Comparison of methods to determine the assigned value in an external quality control programme for embryo evaluation

Area of Science:

• Reproductive Medicine
• Embryology
• Quality Control

Background:

• Image-based embryo evaluation is crucial for assisted reproductive technologies.
• Variability in laboratory assessments can impact clinical decisions.
• Standardization is needed for reliable embryo quality control.

Purpose of the Study:

• To establish assigned values for a National External Quality Control Programme for embryo evaluation.
• To compare embryo quality assessments between Spanish laboratories and national experts.
• To evaluate interobserver agreement in embryo classification and clinical decision-making.

Main Methods:

• Comparison of embryo classification and clinical decisions between laboratories and experts.
• Calculation of agreement proportions and kappa coefficients for interobserver reliability.
• Analysis of cryopreservation recommendations for poor-quality embryos.

Main Results:

• Experts showed high agreement (98.3% classification, 93.3% decision), while laboratories showed lower agreement (44.2% classification, 42.5% decision).
• Interobserver agreement (kappa coefficients) was below 0.6 for both groups.
• Experts recommended cryopreservation for 28% of poor-quality embryos, compared to 4% by laboratories (P=0.05).

Conclusions:

• Laboratory agreement in embryo evaluation is significantly lower than expert agreement.
• Concordance between experts and laboratories is moderate.
• External quality control programs should utilize expert consensus for assigned values in embryo evaluation.