Human Reproduction Unit, Virgen de las Nieves University Hospital, E-18014 Granada, Spain.
Reprod Biomed Online. 2009 Dec;19(6):824-9. doi: 10.1016/j.rbmo.2009.09.026.
This study set out to establish adequate assigned values for a National External Quality Control Programme of embryo evaluation. The results obtained by Spanish laboratories in this programme are compared with those of a group of national experts in embryo quality. Image-based embryo evaluation consists not only of classifying embryos as being of optimal, moderate or poor quality, but also of specifying the clinical decision to be taken regarding each embryo (transfer, cryopreservation or rejection). The proportion of embryos for which there was a high degree of agreement among the experts was 98.3% for embryo classification and 93.3% for clinical decision; for the laboratories, the respective values were 44.2 and 42.5%. With respect to the interobserver agreement among laboratories and experts, kappa coefficients were lower than 0.6 both for classification and for clinical decision. The experts recommended cryopreservation of a higher percentage of embryos classified as poor quality than did the laboratories (28 versus 4%, P = 0.05). The data obtained show that the agreement among laboratories is lower than among experts, and that the concordance among experts and laboratories is moderate. Therefore, it is recommended that an assigned value from external quality control programmes is established based on the consensus values obtained from experts.
本研究旨在为胚胎评估的国家外部质量控制计划设定适当的赋值。将西班牙实验室在该计划中获得的结果与一组胚胎质量的国家专家进行比较。基于图像的胚胎评估不仅包括将胚胎分类为优质、中等或劣质，还包括为每个胚胎指定要采取的临床决策（转移、冷冻保存或拒绝）。专家对胚胎分类的一致性比例为 98.3%，对临床决策的一致性比例为 93.3%；对于实验室，相应的值分别为 44.2%和 42.5%。就实验室和专家之间的观察者间一致性而言，分类和临床决策的kappa 系数均低于 0.6。专家建议冷冻保存的胚胎数量高于实验室分类为劣质的胚胎数量（28%比 4%，P = 0.05）。所获得的数据表明，实验室之间的一致性低于专家之间的一致性，并且专家和实验室之间的一致性是中等的。因此，建议根据专家获得的共识值为外部质量控制计划设定赋值。
