A comparison of morphokinetic models and morphological selection for prioritizing euploid embryos: a multicentre cohort study.

STUDY QUESTION: Are morphokinetic models better at prioritizing a euploid embryo for transfer over morphological selection by an embryologist? SUMMARY ANSWER: Morphokinetic algorithms lead to an improved prioritization of euploid embryos when compared to embryologist selection. WHAT IS KNOWN ALREADY: PREFER (predicting euploidy for embryos in reproductive medicine) is a previously published morphokinetic model associated with live birth and miscarriage. The second model uses live birth as the target outcome (LB model). STUDY DESIGN, SIZE, DURATION: Data for this cohort study were obtained from 1958 biopsied blastocysts at nine IVF clinics across the UK from January 2021 to December 2022. PARTICIPANTS/MATERIALS, SETTING, METHODS: The ability of the PREFER and LB models to prioritize a euploid embryo was compared against arbitrary selection and the prediction of four embryologists using the timelapse video, blinded to the morphokinetic time stamp. The comparisons were made using calculated percentages and normalized discounted cumulative gain (NDCG), whereby an NDCG score of 1 would equate to all euploid embryos being ranked first. In arbitrary selection, the ploidy status was randomly assigned within each cycle and the NDGC calculated, and this was then repeated 100 times and the mean obtained. MAIN RESULTS AND THE ROLE OF CHANCE: Arbitrary embryo selection would rank a euploid embryo first 37% of the time, embryologist selection 39%, and the LB and PREFER ploidy morphokinetic models 46% and 47% of the time, respectively. The AUC for LB and PREFER model was 0.62 and 0.63, respectively. Morphological selection did not significantly improve the performance of both morphokinetic models when used in combination. There was a significant difference between the NDGC metric of the PREFER model versus embryologist selection at 0.96 and 0.87, respectively (t = 14.1, P < 0.001). Similarly, there was a significant difference between the LB model and embryologist selection with an NDGC metric of 0.95 and 0.87, respectively (t = 12.0, P < 0.001). All four embryologists ranked embryos similarly, with an intraclass coefficient of 0.91 (95% CI 0.82-0.95, P < 0.001). LIMITATIONS, REASONS FOR CAUTION: Aside from the retrospective study design, limitations include allowing the embryologist to watch the time lapse video, potentially providing more information than a truly static morphological assessment. Furthermore, the embryologists at the participating centres were familiar with the significant variables in time lapse, which could bias the results. WIDER IMPLICATIONS OF THE FINDINGS: The present study shows that the use of morphokinetic models, namely PREFER and LB, translates into improved euploid embryo selection. STUDY FUNDING/COMPETING INTEREST(S): This study received no specific grant funding from any funding agency in the public, commercial or not-for-profit sectors. Dr Alison Campbell is minor share holder of Care Fertility. All other authors have no conflicts of interest to declare. Time lapse is a technology for which patients are charged extra at participating centres. TRIAL REGISTRATION NUMBER: N/A.

Sustainability in the IVF laboratory: recommendations of an expert panel.

The healthcare industry is a major contributor to greenhouse gas emissions. Assisted reproductive technology is part of the larger healthcare sector, with its own heavy carbon footprint. The social, economic and environmental costs of this collective carbon footprint are becoming clearer, as is the impact on human reproductive health. Alpha Scientists in Reproductive Medicine and the International IVF Initiative collaborated to seek and formulate practical recommendations for sustainability in IVF laboratories. An international panel of experts, enthusiasts and professionals in reproductive medicine, environmental science, architecture, biorepository and law convened to discuss the topics of importance to sustainability. Recommendations were issued on how to build a culture of sustainability in the workplace, implement green design and building, use life cycle analysis to determine the environmental impact, manage cryostorage more sustainably, and understand and manage laboratory waste with prevention as a primary goal. The panel explored whether the industry supporting IVF is sustainable. An example is provided to illustrate the application of green principles to an IVF laboratory through a certification programme. The UK legislative landscape surrounding sustainability is also discussed and a few recommendations on 'Green Conferencing' are offered.

Fast saccades to faces during the feedforward sweep.

Saccadic choice tasks use eye movements as a response method, typically in a task where observers are asked to saccade as quickly as possible to an image of a prespecified target category. Using this approach, face-selective saccades have been observed within 100 ms poststimulus. When taking into account oculomotor processing, this suggests that faces can be detected in as little as 70 to 80 ms. It has therefore been suggested that face detection must occur during the initial feedforward sweep, since this latency leaves little time for feedback processing. In the current experiment, we tested this hypothesis using backward masking-a technique shown to primarily disrupt feedback processing while leaving feedforward activation relatively intact. Based on minimum saccadic reaction time, we found that face detection benefited from ultra-fast, accurate saccades within 110 to 160 ms and that these eye movements are obtainable even under extreme masking conditions that limit perceptual awareness. However, masking did significantly increase the median SRT for faces. In the manual responses, we found remarkable detection accuracy for faces and houses, even when participants indicated having no visual experience of the test images. These results provide evidence for the view that the saccadic bias to faces is initiated by coarse information used to categorize faces in the feedforward sweep but that, in most cases, additional processing is required to quickly reach the threshold for saccade initiation.

The experiences of older adults with cognitive impairment in using falls prevention alarms in hospital: A qualitative descriptive study.

INTRODUCTION: Bed and chair sensor alarms are commonly used for falls prevention in hospitals, despite questionable efficacy. Research analysing older adults' experiences of alarms is scarce, and adults with cognitive impairment are consistently excluded. AIM: The aim of this study was to explore how older adults with cognitive impairment perceive and experience falls prevention alarms in hospital. METHOD: A qualitative descriptive design investigated older adults' experiences of alarms in a Geriatric Evaluation and Management ward in Melbourne. Patients were included if they had been provided an alarm. Semi-structured interviews were the primary method of data collection with two observation sessions and medical record analyses completed to enable triangulation of findings. Data were subjected to thematic analysis, and the Person-Environment-Occupation framework was chosen to add insight into the complexities of older adults' experiences of alarms. FINDINGS: All 11 participants had a level of cognitive impairment with delirium, confusion, or impulsiveness recorded in their medical file. Two overarching themes were identified: communication and collaboration with staff and rationalisation of alarm use. Participants' perceived staff were focussed on falls prevention but experienced a lack of communication about the purpose of alarms. Participants wanted an individualised approach to alarms. Some were comforted with the thought of alarms alerting staff, making them feel well cared for and believed alarms were a useful 'back-up'. Others found alarms uncomfortable, frustrating, and restricting. Application of the Person-Environment-Occupation framework provided insight into how enabling and restrictive factors can impact whether the alarm is experienced positively or negatively. Seven unwitnessed falls occurred during the participants' admissions. Thirty-four per cent of alarm triggers observed were considered false alerts. CONCLUSION: Older adults commonly reported negative experiences using bed/chair sensor alarms. Occupational therapists have the training to collaborate with people with cognitive impairment and assess the usefulness of alarms in reducing falls, based on how they interact with the older adult's unique person, environment, and occupation domains.

A comparison of 12 machine learning models developed to predict ploidy, using a morphokinetic meta-dataset of 8147 embryos.

STUDY QUESTION: Are machine learning methods superior to traditional statistics in predicting blastocyst ploidy status using morphokinetic and clinical biodata? SUMMARY ANSWER: Mixed effects logistic regression performed better than all machine learning methods for ploidy prediction using our dataset of 8147 embryos. WHAT IS KNOWN ALREADY: Morphokinetic timings have been demonstrated to be delayed in aneuploid embryos. Machine learning and statistical models are increasingly being built, however, until now they have been limited by data insufficiency. STUDY DESIGN, SIZE, DURATION: This is a multicentre cohort study. Data were obtained from 8147 biopsied blastocysts from 1725 patients, treated from 2012 to 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS: All embryos were cultured in a time-lapse system at nine IVF clinics in the UK. A total of 3004 euploid embryos and 5023 aneuploid embryos were included in the final verified dataset. We developed a total of 12 models using four different approaches: mixed effects multivariable logistic regression, random forest classifiers, extreme gradient boosting, and deep learning. For each of the four algorithms, two models were created, the first consisting of 22 covariates using 8027 embryos (Dataset 1) and the second, a dataset of 2373 embryos and 26 covariates (Dataset 2). Four final models were created by switching the target outcome from euploid to aneuploid for each algorithm (Dataset 1). Models were validated using internal-external cross-validation and external validation. MAIN RESULTS AND THE ROLE OF CHANCE: All morphokinetic variables were significantly delayed in aneuploid embryos. The likelihood of euploidy was significantly increased the more expanded the blastocyst (P < 0.001) and the better the trophectoderm grade (P < 0.01). Univariable analysis showed no association with ploidy status for morula or cleavage stage fragmentation, morula grade, fertilization method, sperm concentration, or progressive motility. Male age did not correlate with the percentage of euploid embryos when stratified for female age. Multinucleation at the two-cell or four-cell stage was not associated with ploidy status. The best-performing model was logistic regression built using the larger dataset with 22 predictors (F1 score 0.59 for predicting euploidy; F1 score 0.77 for predicting aneuploidy; AUC 0.71; 95% CI 0.67-0.73). The best-performing models using the algorithms from random forest, extreme gradient boosting, and deep learning achieved an AUC of 0.68, 0.63, and 0.63, respectively. When using only morphokinetic predictors the AUC was 0.61 for predicting ploidy status, whereas a model incorporating only embryo grading was unable to discriminate aneuploid embryos (AUC = 0.52). The ploidy prediction model's performance improved with increasing age of the egg provider. LIMITATIONS, REASONS FOR CAUTION: The models have not been validated in a prospective study design or yet been used to determine whether they improve clinical outcomes. WIDER IMPLICATIONS OF THE FINDINGS: This model may aid decision-making, particularly where pre-implantation genetic testing for aneuploidy is not permitted or for prioritizing embryos for biopsy. STUDY FUNDING/COMPETING INTEREST(S): No specific funding was sought for this study; university funds supported the first author. A.Ca. is a minor shareholder of participating centres. TRIAL REGISTRATION NUMBER: N/A.

A comparison of the morphokinetic profiles of embryos developed from vitrified versus fresh oocytes.

RESEARCH QUESTION: Do morphokinetic profiles and treatment outcomes differ between embryos developed from vitrified or fresh oocytes? DESIGN: Retrospective multicentre analysis using data from eight CARE Fertility clinics across the UK between 2012 and 2019. Patients receiving treatment using embryos developed from vitrified oocytes (n = 118 women, n = 748 oocytes), providing 557 zygotes during this time period, were recruited and matched with patients undergoing treatment with embryos developed from fresh oocytes (n = 123 women, n = 1110 oocytes), providing 539 zygotes in the same time frame. Time-lapse microscopy was used to assess morphokinetic profiles, including early cleavage divisions (2- through to 8-cell), post-cleavage stages including time to start of compaction, time to morula, time to start of blastulation and time to full blastocyst. Duration of key stages such as the compaction stage were also calculated. Treatment outcomes were compared between the two groups (live birth rate, clinical pregnancy rate and implantation rate). RESULTS: A significant delay of 2-3 h across all early cleavage divisions (2- through to 8-cell) and time to start of compaction occurred in the vitrified group versus fresh controls (all P ≤ 0.01). The compaction stage was significantly shorter in vitrified oocytes (19.02 ± 0.5 h) compared with fresh controls (22.45 ± 0.6 h, P < 0.001). There was no difference in the time that fresh and vitrified embryos reached the blastocyst stage (108.03 ± 0.7 versus 107.78 ± 0.6 h). There was no significant difference in treatment outcomes between the two groups. CONCLUSION: Vitrification is a useful technique for extending female fertility with no effects on IVF treatment outcome.

The time has come for harmonized international ART registration.

For more than two decades, the European IVF-Monitoring Consortium has collected data on IVF in Europe with the aim of monitoring the quality and safety of assisted reproductive technology (ART) treatments, to ensure the highest performance with the lowest risk for patients and their offspring. Likewise, the Society for Assisted Reproductive Technology in the USA and the Australia/New Zealand Assisted Reproduction Database collect, process and publish data in their regions. The better the legal framework for ART surveillance, the more complete and reliable are the datasets. Worldwide, the landscape of ART regulation is fragmented, and until there is a legal obligation to report ART data in all countries, with an appropriate quality control of the data collected, the reported outcomes should be interpreted with caution. Once uniform and harmonized data are achieved, consensus reports based on collective findings can begin to address key topics such as cycle segmentation and complications. Improved registration systems and datasets allowing optimized surveillance should be developed in collaboration with patient representatives to consider patients' needs, especially aiming to provide higher transparency around ART services. Support from national and international reproductive medicine societies will also be essential to the future evolution of ART registries.

Assuring quality in assisted reproduction laboratories: assessing the performance of ART Compass - a digital art staff management platform.

PURPOSE: Staff management is the most cited ART/IVF laboratory inspection deficiency. Small ART/IVF clinics may be challenged to perform these activities by low staff volume; similarly, large ART/IVF networks may be challenged by high staff volume and large datasets. Here, we sought to investigate the performance of an automated, digital platform solution to manage this necessary task. METHODS: The ART Compass (ARTC) digital staff management platform was used to assess the clinical decision-making of ART laboratory staff. The survey modules presented standardized instructions to technologists and measured inter- and intra-technologist variability for subjective "clinical decision-making" type questions. Internal and external comparisons were achieved by providing technologists two answers: (1) a comparison to their own lab director and (2) to the most popular response collectively provided by all lab director level accounts. The platform is hosted on HIPAA compliant Amazon web servers, accessible via web browser and mobile applications for iOS (Apple) and Android mobile devices. RESULTS: Here, we investigated the performance of a digital staff management platform for single embryologist IVF practices and for three IVF lab networks (sites A, B, C) from 2020 to 2022. Embryology dish preparation survey results show variance among respondents in the following: PPE use, media volume, timing of oil overlay, and timing of moving prepared dishes to incubators. Surveying the perceived Gardner score and terms in use for early blastocysts reveals a lack of standardization of terminology and fair to poor agreement. We observed moderate inter-technologist agreement for ICM and TE grade (0.47 and 0.52, respectively). Lastly, the clinical decision of choice to freeze or discard an embryo revealed that agreement to freeze was highest for the top-quality embryos, and that some embryos can be highly contested, evenly split between choice to freeze or discard. CONCLUSIONS: We conclude that a digital platform is a novel and effective tool to automate, routinely monitor, and assure quality for staff-related parameters in ART and IVF laboratories. Use of a digital platform can increase regulatory compliance and provide actionable insight for quality assurance in both single embryologist practices and for large networks. Furthermore, clinical decision-making can be augmented with artificial intelligence integration.

Embryos are exposed to a significant drop in temperature during the embryo transfer procedure: a pilot study.

RESEARCH QUESTION: During the embryo transfer procedure, to what degree of temperature drop are embryos exposed to between loading the transfer catheter and placing it into the uterus? DESIGN: Twenty-nine simulated embryo transfer procedures were carried out across five clinics. A thermocouple probe was used for standardized measurements inside the embryo transfer catheter to investigate the change in temperature that occurred in the time period between loading and placing the catheter in the uterus. RESULTS: In all cases, the temperature at the loaded catheter tip fell rapidly to ambient temperature during transit from the embryo transfer workstation in the laboratory to the procedure room, even though embryo transfer procedures, ambient temperatures and embryo transfer catheter temperatures at loading varied between clinics. CONCLUSIONS: Given the sensitivity of the pre-implantation embryo to its immediate environment, the rapid and profound drop in temperature observed at the catheter tip that houses the embryo during transit from laboratory to the uterus may affect embryo viability and health. This issue should be addressed to ensure that the tight temperature control aimed for by IVF laboratories continues throughout the embryo transfer procedure, and could improve clinical outcomes.

Fertility technologies and how to optimize laboratory performance to support the shortening of time to birth of a healthy singleton: a Delphi consensus.

PURPOSE: To explore how the assisted reproductive technology (ART) laboratories can be optimized and standardized to enhance embryo culture and selection, to bridge the gap between standard practice and the new concept of shortening time to healthy singleton birth. METHODS: A Delphi consensus was conducted (January to July 2018) to assess how the ART laboratory could be optimized, in conjunction with existing guidelines, to reduce the time to a healthy singleton birth. Eight experts plus the coordinator discussed and refined statements proposed by the coordinator. The statements were distributed via an online survey to 29 participants (including the eight experts from step 1), who voted on their agreement/disagreement with each statement. Consensus was reached if ≥ 66% of participants agreed/disagreed with a statement. If consensus was not achieved for any statement, that statement was revised and the process repeated until consensus was achieved. Details of statements achieving consensus were communicated to the participants. RESULTS: Consensus was achieved for all 13 statements, which underlined the need for professional guidelines and standardization of lab processes to increase laboratory competency and quality. The most important points identified were the improvement of embryo culture and embryo assessment to shorten time to live birth through the availability of more high-quality embryos, priority selection of the most viable embryos and improved cryosurvival. CONCLUSION: The efficiency of the ART laboratory can be improved through professional guidelines on standardized practices and optimized embryo culture environment, assessment, selection and cryopreservation methodologies, thereby reducing the time to a healthy singleton delivery.

Evolution of embryo selection for IVF from subjective morphology assessment to objective time-lapse algorithms improves chance of live birth.

RESEARCH QUESTION: Does using an objective time-lapse imaging algorithm (TLIA) after IVF relate to conventional morphological assessment of human blastocysts as a prognosticator for live birth? DESIGN: Prospective use of a TLIA to select embryos in multicentre IVF clinics all using the same strictly controlled laboratory protocols. Each blastocyst was given a ranking from A to D, with the highest rank preferred for fresh transfer. This ranking was retrospectively compared with a given morphological score, which was blinded to the TLIA rank; all embryos were cultured under the same conditions. RESULTS: Using multiple variable logistic regression models, TLIA embryo rank enabled greater discrimination between cycles with and without live births than the conventional morphology grade, even when considered in isolation, and when adjusting for covariates related to treatment and patient criteria. Of the 1810 cycles of single blastocyst transfer, 894 (49.4%) resulted in a live birth. A Vuong non-nested test including covariates showed strong evidence of the superiority of the embryo rank model compared with the transfer grade model (P = 0.0008 [raw], P = 0.0003 [Akaike information criterion - corrected]). From the receiver operating characteristic (ROC) curves across all possible thresholds the TLIA rank showed better true positive and true negative rates and had a higher area under the curve [AUC] of 67.43% compared with 61.74% for the blastocyst morphology grade. The same analysis but excluding covariates demonstrated an AUC of 62.86% versus 54.02%, respectively. CONCLUSION: Objective TLIA is superior for selecting embryos for their propensity to generate a live birth over a conventional, subjective blastocyst morphology scoring system.

All Aboard Meal Train: Can Child-Friendly Menu Labeling Promote Healthier Choices in Hospitals?

OBJECTIVE: To evaluate patient meal orders and consumption with a revised menu design that includes child-friendly labeling. STUDY DESIGN: A randomized controlled trial among hospitalized children was performed over a 1-month period comparing the control menu layout and the intervention menu. The intervention menu contained the same choices but was labeled to encourage healthy eating. Children on a specialized diet, receiving parenteral nutrition, or age <2 years were excluded. RESULTS: A total of 163 patients (81 males) were included, with a mean age of 9.9 ± 5.1 year, and a mean weight z-score of -0.08 ± 1.3. Children receiving the intervention ordered more "green-light" healthy choices and fewer "red-light" items, with 0.65 lower odds of selecting a red-light item (95% CI, 0.55-0.76) and 1.75 higher odds of selecting a green-light item (95% CI, 1.49-2.04), both at the first meal, but with effects waning over time. There were trends toward increased intake of fruits and vegetables and decreased intake of "foods to limit", but no impact on the consumption of sugar-sweetened beverages. Both intervention and control group consumed their meals in equal proportions. CONCLUSIONS: The combination of menu labeling techniques targeted to children in the inpatient hospital setting was an effective short-term tool for increasing the intake of healthier foods, although the effect of labeling waned over time. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02692001.

Should we still perform fresh embryo transfers in ART?

An increasing number of researchers have alluded to the potential benefit of deferring the transfer of embryos produced during assisted reproductive technologies (ARTs) away from ovarian stimulation, using cryopreservation to enable this. The scientific evidence that may justify this recent trend in the use of the so-called 'freeze-all strategy' includes early, mostly small randomised controlled trials that have demonstrated an increase in live birth rates after elective embryo cryopreservation in certain patient populations, as well as evidence from cohort studies and retrospective analyses. What are the risks and benefits of freeze-all strategies in ART, who are the patients in whom it is likely to be advantageous, and does the current evidence allow us to identify situations when deciding that a fresh embryo transfer would be counter-productive? ART professionals are often faced with challenging clinical decisions regarding the best course of treatment for their patient. The purpose of this opinion paper is to provide a clinical guide for whether to perform a fresh embryo transfer or to opt for freezing all embryos in specific situations.

Implementing a Clinical Practice Change: Adopting the Nutrition Care Process.

The Nutrition Care Process (NCP), created by the Academy of Nutrition and Dietetics, provides a framework that encourages critical thinking and promotes uniform documentation by Registered Dietitians (RD). Additionally, it creates a link between the nutrition assessment, nutrition intervention, and the predicted or actual nutrition outcome. NCP has been integrated into a number of institutions in Canada and internationally. A committee of nonmanagement RDs at the Hospital for Sick Children led the Department of Clinical Dietetics in adopting the NCP. The committee developed and consecutively delivered a tailored education plan to 5 groups of RDs within the department. Additional resources were developed to complement the learning plan. The committee administered informal pre- and post-education surveys to measure outcomes. RDs reported receiving adequate training and felt confident implementing NCP into their practice. Adopting the NCP was well-received and RDs within the department continue to integrate it into their current practice.

Optimal endometrial thickness to maximize live births and minimize pregnancy losses: Analysis of 25,767 fresh embryo transfers.

RESEARCH QUESTION: What is the association of endometrial thickness with pregnancy losses and live births in IVF treatment and the optimal threshold that optimizes the IVF outcome? DESIGN: Data were analysed from 25,767 IVF cycles from centres of the CARE Fertility Group in the UK between 2007 and 2016. Transvaginal ultrasound was conducted to measure the maximum endometrial thickness during gonadotrophin stimulation. Live birth rates were per embryo transfer. Pregnancy loss rates included the combination of biochemical and clinical pregnancy losses. RESULTS: The live birth rate was 15.6% with 5 mm or less endometrial thickness and gradually increased to 33.1% with an endometrial thickness of 10 mm. On the other hand, the pregnancy loss rate was 41.7% with 5 mm or less endometrial thickness and gradually decreased to 26.5% with an endometrial thickness of 10 mm. Statistical modelling for optimal endometrial thickness threshold found 10 mm or more maximized live births and minimized pregnancy losses. This association was independent after adjusting for confounders such as age, oocyte number, number of transferred embryos, ovarian stimulation protocol and embryo quality for live births (crude RR 1.27; 95% CI 1.21 to 1.33; Adjusted RR 1.18; 95% CI 1.12 to 1.23) and pregnancy losses (crude RR 0.83; 95% CI 0.77 to 0.89; adjusted RR 0.86; 95% CI 0.8 to 0.92). CONCLUSIONS: Endometrial thickness is strongly associated with pregnancy losses and live births in IVF, and the optimal endometrial thickness threshold of 10 mm or more maximized live births and minimized pregnancy losses.

Time-lapse imaging algorithms rank human preimplantation embryos according to the probability of live birth.

RESEARCH QUESTION: Can blastocysts leading to live births be ranked according to morphokinetic-based algorithms? DESIGN: Retrospective analysis of 781 single blastocyst embryo transfers, including all patient clinical factors that might be potential confounders for the primary outcome measure of live birth, was weighed using separate multi-variable logistic regression models. RESULTS: There was strong evidence of effect of embryo rank on odds of live birth. Embryos were classified A, B, C or D according to calculated variables; time to start (tSB) and duration (dB{tB - tSB}) of blastulation. Embryos of rank D were less likely to result in live birth than embryos of rank A (odds ratio [OR] 0.3046; 95% confidence interval [CI] 0.129, 0.660; P < 0.005). Embryos ranked B were less likely to result in live birth than those ranked A (OR 0.7114; 95% Cl 0.505, 1.001; P < 0.01), and embryos ranked C were less likely to result in live birth than those ranked A (OR 0.6501, 95% Cl 0.373, 1.118; P < 0.01). Overall, the LRT (Likelihood Ratio Test) p-value for embryo rank shows that there is strong evidence that embryo rank is informative as a whole in discriminating between live birth and no live birth outcomes (p = 0.0101). The incidence of live birth was 52.5% from rank A, 39.2% from rank B, 31.4% from rank C and 13.2% from rank D. CONCLUSIONS: Time-lapse imaging morphokinetic-based algorithms for blastocysts can provide objective hierarchical ranking of embryos for predicting live birth and may have greater discriminating power than conventional blastocyst morphology assessment.

Inversion Impairs Expert Budgerigar Identity Recognition: A Face-Like Effect for a Nonface Object of Expertise.

The face-inversion effect is the finding that picture-plane inversion disproportionately impairs face recognition compared to object recognition and is now attributed to greater orientation-sensitivity of holistic processing for faces but not common objects. Yet, expert dog judges have showed similar recognition deficits for inverted dogs and inverted faces, suggesting that holistic processing is not specific to faces but to the expert recognition of perceptually similar objects. Although processing changes in expert object recognition have since been extensively documented, no other studies have observed the distinct recognition deficits for inverted objects-of-expertise that people as face experts show for faces. However, few studies have examined experts who recognize individual objects similar to how people recognize individual faces. Here we tested experts who recognize individual budgerigar birds. The effect of inversion on viewpoint-invariant budgerigar and face recognition was compared for experts and novices. Consistent with the face-inversion effect, novices showed recognition deficits for inverted faces but not for inverted budgerigars. By contrast, experts showed equal recognition deficits for inverted faces and budgerigars. The results are consistent with the hypothesis that processes underlying the face-inversion effect are specific to the expert individuation of perceptually similar objects.

Perivitelline threads in cleavage-stage human embryos: observations using time-lapse imaging.

Time-lapse imaging of the human preimplantation embryo in vitro has revealed a transient phenomenon involving the appearance of perivitelline threads, commonly observed at the two-cell stage. These threads span the perivitelline space, arising at the specific area where the cytoplasmic membrane contacts the zona pellucida, before any perivitelline space is formed. The threads persist as the cytoplasmic membrane retracts from the zona pellucida to form the first cleavage furrow. In this observational report, these structures and their incidence are described. A total of 834 time-lapse videos from IVF treatment cycles, one per patient, were retrospectively analysed for perivitelline threads, from pronuclear formation until completion of the first cell cycle. Threads were observed in 56.4% (470/834) of embryos and varied from a single to an array spanning an area of the zona pellcida. A total of 91.9% (432/470) were seen to form after cytoplasmic membrane-zona-pellucida contact. A total of 76.4% (359/470) were visible at the first cleavage furrow; 77% (362/470) were associated with cytoplasmic fragments at the two-cell-stage. Presence or absence of threads did not affect embryo development. This descriptive study is limited; further characterization of these structures is needed to elucidate their potential role in early human embryo development.

Live births after embryo selection using morphokinetics versus conventional morphology: a retrospective analysis.

The increasing corpus of clinical studies using time-lapse imaging for embryo selection demonstrates considerable variation in study protocols and only limited-sized study cohorts. Outcome measures are based on implantation or clinical pregnancy; some predict blastulation from early cleavage-stage data, and few have evaluated live birth. Erroneously, most studies treat the embryos as independent variables and do not include patient or treatment variables in the statistical analyses. In this study, cohort size was 14,793 patients and 23,762 cycles. The incidence of live birth (n = 973 deliveries) after embryo selection by objective morphokinetic algorithms was compared with conventional embryology selection parameters (n = 6948 deliveries). A 19% increase in the incidence of live birth was observed when morphokinetic data were used to select embryos for the patient cohort aged younger than 38 years (OR 1.19 with 95% CI 1.06 to 1.34) using their own eggs, and an increase of 37% for oocyte recipients aged over 37 years (OR 1.370; 95% Cl 0.763 to 2.450). This is the largest study of the prospective use of time-lapse imaging algorithms in IVF reporting on live birth outcome, although the nature of purely a closed system versus standard incubation could not be assessed.

Scalable Synthesis of Enantiopure Bis-3,4-diazaphospholane Ligands for Asymmetric Catalysis.

An optimized route to enantiopure tetra-carboxylic acid and tetra-carboxamide bis(diazaphospholane) ligands that obviates chromatographic purification is presented. This synthesis, which is demonstrated on 15 and 100 g scales, features a scalable classical resolution of tetra-carboxylic acid enantiomers with recycling of the resolving agent. When paired with a rhodium metal center, these bis(diazaphospholane) ligands are highly active and selective in asymmetric hydroformylation applications.