title: Interobserver agreement and intraobserver reproducibility of embryo quality assessments.
abstract: BACKGROUND
  The objective of this investigation was to determine the inter- and intraobserver agreement when assessing embryo quality.
  
  
  METHODS
  This investigation included 4002 cleaved embryos from 7535 oocytes retrieved in 688 patients undergoing IVF cycles in a multicentre trial. Embryos were evaluated locally at the inverted microscope at 28, 44 and 68 h (+/-1 h) post-insemination. Digital images of the embryos were assessed centrally by three blinded embryologists. To assess reproducibility, 215 randomly selected cleaved embryos from 33 patients were re-evaluated by the three central embryologists.
  
  
  RESULTS
  The interobserver agreement among the central embryologists (using the same method of evaluation; 2D images) was good for classification of top-quality embryos (kappa 0.71-0.73), excellent for classification of normally developed embryos (kappa 0.83-0.86) and good-excellent for classification of transferable embryos (kappa 0.78-0.82). The interobserver agreement between local and consolidated central assessment (different methods of evaluation, inverted microscopy versus 2D images) was good for all three embryo classifications (kappa 0.64-0.79). The intraobserver reproducibility for all three overall embryo classifications was excellent for the consolidated central assessment (kappa 0.80-0.91).
  
  
  CONCLUSIONS
  Embryo quality can be determined with a good degree of interobserver agreement independently of the method of evaluation. Embryologists classify embryos with excellent intraobserver reproducibility.
authors.affiliation: Ferring Pharmaceuticals A/S, Clinical Research and Development, Copenhagen, Denmark. joan-carles.arce@ferring.com
authors.forename: Joan-Carles
authors.initials: JC
authors.lastname: Arce
authors.forename: Søren
authors.initials: S
authors.lastname: Ziebe
authors.forename: Kersti
authors.initials: K
authors.lastname: Lundin
authors.forename: Ronny
authors.initials: R
authors.lastname: Janssens
authors.forename: Lisbeth
authors.initials: L
authors.lastname: Helmgaard
authors.forename: Per
authors.initials: P
authors.lastname: Sørensen
mesh_terms: D010064:Embryo Implantation; D004624:Embryo Transfer; D004626:Embryology / Q000592:standards; D047108:Embryonic Development; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D015588:Observer Variation; D011247:Pregnancy; D015203:Reproducibility of Results