Intra- and inter-observer analysis in the morphological assessment of early-stage embryos.
BACKGROUND
The aim of this study was to determine the intra- and inter-observer variability in the evaluation of embryo quality. Multilevel images of embryos on day 1, day 2 and day 3, were analysed using different morphological parameters.


METHODS
Multilevel images of embryos on day 1, day 2 and day 3, were analysed using a standard scoring system. The kappa coefficient was calculated to measure intra- and inter-observer variability before and after training sessions.


RESULTS
Good to excellent intra-observer agreement was present for most parameters exceptions being scoring the position of pronuclei and the presence of a cytoplasmic halo on day 1, multinucleation on day 2 and the size of fragments on day 3. Inter-observer agreement was only good to excellent for the number of blastomeres on day 2 and day 3 and the orientation of the cleavage axes on day 2. Training sessions had a positive impact on inter-observer agreement.


CONCLUSIONS
In conclusion, assessment of morphological characteristics of early stage embryos using multilevel images was marked by a high intra-observer and a moderate inter-observer agreement. Training sessions were useful to increase inter-observer agreement.
Leuven University Fertility Centre, UZ Leuven, Campus Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium. goedele.paternot@uzleuven.be
Goedele
G
Paternot
Johanna
J
Devroe
Sophie
S
Debrock
Thomas M
TM
D'Hooghe
Carl
C
Spiessens
D000328:Adult; D001755:Blastocyst / Q000166:cytology*; D002970:Cleavage Stage, Ovum / Q000166:cytology*; D004626:Embryology / Q000193:education; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000706:statistics & numerical data*; D015588:Observer Variation; D011361:Professional Competence; D011786:Quality Control; D012107:Research Design; D016037:Single-Blind Method