title: Interobserver and intraobserver variation in day 3 embryo grading.
abstract: OBJECTIVE
  Variations in pregnancy rates (PR) between IVF programs are due to multiple factors, including embryo quality. Standardized embryo grading systems have been developed to improve communication between embryologists and clinicians. However, these grading systems have not been validated. We sought to quantify both interobserver and intraobserver variability using a standardized day 3 embryo grading system (Veeck scale).
  
  
  METHODS
  Prospective, sample-randomized, controlled, blinded study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Twenty-six practicing embryologists.
  
  
  METHODS
  Observation and grading of 35 video clips of day 3 embryos.
  
  
  METHODS
  Interobserver and intraobserver variability. Embryologists were also assessed by education level, years of experience, size of IVF program, and type of grading system used. Kappa scores and intraclass correlation coefficients were calculated.
  
  
  RESULTS
  Practicing embryologists differed from control (Lucinda Veeck) by as much as two grades, despite using the same grading system (Kappa = 0.24, interclass correlation coefficient = 0.98). There was also variability in grading the same embryo (Kappa = 0.69, interclass correlation coefficient = 0.88). Programs with higher cycle numbers per year had lower variability.
  
  
  CONCLUSIONS
  There is substantial interobserver variability and moderate intraobserver variability among embryologists. Such variability could alter both the expected quality of embryos transferred, as well as the number transferred, both of which directly impact IVF program success.
authors.affiliation: The Muasher Center for Fertility and IVF, Fairfax, Virginia, USA.
authors.forename: Allison E
authors.initials: AE
authors.lastname: Baxter Bendus
authors.forename: Jacob F
authors.initials: JF
authors.lastname: Mayer
authors.forename: Sharon K
authors.initials: SK
authors.lastname: Shipley
authors.forename: William H
authors.initials: WH
authors.lastname: Catherino
mesh_terms: D004624:Embryo Transfer / Q000592:standards; D004622:Embryo, Mammalian / Q000033:anatomy & histology*; D004626:Embryology / Q000379:methods* / Q000592:standards; D005307:Fertilization in Vitro; D006801:Humans; D015588:Observer Variation; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000592:standards; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014481:United States