GeneraLife IVF, Clinica Valle Giulia, Rome, Italy.
Embryos Fertility Center, Battipaglia Salerno, Italy.
Reprod Biomed Online. 2022 Jan;44(1):39-48. doi: 10.1016/j.rbmo.2021.09.022. Epub 2021 Oct 6.
What is the intra- and inter-centre reliability in embryo grading performed according to the Istanbul Consensus across several IVF clinics?
Forty Day 3 embryos and 40 blastocysts were photographed on three focal planes. Senior and junior embryologists from 65 clinics were invited to grade them according to the Istanbul Consensus (Study Phase I). All participants then attended interactive training where a panel of experts graded the same embryos (Study Phase II). Finally, a second set of pictures was sent to both embryologists and experts for a blinded evaluation (Study Phase III). Intra-centre reliability was reported for Study Phase I as Cohen's kappa between senior and junior embryologists; inter-centre reliability was instead calculated between senior/junior embryologists and experts in Study Phase I versus III to outline improvements after training (i.e. upgrade of Cohen's kappa category according to Landis and Koch).
Thirty-six embryologists from 18 centres participated (28% participation rate). The intra-centre reliability was (i) substantial (0.63) for blastomere symmetry (range -0.02 to 1.0), (ii) substantial (0.72) for fragmentation (range 0.29-1.0), (iii) substantial (0.66) for blastocyst expansion (range 0.19-1.0), (iv) moderate (0.59) for inner cell mass quality (range 0.07-0.92), (v) moderate (0.56) for trophectoderm quality (range 0.01-0.97). The inter-centre reliability showed an overall improvement from Study Phase I to III, from fair (0.21-0.4) to moderate (0.41-0.6) for all parameters under analysis, except for blastomere fragmentation among senior embryologists, which was already moderate before training.
Intra-centre reliability was generally moderate/substantial, while inter-centre reliability was just fair. The interactive training improved it to moderate, hence this workflow was deemed helpful. The establishment of external quality assessment services (e.g. UK NEQAS) and the avant-garde of artificial intelligence might further improve the reliability of this key practice for embryo selection.
根据伊斯坦布尔共识，在多个试管婴儿诊所中进行胚胎分级的中心内和中心间可靠性如何？
对 3 天的 40 个胚胎和 40 个囊胚在三个焦点平面上进行拍照。邀请来自 65 个诊所的高级和初级胚胎学家根据伊斯坦布尔共识进行分级（研究阶段 I）。所有参与者随后参加了互动培训，专家小组对相同的胚胎进行了分级（研究阶段 II）。最后，向两位胚胎学家和专家发送了第二组照片，供他们进行盲评（研究阶段 III）。在研究阶段 I 中，报告了中心内可靠性，即高级和初级胚胎学家之间的 Cohen's kappa；在研究阶段 I 与 III 中，高级/初级胚胎学家与专家之间的中心间可靠性是根据培训后的情况计算的（即根据 Landis 和 Koch 升级 Cohen's kappa 类别）。
来自 18 个中心的 36 名胚胎学家参与了研究（参与率为 28%）。中心内可靠性为：（i）卵裂球对称性（范围-0.02 至 1.0）高（0.63）；（ii）碎片（范围 0.29-1.0）高（0.72）；（iii）囊胚扩张（范围 0.19-1.0）高（0.66）；（iv）内细胞团质量（范围 0.07-0.92）中（0.59）；（v）滋养层质量（范围 0.01-0.97）中（0.56）。中心间可靠性显示，除高级胚胎学家的卵裂球碎片外，所有分析参数的总体从研究阶段 I 到 III 均有提高，从公平（0.21-0.4）到中等（0.41-0.6），高级胚胎学家的卵裂球碎片在培训前已经是中等的。
中心内可靠性通常为中等/高，而中心间可靠性仅为公平。互动培训将其提高到中等水平，因此该工作流程被认为是有帮助的。建立外部质量评估服务（如英国 NEQAS）和人工智能的前沿技术可能会进一步提高胚胎选择这一关键实践的可靠性。
