title: Examining the efficacy of six published time-lapse imaging embryo selection algorithms to predict implantation to demonstrate the need for the development of specific, in-house morphokinetic selection algorithms.
abstract: OBJECTIVE
  To study the efficacy of six embryo-selection algorithms (ESAs) when applied to a large, exclusive set of known implantation embryos.
  
  
  METHODS
  Retrospective, observational analysis.
  
  
  METHODS
  Fertility treatment center.
  
  
  METHODS
  Women undergoing a total of 884 in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment cycles (977 embryos) between September 2014 and September 2015 with embryos cultured using G-TL (Vitrolife) at 5% O2, 89% N2, 6% CO2, at 37°C in EmbryoScope instruments.
  
  
  METHODS
  None.
  
  
  METHODS
  Efficacy of each ESA to predict implantation defined using specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV), area under the receiver operating characteristic curve (AUC), and likelihood ratio (LR), with differences in implantation rates (IR) in the categories outlined by each ESA statistically analyzed (Fisher's exact and Kruskal-Wallis tests).
  
  
  RESULTS
  When applied to an exclusive cohort of known implantation embryos, the PPVs of each ESA were 42.57%, 41.52%, 44.28%, 38.91%, 38.29%, and 40.45%. The NPVs were 62.12%, 68.26%, 71.35%, 76.19%, 61.10%, and 64.14%. The sensitivity was 16.70%, 75.33%, 72.94%, 98.67%, 51.19%, and 62.33% and the specificity was 85.83%, 33.33%, 42.33%, 2.67%, 48.17%, and 42.33%, The AUC were 0.584, 0.558, 0.573, 0.612, 0.543, and 0.629. Two of the ESAs resulted in statistically significant differences in the embryo classifications in terms of IR.
  
  
  CONCLUSIONS
  These results highlight the need for the development of in-house ESAs that are specific to the patient, treatment, and environment. These data suggest that currently available ESAs may not be clinically applicable and lose their diagnostic value when externally applied.
authors.affiliation: Hewitt Fertility Centre, Liverpool Women's NHS Foundation Trust, Liverpool, United Kingdom. Electronic address: amy.barrie@lwh.nhs.uk.
authors.forename: Amy
authors.initials: A
authors.lastname: Barrie
authors.affiliation: Hewitt Fertility Centre, Liverpool Women's NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Roy
authors.initials: R
authors.lastname: Homburg
authors.affiliation: Manchester Metropolitan University, Manchester, United Kingdom.
authors.forename: Garry
authors.initials: G
authors.lastname: McDowell
authors.affiliation: Edge Hill University, Ormskirk, United Kingdom.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Brown
authors.affiliation: Hewitt Fertility Centre, Liverpool Women's NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Charles
authors.initials: C
authors.lastname: Kingsland
authors.affiliation: Hewitt Fertility Centre, Liverpool Women's NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Stephen
authors.initials: S
authors.lastname: Troup
mesh_terms: D000465:Algorithms; D001755:Blastocyst / Q000502:physiology*; D046149:Embryo Culture Techniques; D010064:Embryo Implantation; D004624:Embryo Transfer; D047108:Embryonic Development; D004739:England; D005260:Female; D005298:Fertility; D005307:Fertilization in Vitro; D006801:Humans; D007246:Infertility / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D007700:Kinetics; D018715:Microscopy, Video; D011237:Predictive Value of Tests; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic; D059008:Time-Lapse Imaging / Q000379:methods*; D016896:Treatment Outcome
keywords: Embryo development; embryo selection algorithm; morphokinetics