Inter-laboratory agreement on embryo classification and clinical decision: Conventional morphological assessment vs. time lapse.

The aim of this study is to determine inter-laboratory variability on embryo assessment using time-lapse platform and conventional morphological assessment. This study compares the data obtained from a pilot study of external quality control (EQC) of time lapse, performed in 2014, with the classical EQC of the Spanish Society for the Study of Reproductive Biology (ASEBIR) performed in 2013 and 2014. In total, 24 laboratories (8 using EmbryoScope™, 15 using Primo Vision™ and one with both platforms) took part in the pilot study. The clinics that used EmbryoScope™ analysed 31 embryos and those using Primo Vision™ analysed 35. The classical EQC was implemented by 39 clinics, based on an analysis of 25 embryos per year. Both groups were required to evaluate various qualitative morphological variables (cell fragmentation, the presence of vacuoles, blastomere asymmetry and multinucleation), to classify the embryos in accordance with ASEBIR criteria and to stipulate the clinical decision taken. In the EQC time-lapse pilot study, the groups were asked to determine, as well as the above characteristics, the embryo development times, the number, opposition and size of pronuclei, the direct division of 1 into 3 cells and/or of 3 into 5 cells and false divisions. The degree of agreement was determined by calculating the intra-class correlation coefficients and the coefficient of variation for the quantitative variables and the Gwet index for the qualitative variables. For both EmbryoScope™ and Primo Vision™, two periods of greater inter-laboratory variability were observed in the times of embryo development events. One peak of variability was recorded among the laboratories addressing the first embryo events (extrusion of the second polar body and the appearance of pronuclei); the second peak took place between the times corresponding to the 8-cell and morula stages. In most of the qualitative variables analysed regarding embryo development, there was almost-perfect inter-laboratory agreement among conventional morphological assessment (CMA), EmbryoScope™ and Primo Vision™, except for false divisions, vacuoles and asymmetry (users of all methods) and multinucleation (users of Primo Vision™), where the degree of agreement was lower. The inter-laboratory agreement on embryo classification according to the ASEBIR criteria was moderate-substantial (Gwet 0.41-0.80) for the laboratories using CMA and EmbryoScope™, and fair-moderate (Gwet 0.21-0.60) for those using Primo Vision™. The inter-laboratory agreement for clinical decision was moderate (Gwet 0.41-0.60) on day 5 for CMA users and almost perfect (Gwet 0.81-1) for time-lapse users. In conclusion, time-lapse technology does not improve inter-laboratory agreement on embryo classification or the analysis of each morphological variable. Moreover, depending on the time-lapse platform used, inter-laboratory agreement may be lower than that obtained by CMA. However, inter-laboratory agreement on clinical decisions is improved with the use of time lapse, regardless of the platform used.

Situación actual de la técnica time lapse en el laboratorio / Current status of time-lapse systems in the laboratory

El uso de los sistemas time lapse está cada vez más extendido en los laboratorios, se ha demostrado su utilidad a la hora de seleccionar mejor los embriones en combinación con la morfología, que hasta hoy era el método utilizado para realizar esta selección. Aunque existen autores que no están muy de acuerdo con esta afirmación, hay una gran mayoría que coincide en que la monitorización continua de los embriones ofrece una información relevante a la hora de elegir los mejores embriones de un cultivo. Durante los últimos años han surgido estudios avalando el uso de esta técnica, así se ha descrito que se puede conseguir elevar las tasas de embarazo y apostar con más fuerza por la transferencia de embrión único. Todo lo descrito en la literatura habla de resultados con patrones de división y los distintos estudios que validan esos modelos, pero ninguno nombra en profundidad las especificaciones propias de cada sistema, por tanto, el objetivo de este estudio ha sido el intentar resaltar las diferencias existentes entre las plataformas que se pueden encontrar en el mercado e indicar el futuro de cada una de ellas

The use of time-lapse systems is increasingly widespread in laboratories, it has proved useful in the selection of the best embryos when combined with their morphology, the traditional method used until now. Although there are some authors that disagree with this statement, a large majority agrees that the continuous monitorization of the embryos offers relevant information at the time of choosing the best embryos within a culture. In recent years there have been studies that support the use of this technique, and have proven that higher pregnancy rates can be achieved with its use, placing more emphasis on single embryo transfer. Everything published in the literature describes the results of with division patterns and the various studies that validate those models, but none provide an in-depth description of their specifications, thus the aim of this study was to highlight the differences between each of the platforms found on the market and indicate the predicted future of each of them

Collagen-PVP, a collagen synthesis modulator, decreases intraperitoneal adhesions.

BACKGROUND: Adhesion formation in the peritoneal cavity is the most common cause of intestinal obstruction and secondary female infertility. A great effort has been dedicated to reduce adhesion formation because of the associated morbidity and its complications. MATERIALS AND METHODS: This study was designed as a before-after comparative trial and included 14 rabbits, with a weight between 300 and 500 g. All rabbits were appendectomized and 1 month later laparotomized to assess adhesion formation. Rabbits were randomized into two groups, Group I (control group), with no intervention, and Group II (experimental group), treated with an intraperitoneal sponge of collagen-polyvinylpyrrolidone (Clg-PVP). The laparotomy procedure was repeated 1 month later for a new assessment of adhesion formation and histological evaluation by H-E and Masson staining. RESULTS: Histological findings showed abundant infiltrate in the control group, which was mild in the experimental group. With the Masson stain the control group showed a significantly higher amount of collagen than the experimental group and the fibrous tissue was more compact. We found a mean number of adhesions of 3.29 +/- 1.98 for the control group, which decreased to 2.57 +/- 0.79 after the second laparotomy. For the experimental group the mean number of adhesions decreased from 1.86 +/- 0.90 to 0.71 +/- 0.49 after the second laparotomy, with no statistical difference between both groups before Clg-PVP application, but a significant statistical difference after the implantation of Clg-PVP (Student's t test; P < 0.001, two-tailed). CONCLUSION: Collagen-polyvinylpyrrolidone decreases the incidence and size of intraabdominal adhesions after secondary adhesion formation after appendectomy.