a seven-day physiotherapy service would still be required for continuity of postoperative care.

Predicting central lymph node metastasis in patients with papillary thyroid carcinoma based on ultrasound radiomic and morphological features analysis

ObjectivesTo build a combined model based on the ultrasound radiomic and morphological features, and evaluate its diagnostic performance for preoperative prediction of central lymph node metastasis (CLNM) in patients with papillary thyroid carcinoma (PTC).MethodA total of 295 eligible patients, who underwent preoperative ultrasound scan and were pathologically diagnosed with unifocal PTC were included at our hospital from October 2019 to July 2022. According to ultrasound scanners, patients were divided into the training set (115 with CLNM; 97 without CLNM) and validation set (45 with CLNM; 38 without CLNM). Ultrasound radiomic, morphological, and combined models were constructed using multivariate logistic regression. The diagnostic performance was assessed by the area under the curve (AUC) of the receiver operating characteristic curve, accuracy, sensitivity, and specificity.ResultsA combined model was built based on the morphology, boundary, length diameter, and radiomic score. The AUC was 0.960 (95% CI, 0.924–0.982) and 0.966 (95% CI, 0.901–0.993) in the training and validation set, respectively. Calibration curves showed good consistency between prediction and observation, and DCA demonstrated the clinical benefit of the combined model.ConclusionBased on ultrasound radiomic and morphological features, the combined model showed a good performance in predicting CLNM of patients with PTC preoperatively.

Effect of CFTR modulator therapy with elexacaftor/tezacaftor/ivacaftor on pulmonary ventilation derived by 3D phase-resolved functional lung MRI in cystic fibrosis patients

ObjectivesTo investigate whether 3D phase-resolved functional lung (PREFUL)-MRI parameters are suitable to measure response to elexacaftor/tezacaftor/ivacaftor (ETI) therapy and their association with clinical outcomes in cystic fibrosis (CF) patients.MethodsTwenty-three patients with CF (mean age: 21; age range: 14–46) underwent MRI examination at baseline and 8–16 weeks after initiation of ETI. Morphological and 3D PREFUL scans assessed pulmonary ventilation. Morphological images were evaluated using a semi-quantitative scoring system, and 3D PREFUL scans were evaluated by ventilation defect percentage (VDP) values derived from regional ventilation (RVent) and cross-correlation maps. Improved ventilation volume (IVV) normalized to body surface area (BSA) between baseline and post-treatment visit was computed. Forced expiratory volume in 1 second (FEV1) and mid-expiratory flow at 25% of forced vital capacity (MEF25), as well as lung clearance index (LCI), were assessed. Treatment effects were analyzed using paired Wilcoxon signed-rank tests. Treatment changes and post-treatment agreement between 3D PREFUL and clinical parameters were evaluated by Spearman’s correlation.ResultsAfter ETI therapy, all 3D PREFUL ventilation markers (all p < 0.0056) improved significantly, except for the mean RVent parameter. The BSA normalized IVVRVent was significantly correlated to relative treatment changes of MEF25 and mucus plugging score (all |r| > 0.48, all p < 0.0219). In post-treatment analyses, 3D PREFUL VDP values significantly correlated with spirometry, LCI, MRI global, morphology, and perfusion scores (all |r| > 0.44, all p < 0.0348).Conclusions3D PREFUL MRI is a very promising tool to monitor CFTR modulator–induced regional dynamic ventilation changes in CF patients.Clinical relevance statement3D PREFUL MRI is sensitive to monitor CFTR modulator–induced regional ventilation changes in CF patients. Improved ventilation volume correlates with the relative change of mucus plugging, suggesting that reduced endobronchial mucus is predominantly responsible for regional ventilation improvement.Key Points• 3D PREFUL MRI–derived ventilation maps show significantly reduced ventilation defects in CF patients after ETI therapy.• Significant post-treatment correlations of 3D PREFUL ventilation measures especially with LCI, FEV1 %pred, and global MRI score suggest that 3D PREFUL MRI is sensitive to measure improved regional ventilation of the lung parenchyma due to reduced inflammation induced by ETI therapy in CF patients.• 3D PREFUL MRI–derived improved ventilation volume (IVV) correlated with MRI mucus plugging score changes suggesting that reduced endobronchial mucus is predominantly responsible for regional ventilation improvement 8–16 weeks after ETI therapy.

A comparison of culture and cooling for the short term preservation of in vivo derived dromedary camel embryos of varying morphological quality

Despite recent advancements in the cryopreservation of dromedary camel embryos, widespread application of the technique is still limited by the need for specialised vitrification equipment and supplies. Temporary, liquid-phase embryo storage methods provide a useful tool for short-term preservation of camel embryos.In the current study, we compared the use of in vitro embryo culture with cold liquid storage in order to maintain both high- (Grade 1- Excellent and 2-Good) and low- (Grade 3- Moderate and 4-Poor) morphological grade Day-7 dromedary camel embryos in vitro for up to 3 days. Embryos were either cooled and placed in Hams-F10 medium supplemented with HEPES and 10% FBS and then kept at 4 °C; or placed in Hams-F10 supplemented with sodium bicarbonate and 10% FBS and then cultured in a humidified atmosphere of 6% CO2 at 37 °C before being assessed for viability at 24 h. In high-morphological grade embryos, both cold storage and culture supported 100% viability (maintenance of normal morphology) over this period (Cooled n = 22, Cultured n = 20). In low-morphological grade embryos, culture supported higher viability (16/18, 88.9%) than did cooling (4/18, 22.2%). We then evaluated the effect of up to 3 days of cold storage or culture on embryo morphological grade, diameter, and developmental competence following embryo transfer. High-grade embryos were divided between culture and cold storage; low-grade embryos were evaluated only after culture. Over 3 days of culture, both high- and low-grade embryos tended to either maintain or improve upon their initial morphological score (P < 0.05) and increased in diameter (P < 0.001). Embryos subjected to cooling tended to have reduced morphological scores by 48 h of storage and decreased in diameter by 72 h (P < 0.05). No significant influence of storage method (cooling vs. culture), duration (24–72 h), or embryo grade (high vs low) was observed on pregnancy establishment at Day-60 (22.2%–57.2% pregnancy rates for all treatments). Overall, rates of pregnancy establishment were similar for transferred cultured (n = 45) and cooled (n = 45) embryos (pregnancy rates at Day 18, 48% vs 51.1%; at Day 60, 37.7% vs 37.7%). Rates of embryonic loss also were similar (22.7% vs 26%).In conclusion, whilst similar rates of pregnancy and pregnancy loss were observed following the transfer of both cooled and cultured embryos held in vitro for up to 3 days, amongst the two methods, only embryo culture appears to provide a means of effectively preserving Day- 7 dromedary camel embryos with reduced morphological values in vitro. Considering these embryos appear to show poor tolerance to the cooling procedure and are unlikely candidates for vitrification, embryo culture may provide an effective method for deriving pregnancies from low-morphological grade embryos when immediate transfer is not possible on the day of flushing.

The importance of cytoplasmic strings during early human embryonic development.

Objectives: During human in vitro fertilisation (IVF) treatments, embryologists attempt to select the most viable embryos for embryo transfer (ET). Previously, embryos were evaluated based on light microscopic morphological parameters. However, this is currently accomplished by morphokinetic analysis of time-lapse recordings. This technique provides us the opportunity to observe cytoplasmic strings at the blastocyst stage. The aim of this work was to examine the relationship between the presence of cytoplasmic strings (CS) and the embryo viability in human in vitro fertilised embryos. Study design: Herein, we present an evaluation of the morphokinetic data on the development of embryos obtained during IVF treatments performed at the Division of Assisted Reproduction between December 2020 and March 2021. The dynamics of embryo development, embryo morphology, and morphokinetic scores generated by a time-lapse system were compared between the presence of cytoplasmic strings (CS+) and their absence (CS-) at the blastocyst stage. Results: The development of 208 embryos from 78 patients was examined. Moreover, 81.2% of the embryos had CS in the blastocyst stage; 77% of CS existed in embryos created by conventional IVF, while 86% of CS existed in embryos fertilised by intracytoplasmic sperm injection (ICSI) (p = 0.08). A greater number of CS+ embryos developed into a higher quality blastocyst (52.1% vs. 20.5%, p = 0.02). The morphokinetic score values characterising the development of embryos, such as Known Implantation Data Score (KIDScore) and Intelligent Data Analysis (iDAScore), were higher in CS+ groups (KID: 6.1 ± 2.1 vs. 4.7 ± 2.07; iDA: 8.0 ± 1.9 vs. 6.8 ± 2.3, p < 0.01). The dynamics of the early embryo development were similar between the two groups; however, CS+ embryos reached the blastocyst stage significantly earlier (tB: 103.9h vs. tB: 107.6h; p = 0.001). Conclusion: Based on our results, the number of embryos with cytoplasmic strings was higher than that without cytoplasmic strings, and its presence is not related to the fertilisation method. These embryos reached the blastocyst stage earlier, and their morphokinetic (KIDScore and iDAScore) parameters were better. All these results suggest that the presence of CS indicates higher embryo viability. The examination of this feature may help us make decisions about the embryos with higher implantation potential.

TTC4 inhibits NLRP3 inflammation in rheumatoid arthritis by HSP70.

This experiment explored the function of TTC4 in rheumatoid arthritis inflammation and its possible mechanism. C57BL/6 mice were immunized intradermally with bovine type II collagen. Lipopolysaccharide induction was performed on RAW264.7 cells. The mRNA expression of TTC4 in articular tissue of mice with rheumatoid arthritis was downregulated. Sh-TTC4 virus increased arthritis score, morphological change score, paw edema, and spleen index, as well as alkaline phosphatase level in mice with rheumatoid arthritis. Sh-TTC4 virus increased the levels of inflammatory factors and MDA, and decreased anti-oxidant factors in articular tissue of mice with rheumatoid arthritis. TTC4 reduced inflammation and oxidative stress in an in vitro model. TTC4 regulated HSP70 in a rheumatoid arthritis model. The inhibition of HSP70 reduced the effects of sh-TTC4 gene in mice with rheumatoid arthritis. METTL3 reduced the stability of the TTC4 gene. In this study, the TTC4 gene reduced oxidative response and inflammation in the rheumatoid arthritis model through the HSP70/NLRP3 pathway. Therefore, it can be concluded that TTC4 can be used as diagnosis and prognosis evaluation of rheumatoid arthritis.

Persistent and occasional: Searching for the variable population of the ZTF/4MOST sky using ZTF Data Release 11

Aims. We present a variability-, color-, and morphology-based classifier designed to identify multiple classes of transients and persistently variable and non-variable sources from the Zwicky Transient Facility (ZTF) Data Release 11 (DR11) light curves of extended and point sources. The main motivation to develop this model was to identify active galactic nuclei (AGN) at different redshift ranges to be observed by the 4MOST Chilean AGN/Galaxy Evolution Survey (ChANGES). That being said, it also serves as a more general time-domain astronomy study. Methods. The model uses nine colors computed from CatWISE and Pan-STARRS1 (PS1), a morphology score from PS1, and 61 single-band variability features computed from the ZTF DR11 g and r light curves. We trained two versions of the model, one for each ZTF band, since ZTF DR11 treats the light curves observed in a particular combination of field, filter, and charge-coupled device (CCD) quadrant independently. We used a hierarchical local classifier per parent node approach-where each node is composed of a balanced random forest model. We adopted a taxonomy with 17 classes: non-variable stars, non-variable galaxies, three transients (SNIa, SN-other, and CV/Nova), five classes of stochastic variables (lowz-AGN, midz-AGN, highz-AGN, Blazar, and YSO), and seven classes of periodic variables (LPV, EA, EB/EW, DSCT, RRL, CEP, and Periodic-other). Results. The macro-averaged precision, recall, and F1-score are 0.61, 0.75, and 0.62 for the g-band model, and 0.60, 0.74, and 0.61, for the r-band model. When grouping the four AGN classes (lowz-AGN, midz-AGN, highz-AGN, and Blazar) into one single class, its precision-recall, and F1-score are 1.00, 0.95, and 0.97, respectively, for both the g and r bands. This demonstrates the good performance of the model in classifying AGN candidates. We applied the model to all the sources in the ZTF/4MOST overlapping sky (−28 ≤ Dec ≤ 8.5), avoiding ZTF fields that cover the Galactic bulge (|gal_b| ≤ 9 and gal_l ≤ 50). This area includes 86 576 577 light curves in the g band and 140 409 824 in the r band with 20 or more observations and with an average magnitude in the corresponding band lower than 20.5. Only 0.73% of the g-band light curves and 2.62% of the r-band light curves were classified as stochastic, periodic, or transient with high probability (Pinit ≥ 0.9). Even though the metrics obtained for the two models are similar, we find that, in general, more reliable results are obtained when using the g-band model. With it, we identified 384 242 AGN candidates (including low-, mid-, and high-redshift AGN and Blazars), 287 156 of which have Pinit ≥ 0.9.

Variation and phenetic relationships of Dendrophthoe pentandra (L.) Miq. from various host trees based on morphological characters

Dendrophthoe pentandra (L.) Miq.; Loranthaceae) is a shrub parasitic on various host tree species. This species is often used for herbal medicinal ingredients by local communities based on the spesies of host tree. The morphological characteristics of D. pentandra are important to study because their adaptation to different host trees may resulting population of ecotypes. This study aims to determine the variation of D. pentandra accession characters on different host tree species based on morphological characters and to determine morphological phenetic relationships between accessions. Besides studies of D. pentandra accessions in Yogyakarta Province have never been conducted in full. Sample collection (accession) of D. pentandra was conducted for various host tree species from various locations, including roots, stems, leaves, flowers, and fruit. Morphological characterization and scoring of each accession were conducted to create a similarity matrix using the Jaccard Coefficient formula. Based on the similarity matrix between OTUs and the UPGMA algorithm, it can be formed into a dendrogram. The results showed that the morphological variations of D. pentandra were found in phyllotaxis, leaf thickness, petiole length, number of stomata density per field of view, flower color, crown tube length, corolla lobe length, petal length, stamen : corolla lobe ratio, fruit color, and seed color. The population of D. pentandra in Yogyakarta can be divided into two groups, D. pentandra which has alternate and opposite arrangements in phyllotaxis. The accession dendrogram of D. pentandra in Yogyakarta was divided into five clusters starting from a similarity index of 0.089 to 0.952. Thus, the diversity of morphological variations of D. pentandra on host trees is high.

Anti-NGF treatment worsens subchondral bone and cartilage measures while improving symptoms in floor-housed rabbits with osteoarthritis.

Objective: Osteoarthritis (OA) is a common joint disorder often affecting the knee. It is characterized by alterations of various joint tissues including subchondral bone and by chronic pain. Anti-nerve growth factor (NGF) antibodies have demonstrated improvement in pain associated with OA in phase 3 clinical trials but have not been approved due to an increased risk of developing rapidly progressive OA. The aim of this study was to investigate effects of systemic anti-NGF-treatment on structure and symptoms in rabbits with surgically induced joint instability. Methods: This was elicited by anterior cruciate ligament transection and partial resection of the medial meniscus in right knee of 63 female rabbits, housed altogether in a 56m2 floor husbandry. Rabbits received either 0.1, 1 or 3mg/kg anti-NGF antibody intra-venously at weeks 1, 5 and 14 after surgery or vehicle. During in-life phase, static incapacitance tests were performed and joint diameter was measured. Following necropsy, gross morphological scoring and micro-computed tomography analysis of subchondral bone and cartilage were performed. Results: After surgery, rabbits unloaded operated joints, which was improved with 0.3 and 3mg/kg anti-NGF compared to vehicle injection during the first half of the study. The diameter of operated knee joints increased over contralateral measures. This increase was bigger in anti-NGF treated rabbits beginning 2weeks after the first IV injection and became dose-dependent and more pronounced with time. In the 3mg/kg anti-NGF group, the bone volume fraction and trabecular thickness increased in the medio-femoral region of operated joints compared to contralateral and to vehicle-treated animals, while cartilage volume and to a lesser extent thickness decreased. Enlarged bony areas were found in right medio-femoral cartilage surfaces of animals receiving 1 and 3mg/kg anti-NGF. Alterations of all structural parameters were particularly distinct in a subgroup of three rabbits, which also exhibited more prominent symptomatic improvement. Conclusion: This study showed that anti-NGF administration exerted negative impact on structure in destabilized joints of rabbits, while pain-induced unloading of joints was improved. Our findings open up the possibility to better understand the effects of systemic anti-NGF, particularly on subchondral bone, and thus the occurrence of rapidly progressive OA in patients.

P-302 Correlation of blastocyst shrinkage-pattern during vitrification and post-warming embryo performance

Abstract Study question Can blastocyst shrinkage-pattern during vitrification be predictive of post-warming survival and reproductive potential? Summary answer Blastocysts assuming a specific shrinkage-pattern during vitrification are liable to lower post-warming morphology and, potentially, degeneration. What is known already Blastocyst vitrification is a highly standardized technique. However, there are still possible factors than can compromise the outcome of the technique which should be minimized. For example, the degree of blastocoel expansion before vitrification may negatively influence embryo survival post-warming. There are studies which demonstrate that expanded blastocysts exhibit lower survival rate because of their higher blastocoel volume and amount of water, which is more prone to the detrimental ice crystal formation during vitrification. Moreover, shrinkage of expanded blastocysts during vitrification differs as some of them shrink in a uniform, spherical way while others shrink in a non-canonical way Study design, size, duration A retrospective study was conducted at IAKENTRO fertility clinic, Thessaloniki. A total of 2167 blastocysts vitrified between November 2018-December 2022, out of which 532 blastocysts warmed during the same period, were included in the present study. No biopsied or PGT-a tested embryos were included. Embryo vitrification was performed following the same protocol during the whole period of the study. For the clinical outcomes, 178 single-embryo transfers and 123 double-embryo transfers were analyzed Participants/materials, setting, methods During blastocyst exposure to the vitrification solution two shrinkage patterns were detected, allocating embryos into Group-1 for blastocysts presenting shrinkage without any detachment of the trophectoderm cells from the zona pellucida, leading to a ZP reforming which eventually resembled a “deflated” ball and into Group-2 for blastocysts that collapsed in a uniform way, having their TE cells fully detached from the ZP, which remained spherical throughout the exposure to the vitrification solution Main results and the role of chance In the total cohort of 2167 assessed blastocysts, 437 were allocated in Group-1 and 1730 in Group-2, which can be translated as 20,2% event occurrence. The Group-1 blastocysts were mostly of expansion degree 4 (76,7%) and degree 3 (23,3%), according to the Gardner system, while no smaller blastocysts were assigned in this group. As primary outcome was examined post-warming embryo survival with blastocysts in Group-1 presenting significantly higher degeneration rate (22/187, 11,7%) respect to blastocysts in Group-2 (7/345, 2%) (χ2 test, p &amp;lt; 0.0001, OR = 5,798, 95%CI = 2,511 to 14,55). Moreover, in order to assess any potential decline in embryo morphology post-warming, we corresponded Gardner’s system evaluation to a numerical score and we calculated the integrity in morphology before and after vitrification. Before vitrification, embryos’ morphology score was similar in both groups (74,8% and 73,1% for Group-1 and Group-2, respectively) while, after warming, Group-1 blastocysts exhibited significantly lower integrity of their morphology (86,52% integrity in score) respect to Group-2 blastocysts (93,82% integrity in score) (t-test, p &amp;lt; 0,0001). However, when analyzing PR and CPR no significant differences were observed between the two groups Limitations, reasons for caution The retrospective aspect of the study is per se a general limitation. Moreover, given that the analysis of the data was not limited to freeze-all cases, the embryos chosen for the fresh embryo-transfers, which means those with the highest implantation potential, were excluded from the study’s cohort Wider implications of the findings Our results show that blastocysts resembling a “deflated” ball during vitrification have compromised post-warming survival. Given that this phenomenon is exclusively observed in expanded blastocysts, whose ZP is thin and TE cells are stretched, identifying the expansion grade over which is happening could be beneficial in clinical practice Trial registration number Not applicable

P-190 Spontaneous blastocyst collapse during pre-vitrification equilibration is related to a lower live birth rate: a prospective cohort study

Abstract Study question This report provides updated data from a study investigating the association between the spontaneous collapse patterns of blastocysts during pre-vitrification equilibration and pregnancy success. Summary answer Live birth rates were lower for completely collapsed blastocysts, suggesting the possibility for including blastocyst collapse pattern as a criterion for selecting embryos for transfer. What is known already Previous time-lapse studies have found that blastocysts exhibiting strong contraction during culture have a low probability of hatching in animals and implanting in humans, suggesting blastocyst contraction has a negative impact on reproductive outcomes. Conversely, artificial shrinkage of human blastocysts before vitrification is considered to improve embryo survival and/or pregnancy rates by promoting cryoprotectant permeation inside the blastocoel. However, shrinkage is not induced in some vitrification protocols, including ours, as the viability is high; this demonstrates the potential of existing protocols to achieve sufficient cryoprotectant permeation. Moreover, the Alpha consensus meeting on cryopreservation did not issue recommendations regarding artificial shrinkage. Study design, size, duration This study included 798 patients who were undergoing their first autologous IVF/ICSI cycle followed by a freeze-all strategy, including blastocyst vitrification, at our clinic between June 2018 and November 2021. For patients with multiple vitrified blastocysts, embryos for transfer were selected hierarchically based only on morphological scoring during culture. To reduce bias, only data from a single blastocyst (day 5, Gardner score 4, excluding CC) transfer from each patient’s first warmed cycle was analyzed. Participants/materials, setting, methods Blastocysts were vitrified-warmed in in-house-prepared solutions using Rapid-i carriers. Prior to vitrification, intact blastocysts were equilibrated in 10% ethylene glycol (15 min, 37 °C). Their spontaneous collapse patterns were assessed under an inverted microscope before they were vitrified in 15% ethylene glycol + 15% dimethylsulfoxide + 0.5 M sucrose. Blastocyst collapse was defined as the separation of the trophectoderm cells from the zona pellucida. Collapsed blastocysts with/without a blastocoel cavity were defined as partially/completely collapsed blastocysts. Main results and the role of chance Non-collapsed (Nc), partially collapsed (Pc), and completely collapsed (Cc) blastocyst transfers (embryo survival rate, 99.6%) constituted 27.1%, 54.6%, and 18.3% of the 798 cycles, respectively. Live birth rates differed significantly between groups (Nc, 54.2%; Pc, 46.6%; Cc, 34.2%; P &amp;lt; 0.001). Regarding perinatal outcomes of 366 singletons, the female rate tended to differ between groups (Nc, 35.3%; Pc, 44.3%; Cc, 53.1%; P = 0.084). Significant differences in maternal age (years: Nc, 34.6 ± 4.0; Pc, 35.4 ± 3.7; Cc, 36.4 ± 4.0; P &amp;lt; 0.001), MII oocyte number (Nc, 13.0 ± 6.2; Pc, 12.0 ± 6.6; Cc, 10.8 ± 6.9; P = 0.009), blastocyst diameter (μM: Nc, 184 ± 18; Pc, 181 ± 20; Cc, 173 ± 23; P &amp;lt; 0.001), and good-quality (4AA/4AB/4BA) blastocyst percentage (Nc, 70.4%; Pc, 61.2%; Cc, 47.9%; P &amp;lt; 0.001) were found between groups. Upon logistic regression analysis including these potential confounders, only maternal age (odds ratio (OR), 0.89; 95% confidence interval (CI), 0.86–0.93; P &amp;lt; 0.001) and collapse pattern (Cc/Nc: OR, 0.59; 95% CI, 0.37–0.93; P = 0.023) significantly impacted the live birth rate, whereas blastocyst morphology (good/not: OR, 1.37; 95% CI, 0.97–1.94; P = 0.069) tended to impact it. Limitations, reasons for caution The cryoprotectant concentration of our pre-vitrification equilibration solution is relatively low. Thus, caution is required when assessing the collapse pattern, as the solution osmolarity can influence blastocyst shrinkage. Follow-up studies with more participants are warranted to confirm these results and the health of the children born after vitrified-warmed embryo transfers. Wider implications of the findings A negative relationship was found between spontaneous blastocyst collapse during pre-vitrification equilibration and live birth rate. Studying blastocyst collapse pattern may assist selection of the most viable blastocysts after vitrification in ethylene glycol and dimethylsulfoxide—a widely used permeable cryoprotectant combination—thus, increasing IVF success rates. Trial registration number Not applicable

P-093 Single sperm morphokinetic variables during ICSI at the time of sperm aspiration into the microneedle

Abstract Study question Is it possible to classify sperm morphology as normal or abnormal based on their kinetic characteristics? Summary answer Using different classifiers, it was found that balanced dataset the classification scores of individual sperm morphology can be optimized during their motility just before ICSI What is known already Sperm selection plays a crucial role during ICSI. This selection by the embryologists is accompanied by two factors: motility parameters of the sperm to be injected, as well as the morphology. Motility affects morphological decision-making which may be subjective due to spermatozoa not being in a narrow vertical space in a PVP droplet, i.e. counting chamber. Machine/Deep Learning models -as classifiers- are gaining popularity in IVF as it could minimize subjectivity in gamete selection. SiD software is an algorithm that from a group of spermatozoa characteristics can support the selection of a single sperm during real time ICSI. Study design, size, duration In this prospective study 1699 individual spermatozoa were video-recorded (resolution of 200 X 200 pix.) during sperm selection in a 7%PVP solution. Motility variables (VSL, VCL, LIN, VAP, ALH, WOB, STR, MAD) were obtained from each video using the software SiD. Each sperm was classified as normal or abnormal. Based on motility variables, different classification models were used to make a morphokinetic association of the variables with the classification of each sperm. Participants/materials, setting, methods 1699 individual spermatozoa were classified and labeled by three senior embryologists into two categories: normal or anormal. To belong to any category, at least two embryologists had to agree. A normalization was applied to the motility data obtained with SiD. Machine learning classification models were applied. The three classification models with the best results were selected to optimize the hyper-parameters and improve their performance. Main results and the role of chance A set of motility variables were obtained using the software SiD1 (IVF2.0 Ltd., UK) these were used as features for each of the sperm samples and were tagged either as normal or abnormal having a total of 257 normal samples and 1442 abnormal samples. Different classification algorithms were used to perform sperm classification as normal and abnormal. Then hyperparameter tuning algorithms such as GridSearch were used to compute the optimum values, finding KNN algorithm to achieve the best results to classify normal and abnormal spermatozoa with 80% accuracy. Given the nature of the unbalanced dataset, the F1 score was calculated, achieving 0.77, other algorithms such as Decision-Tree and Random-Forest were used achieving similar results in the F1 score. We will continue growing the dataset until it is balanced and run the same algorithms expecting the performance to improve. Limitations, reasons for caution Each clinic's laboratory setup, including the camera used to record the ICSI procedure, is a clinic-specific configuration. Sperm abnormality detection is sensitive to camera resolution, showing the classifiers are resolution-dependent observers. To replicate these results, it is important to consider the quality of the camera. Wider implications of the findings Using the selected kinematics features, it is possible to classify individual spermatozoa during motility as having normal or abnormal morphology. Results may improve using standard morphological examination of each population and having more normal sperm samples. Trial registration number Not applicable

P-148 The importance of filopodia during early human embryonic development

Abstract Study question The aim of this study was to examine the relation between the presence of filopodia and the embryo viability in human in vitro fertilised embryos. Summary answer The presence of filopodia related to a faster blastocyst development, a better blastocyst quality and higher morphokinetic scores which indicates a higher embryo viability. What is known already Filopodia are involved in numerous cellular processes, for example cell migration, neuronal extension growth and during embryonic development. There is no uniform name to describe these cytoplasmic string structures in the literature. Beside the frequent presence in different cell functions, we have limited information about its function in human embryos. In the early 2000s, the occurrence of filopodia or cytoplasmic strings at the blastocyst stage was classified as a negative sign of embryo viability, but more recently, it has been described as a positive feature, however, the importance and clinical significance of this structure is still controversial. Study design, size, duration Evaluation of the morphokinetic data on the development of 208 embryos from 78 IVF cycles. Examination was carried out at the Division of Assisted Reproduction, Department of Obstetrics and Gynaecology, Semmelweis University, Budapest between December 2020 and March 2021. Participants/materials, setting, methods Embryos from both conventional IVF (cIVF) and intracytoplasmic sperm injection (ICSI) treatments were analysed and evaluated. The dynamics of embryo development, embryo morphology and morphokinetic scores generated by time-lapse system was compared between the embryos with filopodia (FP+) and embryos without filopodia- (FP-) groups. Main results and the role of chance 81.2% of the embryos had filopodia in blastocyst stage. Embryos created by cIVF had 77%, while embryos fertilised by ICSI had 86% of filopodia presence (p = 0.08). FP+ embryos developed in a greater number into a higher quality blastocyst (52.1% vs 20.5%, p = 0,02), their KIDScore was higher (6.1 ± 2.1 vs 4,7 ± 2,07, p &amp;lt; 0.001) and they showed a tendency of higher implantation rate (39.7% vs 14.3% p = 0.16) than the FP- group. The dynamic of the early embryo development was similar between the two groups, however, FP+ embryos reached blastocyst stage significantly earlier (tB: 103.9 hours vs. tB: 107.6 hours; p = 0.007). Based on our results, there was a higher number of embryos with filopodia than without, and the presence of it is not related to the fertilisation method. These embryos developed faster into a blastocyst stage, their morphokinetic parameters were better. KIDScore and iDAScore embryo evaluation systems also recommend in a greater number the FP+ blastocysts for ET. We could also observe vesicle like transport along the filopodia, which leads us to believe that there might be a molecular communication between the differentiating cell populations. Limitations, reasons for caution Due to the low number of cases, the higher implantation rate is not significant. Wider implications of the findings The examination of this feature improves our knowledge of the early embryonic development and may help us to make decisions about the embryos with higher implantation potential. Trial registration number Not applicable

O-158 Prediction of implantation of vitrified-warmed blastocysts using a deep learning algorithm on a single post-warming image of each embryo

Abstract Study question Can a deep learning algorithm determine the implantation likelihood of vitrified blastocysts from single time-point post-warming time-lapse images obtained from EmbryoScope? Summary answer A significant positive correlation was found between the score given by the deep learning algorithm and the implantation rate of the frozen blastocysts analyzed. What is known already Despite the safety and success of the vitrification technique, many of the best morphologically classified embryos prior to vitrification do not maintain their characteristics when returned to room temperature. Since artificial intelligence (AI) has been shown to be useful in assessing the quality of fresh embryos at different stages, it could also be used to predict the outcome of frozen embryo transfers. This is the first attempt to distinguish vitrified blastocysts that will implant from those that will not by applying deep learning on a single image taken in the period between warming and transfer. Study design, size, duration This retrospective single-centre study included 689 blastocysts with known implantation data. All of them were vitrified and warmed using the Cryotop method (Kitazato, Biopharma, Japan). Warmed embryos were assessed by experienced embryologists according to the ASEBIR morphological scoring system and the degree of expansion. Immediately after warming, blastocysts were placed in EmbryoScope (Vitrolife, Denmark) time-lapse incubators for 2-5 hours to let them re-expand until embryo transfer. Participants/materials, setting, methods A pre-transfer embryo image was provided to the algorithm (Life Whisperer Viability), which returned scores from 0 to 10. Data were analyzed by chi-square test or one-way ANOVA. Multivariate logistic regression analysis was performed including embryo score, oocyte origin (donated vs. autologous), oocyte age, patient age, oocyte handling (fresh vs. vitrified eggs), and day of vitrification (5 vs. 6). The area under the receiver operating characteristic (ROC) curve (AUC) was used to calculate evaluation performance. Main results and the role of chance There was a significant difference between the scores given to vitrified implanted and non-implanted embryos. The mean value was 4.98 [95% CI 4.70-5.26]* for non-implanted embryos and 6.16 [95% CI 5.84-6.48]* for implanted embryos. When dividing the embryo score by quartiles, the implantation rate for each quartile was 27.7% for Q1, 33.7% for Q2 (Odds ratio (OR)=1.31 [0.82–2.09]), 44.8% for Q3 (OR = 2.05 [1.30–3.22]*) and 48.3% for Q4 (OR = 2.46 [1.56–3.87]*). The contribution of each increased unit of the algorithm score to the implantation (OR = 1.16 [95% CI: 1.09–1.23]*) was statistically significant. The deep learning algorithm score successfully predicted implantation with an AUC of 0.65 [95% CI: 0.60–0.69]*. Moreover, the algorithm performed better than the ASEBIR morphological classification, which achieved an AUC of 0,62 [95% CI: 0.58–0.66] in predicting implantation. *P &amp;lt; 0.001. Limitations, reasons for caution Our clinic was not involved in the development of the algorithm. Furthermore, it was designed to assess fresh embryos prior to vitrification but not thawed ones, so this study should be considered an external trial. A post-warming full video analysis by AI could possibly provide additional information. Wider implications of the findings The use of predictive models on vitrified cycles may help to select the best frozen embryo for transfer and predict which embryos will result in implantation failure early enough to thaw another one with a better chance of success. It also indicates that AI can generalize to thawed embryo assessment. Trial registration number -

P-208 Culture media affect gender after IVF treatment: A detailed analysis of explanatory variables

Abstract Study question Does embryo culture media affect gender at birth and why? Summary answer More male children were born after culture in the Sage 1-Step media compared to the G-TL media. What is known already ART increases the proportion of male children at birth. Laboratory techniques and culture conditions is known to impact secondary sex ratio (SSR). Physiological development differs in male and female embryos, leading to different metabolic requirements at the preimplantation stage. The composition of commercial culture medias varies and thus, the different medias may have different impact on embryo development and quality according to gender. This, in turn, may influence SSR, as embryos are selected based on morphological scoring systems and developmental speed. Study design, size, duration The study was designed as a retrospective registry-based study with all data collected at a single clinic. All embryos resulting in live birth from frozen and fresh single blastocyst transfers, in the period from 1. January 2017 to 31. December 2020 were included. Donor embryos and embryos cultured in more than one culture media were excluded. A total of 1371 SET embryos were included. Participants/materials, setting, methods Embryos were cultured in either the G-TL media, Vitrolife (n = 686) or the Sage 1-Step media, Origio (n = 685). All embryos were monitored for 5-6 days in a time-lapse incubator, Vitrolife, before single blastocyst transfer. Multivariate logistic analysis of cycle and embryo characteristics was performed to identify all factors associated to sex. The association between culture media and embryo morphokinetic according to sex was evaluated using a mixed model analysis. Main results and the role of chance Significantly more male singletons were born after culture in 1-Step media compared to G-TL media (risk ratio (RR) 1,1 95% CI [1,0, 1,3], P = 0,01). The female/male ratio was 42,3/57,7% in 1-Step media and 48,5/51,5% in G-TL media. The multivariate regression analysis displayed a higher chance of a male child with higher expansion grade (grade 5) (RR, 1,2 95% CI [1,0, 1,4] P = 0,04), lower inner cell mass grade (grade B) (RR 1,13 95% CI [1,0, 1,3] P = 0,02) and second embryo transfer (RR 1,2 95% CI [1,0, 1,3] P = 0,03). Trophectoderm (TE) grade B reduced the probability of male child compared with TE grade A (RR 0,8 95% CI [0,8, 0,9] P &amp;gt; 0,05). Male embryos developed significantly faster in the 1-Step media compared to the G-TL media for the stages of; blastocyst (tB) (-1,1 hours 95% CI [-2,1, -0,1]), expanded blastocyst (tEB) (-1,3 hours 95% CI [-2,3, -0,3]) and hatched blastocyst (tH) (-1,7 hours 95% CI [-3,0, -0,5]). Timing of development were the same for female embryos in the G-TL media compared to the 1-Step media. There was no significant difference in timing of development between female and male embryos in identical culture media. Limitations, reasons for caution This study was a retrospective study with data collection from only a single clinic, and as such in risk of confounding. Apart from culture media, culture conditions were similar during the two time periods. Paternal factors and type of infertility was not included. Wider implications of the findings Our observations suggest that culture media impact male embryo quality selectively, thus favoring selection of male embryos. As the impact appears to vary between different culture media, and has a measurable impact on gender after birth, the influence of culture media on embryo quality deserves more attention. Trial registration number not applicable

P-264 Correlations between the artificial intelligence scoring system (iDAScore v1.0) and live birth outcomes in preimplantation genetic testing for aneuploidy cycles

Abstract Study question Is the iDAScore v1.0 score correlated with pregnancy outcomes in single embryo transfer (SET) cycles following preimplantation genetic testing for aneuploidy (PGT-A)? Summary answer We demonstrated that elevated iDAScore v1.0 scores are positively correlated with the probabilities of pregnancy and live birth (LB) in SETs following PGT-A. What is known already To select the blastocysts with high development potential in advance, several groups have proposed the implementation of artificial intelligence (AI)-based software is capable of predicting implantation in women undergoing in vitro fertilization (IVF). It has also been known that using high resolution next generation sequencing preimplantation genetic screening (hr-NGS) for PGT-A can enable the exclusion of aneuploid embryos before embryo transfers and thus improve pregnancy outcomes of SETs. However, the capacity of AI-based assessments has remained unclear in IVF cycles with PGT-A. Study design, size, duration This retrospective study, approved by the Institutional Review Board of Chung Sun Medical University, was performed to assess the dataset of 317 SET cycles after PGT-A from January 2017 to September 2019. A single euploid or mosaic blastocyst with an AI score calculated using the iDAScore software (v1.0) was selected for frozen embryo transfer according to the given priority of blastocyst morphology. The iDAScore groups were categorized by quartiles of AI scores. Participants/materials, setting, methods Embryos were cultured in a time-lapse incubator and qualified blastocysts underwent next generation sequencing (NGS)-based PGT-A. The confounding factors associated with LB were evaluated using logistic regression analysis in generalized estimating equations (GEEs). The differences between iDAScore groups were assessed using the Mann–Whitney U test or Fisher’s exact test, as applicable. The receiver operating characteristic (ROC) curve analysis was used to estimate the predictive powers. A P value &amp;lt; 0.05 was considered statistically significant. Main results and the role of chance The results revealed the patient age, anti-Müllerian hormone, body mass index, oocyte sources (autologous or donor), PGT-A results (euploidy, low-level mosaicism, or high-level mosaicism), aberrant chromosome types (none, whole chromosome, segmental chromosome, or whole with segmental chromosome), and aberrant chromosome sites (0, 1, 2, or &amp;gt; 2) were not correlated with LB. However, embryo biopsy days (day 5 vs. day 6, OR = 2.271, 95% CI = 1.534–14.824), blastocyst morphology scores (OR = 1.185, 95% CI = 1.034–1.359), and AI scores (OR = 1.640, 95% CI = 1.231–2.183) were significantly correlated with LB. The AI scores were then divided into quartiles (group 1: 5.0–7.9; group 2: 8.0–8.5; group 3: 8.6–8.9; and group 4: 9.0–9.5). The ongoing pregnancy (29.1% vs. 54.2%–57.5%) and live birth (27.8% vs. 52.8%–56.3%) rates of group 1 were significantly lower than other groups. The blastocyst morphology score (5.3 ± 1.2), and KIDScore D5 scores (v1 = 3.0 ± 1.7; v3 = 4.6 ± 1.5) were also lowest in group 1. The ROC curve analysis confirmed a significant but limited LB prediction capability for iDAScore v1.0 (AUC = 0.6), which was similar to the KIDScore D5 (AUC = 0.61–0.62). Limitations, reasons for caution Because of the retrospective nature, the major limitation was the lack of randomization, which may present a risk of selection bias. According to the criteria of blastocyst selection for SETs, the embryos with low (&amp;lt; 5.0) or high (&amp;gt; 9.5) AI scores were not present in this dataset. Wider implications of the findings Although prediction capability of iDAScore remains perfectible, the AI score is still significantly associated with LB probability. Euploid or mosaic blastocysts with low AI scores (&amp;lt;8.0) processed a decreased LB rate, indicating the potential of annotation-free iDAScore system as a decision support tool for deselecting embryos with poor post-implantation development. Trial registration number not applicable

O-121 Temporal development of scores from a time-lapse based artificial intelligence provides no additional benefit compared to the latest score

Abstract Study question Does the temporal development of scores from an artificial intelligence (AI) based embryo selection model provide additional predictive power compared to the latest score? Summary answer Earlier predictions provide no additional predictive power given the latest prediction. Knowing the development of AI scores is thus not beneficial for embryo selection. What is known already Traditionally, embryo grading takes into consideration the final morphology score together with the history of embryo development events. Recent publications have shown that time-lapse based AI models trained on clinical outcomes can automatically rank embryos by the likelihood of implantation that equal or surpass traditional methods, without the necessity for manual evaluation. AI-based methods based on time-lapse data may account for the impact of the full temporal development on likelihood of implantation. In this study, we examine if the addition of previous scores adds to the performance of an embryo selection model. Study design, size, duration A retrospective multicenter study of transferred embryos (n = 2422) with known implantation data (KID) between 2012-2020 from 21 international clinics. Embryos were cultured in EmbryoScope time-lapse incubators for at least 5 days. Both single and multi-embryo transfers in fresh and warmed cycles were included. Embryos were classified as positive (KIDp) or negative (KIDn) by the presence of fetal heartbeat. Implantation likelihood was evaluated at cleavage- and blastocyst stages by a 3D CNN model; iDAScore v2.0. Participants/materials, setting, methods A kernel-based conditional independence test was used to evaluate if a score at x hours post insemination (hpi) provide extra information compared to a score at y hpi. The test estimates the likelihood that a prediction after x hpi does not provide any additional information with regards to predicting KIDp when a prediction after y hpi is available. These likelihoods (p-values) were Bonferroni corrected to adjust for multiple comparisons. Main results and the role of chance KIDp predictions were computed for all embryos at 40, 44, 64, 68, 112, and 116 hpi corresponding to early and median time of transfer for day 2, 3, and 5. For all time points, the conditional independence test showed that there was no added information from knowing predictions at an earlier time point (p &amp;gt; 0.21). Similarly, it was tested if a known later prediction will improve model performance for an earlier prediction. This was always the case (p &amp;lt; 0.01) except for predictions close in time (68 vs 64 hpi; p = 1.0) and (44 vs 40 hpi; p = 1.0). This may reflect that there was little additional embryo development information during a 4-hour period at this development stage. The above shows that knowledge of the temporal score development does not improve model performance compared to using latest available score. This means that an AI model based on time-lapse videos likely considers earlier embryo development events in the context of the entire development history. Limitations, reasons for caution This study is a retrospective study that only looks at AI based on time-lapse videos. There is a potential bias as the embryos were likely of higher quality having been chosen for transfer. It is possible that the results do not generalize to simpler non-3D CNNs. Wider implications of the findings Knowing the temporal score development can introduce subjectivity that might lower implantation rates as the earlier scores were shown to not provide any significant prediction improvement. Trial registration number not applicable

P-262 Comparative ability of iDAScore and embryo morphology grade to predict clinical pregnancy: Retrospective cohort study of 1510 fresh and frozen elective single embryo transfers

Abstract Study question Can iDAScore predict ongoing clinical pregnancy (CP) with a sensitivity and specificity equivalent to that associated with manual morphology assessment and grading? Summary answer The fully automated iDAScore was able to predict CP with equivalent performance to manual morphology assessment and grading in this retrospective cohort study. What is known already iDAScore is an artificial intelligence (AI) based algorithm developed by applying machine learning to morphokinetic time laps (TL) image data of embryos with a known treatment outcome. Embryos are automatically assessed on day 5 of culture and ranked according iDAScore, ranging from 1 to 9.9. Embryos may be prioritised for transfer based on highest sore. Along with other published AI algorithms, iDAScore has been proposed to optimise the chance of CP following ET by improving objectivity of embryo assessment compared with manual scoring systems. The fully autonomous assessment of embryos by AI algorithms has beneficial implications for laboratory workload. Study design, size, duration Retrospective audit of 787 fresh and 723 frozen single embryo transfer cycles which took place from April 2019 to September 2022. All recipient, surrogacy, warmed oocyte, embryo biopsy, cleavage stage and slow thaw frozen ET cycles were excluded. Participants/materials, setting, methods Selection for transfer was based on blastocyst morphology grade. iDAScores were obtained retrospectively. The area under the receiver operator characteristic (AUROC) curve and sensitivity and specificity for CP prediction of both iDAScore and blastocyst morphology grade was compared overall and in two stratified analyses. The first assessed fresh and frozen cycles separately, the second compared their performance in female age groups of ≤ 35 and &amp;gt;35 years. CP was defined by ultrasound detection of foetal heartbeat. Main results and the role of chance The mean grading of blastocysts by iDA was 8.34 ± 1.4, with a strong correlation to classic morphological scoring (r = 0.69, P &amp;lt; 0.001). The clinical pregnancy rate for fresh and frozen embryo transfer was 31.0% (95%CI 27.9-34.3) and 44.0% (95%CI 40.8-48.0) respectively. iDA score was positively associated with clinical pregnancy rates in both fresh (adjOR 1.69, 95%CI 1.44-1.99) and frozen embryo transfers (adjOR 1.45, 95%CI 1.26-1.67), independent of maternal age. There was no difference in the AUROC for iDA (AUC 0.64, 95%CI 0.62-0.67) versus conventional morphology (AUROC 0.63, 95CI 0.61-0.66) when all eSETs were considered, or when fresh eSETS (AUROC for fresh iDA 0.66 95%CI 0.62-0.70 vs morphology 0.65 95%CI 0.62-0.69) or frozen iDA 0.63 95%CI 0.59-0.67 vs morphology 0.61 95%CI 0.57-0.64) eSETS were considered separately. The iDA score exhibited slightly better performance in the age stratified analyses, with a higher AUROC in women &amp;gt;35 years; iDA 0.68 95%CI 0.64-0.71 vs morphology 0.64 95%CI 0.60-0.67, p = 0.021) but no difference was observed in younger women. This age difference in iDA performance was primarily driven by frozen embryo transfers (p = 0.002). For women &amp;gt;35years an iDA score of 8.75 was associated with an AUROC of 0.63 and 67% sensitivity and 60% specificity for prediction of clinical pregnancy. Limitations, reasons for caution This was a retrospective single centre study and the performance of iDA needs to be confirmed prospectively in a multi-centre trial. That selection of embryos for transfer was based on morphology, may have contributed to overestimation of model performance. Wider implications of the findings The application of AI based embryo ranking algorithms to embryo selection for transfer, has the potential to maintain clinical pregnancy rates while reducing the time burden associated with conventional morphology / morphokinetic assessments. Trial registration number Nil