Using the Eeva Test™ adjunctively to traditional day 3 morphology is informative for consistent embryo assessment within a panel of embryologists with diverse experience
- 442 Downloads
Since many transferred, good morphology embryos fail to implant, technologies to identify embryos with high developmental potential would be beneficial. The Eeva™ (Early Embryo Viability Assessment) Test, a prognostic test based on automated detection and analysis of time-lapse imaging information, has been shown to benefit embryo selection specificity for a panel of three highly experienced embryologists (Conaghan et al., 2013). Here we examined if adjunctive use of Eeva Test results following morphological assessment would allow embryologists with diverse clinical backgrounds to consistently improve the selection of embryos with high developmental potential.
Prospective, double-blinded multi-center study with 54 patients undergoing blastocyst transfer cycles consented to have embryos imaged using the Eeva System, which automatically measures key cell division timings and categorizes embryos into groups based on developmental potential. Five embryologists of diverse clinical practices, laboratory training, and geographical areas predicted blastocyst formation using day 3 morphology alone and day 3 morphology followed by Eeva Test results. Odds ratio (OR) and diagnostic performance measures were calculated by comparing prediction results to true blastocyst outcomes.
When Eeva Test results were used adjunctively to traditional morphology to help predict blastocyst formation among embryos graded good or fair on day 3, the OR was 2.57 (95 % CI=1.88–3.51). The OR using morphology alone was 1.68 (95 % CI=1.29–2.19). Adjunct use of the Eeva Test reduced the variability in prediction performance across all five embryologists: the variability was reduced from a range of 1.06 (OR=1.14 to 2.20) to a range of 0.45 (OR=2.33 to 2.78).
The Eeva Test, an automated, time-lapse enabled prognostic test, used adjunctively with morphology, is informative in helping embryologists with various levels of experience select embryos with high developmental potential.
KeywordsIn-vitro fertilization Time-lapse imaging Cell division timings Embryo selection Elective single embryo transfer Prognostic test
We acknowledge Auxogyn, Inc. for sponsoring this study, the clinical, scientific and algorithm groups at Auxogyn for insightful discussion, and the physicians, embryologists and patients who participated in the development and validation of the Eeva Test.
- 6.Cruz M, Gadea B, Garrido N, Pedersen KS, Martinez M, Perez-Cano I, et al. Embryo quality, blastocyst and ongoing pregnancy rates in oocyte donation patients whose embryos were monitored by time-lapse imaging. J Assist Reprod Genet. 2011;28(7):569–73. doi: 10.1007/s10815-011-9549-1.PubMedCentralPubMedCrossRefGoogle Scholar
- 11.Sazonova A, Kallen K, Thurin-Kjellberg A, Wennerholm UB, Bergh C. Neonatal and maternal outcomes comparing women undergoing two in vitro fertilization (IVF) singleton pregnancies and women undergoing one IVF twin pregnancy. Fertil Steril. 2013;99(3):731–7. doi: 10.1016/j.fertnstert.2012.11.023.PubMedCrossRefGoogle Scholar
- 12.Practice Committees of the American Society for Reproductive M, the Society for Assisted Reproductive T. Blastocyst culture and transfer in clinical-assisted reproduction: a committee opinion. Fertility and sterility. 2013;99(3):667–72. doi: 10.1016/j.fertnstert.2013.01.087.
- 14.Conaghan J, Chen AA, Willman SP, Ivani K, Chenette PE, Boostanfar R, et al. Improving embryo selection using a computer-automated time-lapse image analysis test plus day 3 morphology: results from a prospective multicenter trial. Fertil Steril. 2013;100(2):412–9 e5. doi: 10.1016/j.fertnstert.2013.04.021.PubMedCrossRefGoogle Scholar
- 15.Yang Z, Liu J, Collins GS, Salem SA, Liu X, Lyle SS, et al. Selection of single blastocysts for fresh transfer via standard morphology assessment alone and with array CGH for good prognosis IVF patients: results from a randomized pilot study. Mol Cytogenet. 2012;5(1):24. doi: 10.1186/1755-8166-5-24.PubMedCentralPubMedCrossRefGoogle Scholar
- 16.Forman EJ, Upham KM, Cheng M, Zhao T, Hong KH, Treff NR, et al. Comprehensive chromosome screening alters traditional morphology-based embryo selection: a prospective study of 100 consecutive cycles of planned fresh euploid blastocyst transfer. Fertil Steril. 2013;100(3):718–24. doi: 10.1016/j.fertnstert.2013.04.043.PubMedCrossRefGoogle Scholar
- 17.Chen AA, Shen S. Predicting Embryo Developmental Potential and Viability Using Automated Time-Lapse Analysis (Eeva Test). 2013:377–89. doi: 10.1007/978-1-4614-8376-2_22.
- 20.Meseguer M, Rubio I, Cruz M, Basile N, Marcos J, Requena A. Embryo incubation and selection in a time-lapse monitoring system improves pregnancy outcome compared with a standard incubator: a retrospective cohort study. Fertil Steril. 2012;98(6):1481–9 e10. doi: 10.1016/j.fertnstert.2012.08.016.PubMedCrossRefGoogle Scholar
- 27.Racowsky C, Stern JE, Gibbons WE, Behr B, Pomeroy KO, Biggers JD. National collection of embryo morphology data into society for assisted reproductive technology clinic outcomes reporting system: associations among day 3 cell number, fragmentation and blastomere asymmetry, and live birth rate. Fertil Steril. 2011;95(6):1985–9. doi: 10.1016/j.fertnstert.2011.02.009.PubMedCrossRefGoogle Scholar
- 28.Rubin DB. Multiple Imputation for Nonresponse in Surveys. 1987.Google Scholar