Abstract
Purpose
To assess whether utilization of a mathematical ranking algorithm for assistance with embryo selection improves clinical outcomes compared with traditional embryo selection via morphologic grading in single vitrified warmed euploid embryo transfers (euploid SETs).
Methods
A retrospective cohort study in a single, academic center from September 2016 to February 2020 was performed. A total of 4320 euploid SETs met inclusion criteria and were included in the study. Controls included all euploid SETs in which embryo selection was performed by a senior embryologist based on modified Gardner grading (traditional approach). Cases included euploid SETs in which embryo selection was performed using an automated algorithm-based approach (algorithm-based approach). Our primary outcome was implantation rate. Secondary outcomes included ongoing pregnancy/live birth rate and clinical loss rate.
Results
The implantation rate and ongoing pregnancy/live birth rate were significantly higher when using the algorithm-based approach compared with the traditional approach (65.3% vs 57.8%, p<0.0001 and 54.7% vs 48.1%, p=0.0001, respectively). After adjusting for potential confounding variables, utilization of the algorithm remained significantly associated with improved odds of implantation (aOR 1.51, 95% CI 1.04, 2.18, p=0.03) ongoing pregnancy/live birth (aOR 1.99, 95% CI 1.38, 2.86, p=0.0002), and decreased odds of clinical loss (aOR 0.42, 95% CI 0.21, 0.84, p=0.01).
Conclusions
Clinical implementation of an automated mathematical algorithm for embryo ranking and selection is significantly associated with improved implantation and ongoing pregnancy/live birth as compared with traditional embryo selection in euploid SETs.
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Data Availability
The data underlying this article may be obtained upon reasonable request.
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Acknowledgements
The authors thank the physicians, embryologists, research, and other staff members at the study site and affiliated hospitals for their valuable contributions to the development of this manuscript.
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J.F., C.H.N., A.C., and T.N. provided substantial contribution to the design of the study. J.F., C.H.N., D.G. R.M.R, R.S., and C.B.J. collected and analyzed the data. J.F., C.H.N., J.A.L., A.C., and C.B.J. drafted the manuscript. All authors interpreted the data, revised the work, and approved the final submitted version. All authors contributed to the study conception and design. Material preparation and data collection was performed by Jenna Friedenthal, Dmitry Gounko, Rose Marie Roth, and Richard Slifkin. Formal analysis was performed by Jenna Friedenthal, Carlos Hernandez-Nieto, and Dmitry Gounko. Original draft preparation was performed by Jenna Friedenthal; review and editing was performed by all authors. Christine Briton-Jones, Taraneh Nazem, Joseph A. Lee, and Alan Copperman made significant editorial contributions to the manuscript.
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This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB# 18-00452) of the Icahn School of Medicine at Mount Sinai approved this study.
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Not applicable. The Human Investigation Committee (IRB# 18-00452) of the Icahn School of Medicine at Mount Sinai approved this retrospective chart review study.
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Not applicable. The Human Investigation Committee (IRB# 18-00452) of the Icahn School of Medicine at Mount Sinai approved this retrospective chart review study.
Conflict of interest
Alan Copperman is a board member of Sema4 Genomics and Progyny and possesses stock/stock options in Sema4 Genomics and Progyny. The other coauthors declare no conflicts of interest.
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Friedenthal, J., Hernandez-Nieto, C., Roth, R.M. et al. Clinical implementation of algorithm-based embryo selection is associated with improved pregnancy outcomes in single vitrified warmed euploid embryo transfers. J Assist Reprod Genet 38, 1647–1653 (2021). https://doi.org/10.1007/s10815-021-02203-3
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DOI: https://doi.org/10.1007/s10815-021-02203-3