title: Intra- and interobserver analysis in the morphological assessment of early stage embryos during an IVF procedure: a multicentre study.
abstract: BACKGROUND
  Quality control programs are necessary to maintain good clinical practice. Embryo grading has been described as one of the external quality assurance schemes. Although the evaluation of embryos is based on the assessment of morphological characteristics, considerable intra- and inter-observer variability has been described. In this multicentre study, the variability in the embryo evaluation has been evaluated using morphological characteristics on day 1, day 2 and day 3 of embryo development.
  
  
  METHODS
  Five embryologists of four different IVF centers participated in this study. Multilevel images of embryos were presented on a website at different time points to evaluate intra-and inter-observer agreement in the assessment of embryo morphology. The embryos were evaluated on day 1, day 2 and day 3 of their development and each embryologist had to decide if the embryo had to be transferred, cryopreserved or discarded.
  
  
  RESULTS
  Both intra-observer agreement and inter-observer agreement were good to excellent for the position of the pronuclei on day 1, the number of blastomeres on day 2 and day 3 and the clinical decision (transfer, cryopreservation, discard). For all other characteristics (size of pronuclei, presence of cytoplasomic halo, degree of fragmentation and size of blastomeres) the intra- and inter-observer agreement was moderate to very poor.
  
  
  CONCLUSIONS
  Mono- or multicentre quality control on embryo scoring by morphological assessment can easily be performed through the design of a simple website. In the future the website design can be adapted to generate statistical feedback upon scoring and can even include a training module.
authors.affiliation: Leuven University Fertility Centre, UZ Gasthuisberg, Leuven, Belgium. Goedele.paternot@uzleuven.be
authors.forename: Goedele
authors.initials: G
authors.lastname: Paternot
authors.forename: Alex M
authors.initials: AM
authors.lastname: Wetzels
authors.forename: Fabienne
authors.initials: F
authors.lastname: Thonon
authors.forename: Anne
authors.initials: A
authors.lastname: Vansteenbrugge
authors.forename: Dorien
authors.initials: D
authors.lastname: Willemen
authors.forename: Johanna
authors.initials: J
authors.lastname: Devroe
authors.forename: Sophie
authors.initials: S
authors.lastname: Debrock
authors.forename: Thomas M
authors.initials: TM
authors.lastname: D'Hooghe
authors.forename: Carl
authors.initials: C
authors.lastname: Spiessens
mesh_terms: D001755:Blastocyst / Q000648:ultrastructure*; D001757:Blastomeres / Q000166:cytology; D002467:Cell Nucleus / Q000648:ultrastructure; D048429:Cell Size; D003593:Cytoplasm / Q000648:ultrastructure; D003658:Decision Making, Computer-Assisted; D004622:Embryo, Mammalian / Q000648:ultrastructure; D004626:Embryology; D047108:Embryonic Development; D005307:Fertilization in Vitro; D006801:Humans; D020407:Internet; D015588:Observer Variation; D011786:Quality Control; D015203:Reproducibility of Results; D000078329:Workforce; D015053:Zygote / Q000648:ultrastructure