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Hum. Reprod. Advance Access published online on April 10, 2006
Human Reproduction, doi:10.1093/humrep/del106
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org
Received November 28, 2005
Revised February 22, 2006
Accepted March 14, 2006

Article

Interobserver agreement and intraobserver reproducibility of embryo quality assessments

Joan-Carles Arce 1 *, Søren Ziebe 2, Kersti Lundin 3, Ronny Janssens 4, Lisbeth Helmgaard 1, and Per Sørensen 1

1 Ferring Pharmaceuticals A/S, Clinical Research and Development, Copenhagen, Denmark
2 The Fertility Clinic, Copenhagen University Hospital, Copenhagen, Denmark
3 Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
4 Centre for Reproductive Medicine, Academisch Ziekenhuis Vrije Universiteit Brussel, Brussels, Belgium

* To whom correspondence should be addressed.
Joan-Carles Arce, E-mail: joan-carles.arce{at}ferring.com


  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). CONCLUSION: 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.

Keywords: agreement/embryo quality/interobserver/intraobserver/reproducibility.
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