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Lee T, Natalwala J, Chapple V, Liu Y. A brief history of artificial intelligence embryo selection: from black-box to glass-box. Hum Reprod 2024; 39:285-292. [PMID: 38061074 PMCID: PMC11016335 DOI: 10.1093/humrep/dead254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
With the exponential growth of computing power and accumulation of embryo image data in recent years, artificial intelligence (AI) is starting to be utilized in embryo selection in IVF. Amongst different AI technologies, machine learning (ML) has the potential to reduce operator-related subjectivity in embryo selection while saving labor time on this task. However, as modern deep learning (DL) techniques, a subcategory of ML, are increasingly used, its integrated black-box attracts growing concern owing to the well-recognized issues regarding lack of interpretability. Currently, there is a lack of randomized controlled trials to confirm the effectiveness of such black-box models. Recently, emerging evidence has shown underperformance of black-box models compared to the more interpretable traditional ML models in embryo selection. Meanwhile, glass-box AI, such as interpretable ML, is being increasingly promoted across a wide range of fields and is supported by its ethical advantages and technical feasibility. In this review, we propose a novel classification system for traditional and AI-driven systems from an embryology standpoint, defining different morphology-based selection approaches with an emphasis on subjectivity, explainability, and interpretability.
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Affiliation(s)
- Tammy Lee
- Fertility North, Joondalup Private Hospital, Joondalup, Western Australia, Australia
- School of Human Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Jay Natalwala
- Fertility North, Joondalup Private Hospital, Joondalup, Western Australia, Australia
| | - Vincent Chapple
- Fertility North, Joondalup Private Hospital, Joondalup, Western Australia, Australia
| | - Yanhe Liu
- Fertility North, Joondalup Private Hospital, Joondalup, Western Australia, Australia
- School of Human Sciences, University of Western Australia, Crawley, Western Australia, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
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Glatstein I, Chavez-Badiola A, Curchoe CL. New frontiers in embryo selection. J Assist Reprod Genet 2023; 40:223-234. [PMID: 36609943 PMCID: PMC9935769 DOI: 10.1007/s10815-022-02708-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 12/23/2022] [Indexed: 01/09/2023] Open
Abstract
Human infertility is a major global public health issue estimated to affect one out of six couples, while the number of assisted reproduction cycles grows impressively year over year. Efforts to alleviate infertility using advanced technology are gaining traction rapidly as infertility has an enormous impact on couples and the potential to destabilize entire societies if replacement birthrates are not achieved. Artificial intelligence (AI) technologies, leveraged by the highly advanced assisted reproductive technology (ART) industry, are a promising addition to the armamentarium of tools available to combat global infertility. This review provides a background for current methodologies in embryo selection, which is a manual, time-consuming, and poorly reproducible task. AI has the potential to improve this process (among many others) in both the clinician's office and the IVF laboratory. Embryo selection is evolving through digital methodologies into an automated procedure, with superior reliability and reproducibility, that is likely to result in higher pregnancy rates for patients. There is an emerging body of data demonstrating the utility of AI applications in multiple areas in the IVF laboratory. AI platforms have been developed to evaluate individual embryologist performance; to provide quality assurance for culture systems; to correlate embryologist's assessments and AI systems; to predict embryo ploidy, implantation, fetal heartbeat, and live birth outcome; and to replace the current "analogue" system of embryo selection with a digital paradigm. AI capability will distinguish high performing, high profit margin, low-cost, and highly successful IVF clinic business models. We think it will become the standard, "new normal" in IVF labs, as rapidly and thoroughly as vitrification, blastocyst culture, and intracytoplasmic sperm injection replaced their predecessor technologies. At the time of this review, the AI technology to automate embryo evaluation and selection has robustly matured, and therefore, it is the main focus of this review.
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Affiliation(s)
| | - Alejandro Chavez-Badiola
- IVF 2.0 LTD, 1 Liverpool Road, Maghull, L31 2HB, Merseyside, UK
- New Hope Fertility Center, Av. Prado Norte 135, Lomas de Chapultepec, CP11000, Mexico City, Mexico
- Reproductive Genetics, School of Biosciences, University of Kent, Canterbury, CT2 7NZ, Kent, UK
| | - Carol Lynn Curchoe
- ART Compass, a Fertility Guidance Technology, Newport Beach, CA, 92660, USA
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Automated identification of blastocyst regions at different development stages. Sci Rep 2023; 13:15. [PMID: 36593239 PMCID: PMC9807603 DOI: 10.1038/s41598-022-26386-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/14/2022] [Indexed: 01/04/2023] Open
Abstract
The selection of the best single blastocyst for transfer is typically based on the assessment of the morphological characteristics of the zona pellucida (ZP), trophectoderm (TE), blastocoel (BC), and inner cell-mass (ICM), using subjective and observer-dependent grading protocols. We propose the first automatic method for segmenting all morphological structures during the different developmental stages of the blastocyst (i.e., expansion, hatching, and hatched). Our database contains 592 original raw images that were augmented to 2132 for training and 55 for validation. The mean Dice similarity coefficient (DSC) was 0.87 for all pixels, and for the BC, BG (background), ICM, TE, and ZP was 0.85, 0.96, 0.54, 0.63, and 0.71, respectively. Additionally, we tested our method against a public repository of 249 images resulting in accuracies of 0.96 and 0.93 and DSC of 0.67 and 0.67 for ICM and TE, respectively. A sensitivity analysis demonstrated that our method is robust, especially for the BC, BG, TE, and ZP. It is concluded that our approach can automatically segment blastocysts from different laboratory settings and developmental phases of the blastocysts, all within a single pipeline. This approach could increase the knowledge base for embryo selection.
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Voliotis M, Hanassab S, Abbara A, Heinis T, Dhillo WS, Tsaneva-Atanasova K. Quantitative approaches in clinical reproductive endocrinology. CURRENT OPINION IN ENDOCRINE AND METABOLIC RESEARCH 2022; 27:100421. [PMID: 36643692 PMCID: PMC9831018 DOI: 10.1016/j.coemr.2022.100421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Understanding the human hypothalamic-pituitary-gonadal (HPG) axis presents a major challenge for medical science. Dysregulation of the HPG axis is linked to infertility and a thorough understanding of its dynamic behaviour is necessary to both aid diagnosis and to identify the most appropriate hormonal interventions. Here, we review how quantitative models are being used in the context of clinical reproductive endocrinology to: 1. analyse the secretory patterns of reproductive hormones; 2. evaluate the effect of drugs in fertility treatment; 3. aid in the personalization of assisted reproductive technology (ART). In this review, we demonstrate that quantitative models are indispensable tools enabling us to describe the complex dynamic behaviour of the reproductive axis, refine the treatment of fertility disorders, and predict clinical intervention outcomes.
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Key Words
- AI, artificial intelligence
- AMH, anti-Müllerian hormone
- ART, assisted reproductive technology
- Artificial intelligence
- Assisted reproductive technology
- BSA, Bayesian Spectrum Analysis
- Clinical decision making
- E2, estradiol
- FSH, follicle-stimulating hormone
- GnRH, gonadotropin-releasing hormone
- HA, hypothalamic amenorrhea
- HPG, hypothalamic-pituitary gonadal
- IVF, in vitro fertilization
- In vitro fertilization
- LH, luteinizing hormone
- ML, machine learning
- Machine learning
- Mathematical modelling
- OHSS, ovarian hyperstimulation syndrome
- P4, progesterone
- PCOS, polycystic ovary syndrome
- Pulsatility analysis
- Quantitative modelling
- Reproductive endocrinology
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Affiliation(s)
- Margaritis Voliotis
- Department of Mathematics and Living Systems Institute, College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, United Kingdom,Corresponding author: Voliotis, Margaritis
| | - Simon Hanassab
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom,Department of Computing, Imperial College London, London, United Kingdom,UKRI Centre for Doctoral Training in AI for Healthcare, Imperial College London, London, United Kingdom
| | - Ali Abbara
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom
| | - Thomas Heinis
- Department of Computing, Imperial College London, London, United Kingdom
| | - Waljit S. Dhillo
- Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom
| | - Krasimira Tsaneva-Atanasova
- Department of Mathematics and Living Systems Institute, College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, United Kingdom
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Tokuoka Y, Yamada TG, Mashiko D, Ikeda Z, Kobayashi TJ, Yamagata K, Funahashi A. An explainable deep learning-based algorithm with an attention mechanism for predicting the live birth potential of mouse embryos. Artif Intell Med 2022; 134:102432. [PMID: 36462898 DOI: 10.1016/j.artmed.2022.102432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 08/13/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022]
Abstract
In assisted reproductive technology (ART), embryos produced by in vitro fertilization (IVF) are graded according to their live birth potential, and high-grade embryos are preferentially transplanted. However, rates of live birth following clinical ART remain low worldwide. Grading is based on the embryo shape at a limited number of stages and does not consider the shape of embryos and intracellular structures, e.g., nuclei, at various stages important for normal embryogenesis. Here, we developed a Normalized Multi-View Attention Network (NVAN) that directly predicts live birth potential from the nuclear structure in live-cell fluorescence images of mouse embryos from zygote to across a wide range of stages. The input is morphological features of cell nuclei, which were extracted as multivariate time-series data by using the segmentation algorithm for mouse embryos. The classification accuracy of our method (83.87%) greatly exceeded that of existing machine-learning methods and that of visual inspection by embryo culture specialists. Our method also has a new attention mechanism that allows us to determine which values of multivariate time-series data, used to describe nuclear morphology, were the basis for the prediction. By visualizing the features that contributed most to the prediction of live birth potential, we found that the size and shape of the nucleus at the morula stage and at the time of cell division were important for live birth prediction. We anticipate that our method will help ART and developmental engineering as a new basic technology for IVF embryo selection.
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Affiliation(s)
- Yuta Tokuoka
- Center for Biosciences and Informatics, Graduate School of Fundamental Science and Technology, Keio University, 3-14-1 Hiyoshi, Kouhoku-ku, Yokohama, 223-8522, Japan
| | - Takahiro G Yamada
- Center for Biosciences and Informatics, Graduate School of Fundamental Science and Technology, Keio University, 3-14-1 Hiyoshi, Kouhoku-ku, Yokohama, 223-8522, Japan; Department of Biosciences and Informatics, Keio University, 3-14-1 Hiyoshi, Kouhoku-ku, Yokohama, 223-8522, Japan
| | - Daisuke Mashiko
- Faculty of Biology-Oriented Science and Technology, Kindai University, 930 Nishimitani, Kinokawa, Wakayama, 649-6493, Japan
| | - Zenki Ikeda
- Faculty of Biology-Oriented Science and Technology, Kindai University, 930 Nishimitani, Kinokawa, Wakayama, 649-6493, Japan
| | - Tetsuya J Kobayashi
- Institute of Industrial Science, The University of Tokyo, 4-6-1 Komaba, Meguro-ku, Tokyo, 153-8505, Japan
| | - Kazuo Yamagata
- Faculty of Biology-Oriented Science and Technology, Kindai University, 930 Nishimitani, Kinokawa, Wakayama, 649-6493, Japan
| | - Akira Funahashi
- Center for Biosciences and Informatics, Graduate School of Fundamental Science and Technology, Keio University, 3-14-1 Hiyoshi, Kouhoku-ku, Yokohama, 223-8522, Japan; Department of Biosciences and Informatics, Keio University, 3-14-1 Hiyoshi, Kouhoku-ku, Yokohama, 223-8522, Japan.
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Morphometric evaluation of two-pronucleus zygote images using image-processing techniques. ZYGOTE 2022; 30:819-829. [PMID: 35974446 DOI: 10.1017/s0967199422000326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Identifying embryos with a high potential for implementation remains a challenge in in vitro fertilization (IVF) cycles. Despite progress in IVF treatment, only a minority of generated embryos has the ability to implant. Another drawback of this practice is the high frequency of multiple pregnancies. This problem leads to economic and health problems. Therefore, the transfer of a single embryo with high implantation potential is the ideal strategy. Morphometric evaluation of two-pronucleus zygote images is a helpful technique when aiming to transfer a single embryo with a high implantation potential. In this study, an automated zygote morphometric evaluation algorithm, called the zygote morphology evaluation (ZME) algorithm, was created to analyze the zygote and provide morphological measurements. The first and most crucial step of the ZME algorithm is the noise reduction step, which was first applied to zygote images. After that, the proposed algorithm detects different parts of the zygote that are indicators of embryo viability and normality, that is the oolemma, perivitelline space, zona pellucida, and nucleolar precursor bodies (NPBs). In addition, a novel dataset was prepared for this task. This dataset consisted of 703 human zygote images, and called the human zygote morphometric evaluation dataset (HZME-DS). Our experimental results in the HZME-DS showed that the ZME algorithm was able to achieve 79.58% average accuracy in identifying the oolemma region, 79.40% average accuracy in determining the perivitelline space, and 79.72% accuracy in identifying the zona pellucida. To calculate the accuracy of identifying NPBs, the proposed algorithm uses Recall and Precision measures, and their harmonic average (F1 measure) reached values of 81.14% and 79.53%, respectively. These encouraging results for our proposed method, which is an automatic and very fast method, showed that the ZME algorithm could help embryologists to evaluate the best zygotes in real time and the best embryos subsequently.
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Payá E, Bori L, Colomer A, Meseguer M, Naranjo V. Automatic characterization of human embryos at day 4 post-insemination from time-lapse imaging using supervised contrastive learning and inductive transfer learning techniques. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 221:106895. [PMID: 35609359 DOI: 10.1016/j.cmpb.2022.106895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/03/2022] [Accepted: 05/15/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Embryo morphology is a predictive marker for implantation success and ultimately live births. Viability evaluation and quality grading are commonly used to select the embryo with the highest implantation potential. However, the traditional method of manual embryo assessment is time-consuming and highly susceptible to inter- and intra-observer variability. Automation of this process results in more objective and accurate predictions. METHOD In this paper, we propose a novel methodology based on deep learning to automatically evaluate the morphological appearance of human embryos from time-lapse imaging. A supervised contrastive learning framework is implemented to predict embryo viability at day 4 and day 5, and an inductive transfer approach is applied to classify embryo quality at both times. RESULTS Results showed that both methods outperformed conventional approaches and improved state-of-the-art embryology results for an independent test set. The viability result achieved an accuracy of 0.8103 and 0.9330 and the quality results reached values of 0.7500 and 0.8001 for day 4 and day 5, respectively. Furthermore, qualitative results kept consistency with the clinical interpretation. CONCLUSIONS The proposed methods are up to date with the artificial intelligence literature and have been proven to be promising. Furthermore, our findings represent a breakthrough in the field of embryology in that they study the possibilities of embryo selection at day 4. Moreover, the grad-CAMs findings are directly in line with embryologists' decisions. Finally, our results demonstrated excellent potential for the inclusion of the models in clinical practice.
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Affiliation(s)
- Elena Payá
- Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, 46022, Spain; IVI-RMA Valencia, Spain.
| | | | - Adrián Colomer
- Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, 46022, Spain
| | | | - Valery Naranjo
- Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, 46022, Spain
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Improved Deep Convolutional Neural Networks via Boosting for Predicting the Quality of In Vitro Bovine Embryos. ELECTRONICS 2022. [DOI: 10.3390/electronics11091363] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Automated diagnosis for the quality of bovine in vitro-derived embryos based on imaging data is an important research problem in developmental biology. By predicting the quality of embryos correctly, embryologists can (1) avoid the time-consuming and tedious work of subjective visual examination to assess the quality of embryos; (2) automatically perform real-time evaluation of embryos, which accelerates the examination process; and (3) possibly avoid the economic, social, and medical implications caused by poor-quality embryos. While generated embryo images provide an opportunity for analyzing such images, there is a lack of consistent noninvasive methods utilizing deep learning to assess the quality of embryos. Hence, designing high-performance deep learning algorithms is crucial for data analysts who work with embryologists. A key goal of this study is to provide advanced deep learning tools to embryologists, who would, in turn, use them as prediction calculators to evaluate the quality of embryos. The proposed deep learning approaches utilize a modified convolutional neural network, with or without boosting techniques, to improve the prediction performance. Experimental results on image data pertaining to in vitro bovine embryos show that our proposed deep learning approaches perform better than existing baseline approaches in terms of prediction performance and statistical significance.
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An Image Processing Protocol to Extract Variables Predictive of Human Embryo Fitness for Assisted Reproduction. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12073531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Despite the use of new techniques on embryo selection and the presence of equipment on the market, such as EmbryoScope® and Geri®, which help in the evaluation of embryo quality, there is still a subjectivity between the embryologist’s classifications, which are subjected to inter- and intra-observer variability, therefore compromising the successful implantation of the embryo. Nonetheless, with the acquisition of images through the time-lapse system, it is possible to perform digital processing of these images, providing a better analysis of the embryo, in addition to enabling the automatic analysis of a large volume of information. An image processing protocol was developed using well-established techniques to segment the image of blastocysts and extract variables of interest. A total of 33 variables were automatically generated by digital image processing, each one representing a different aspect of the embryo and describing a different characteristic of the blastocyst. These variables can be categorized into texture, gray-level average, gray-level standard deviation, modal value, relations, and light level. The automated and directed steps of the proposed processing protocol exclude spurious results, except when image quality (e.g., focus) prevents correct segmentation. The image processing protocol can segment human blastocyst images and automatically extract 33 variables that describe quantitative aspects of the blastocyst’s regions, with potential utility in embryo selection for assisted reproductive technology (ART).
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Dhombres F, Bonnard J, Bailly K, Maurice P, Papageorghiou A, Jouannic JM. Contributions of artificial intelligence reported in Obstetrics and Gynecology journals: a systematic review. J Med Internet Res 2022; 24:e35465. [PMID: 35297766 PMCID: PMC9069308 DOI: 10.2196/35465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/11/2022] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background The applications of artificial intelligence (AI) processes have grown significantly in all medical disciplines during the last decades. Two main types of AI have been applied in medicine: symbolic AI (eg, knowledge base and ontologies) and nonsymbolic AI (eg, machine learning and artificial neural networks). Consequently, AI has also been applied across most obstetrics and gynecology (OB/GYN) domains, including general obstetrics, gynecology surgery, fetal ultrasound, and assisted reproductive medicine, among others. Objective The aim of this study was to provide a systematic review to establish the actual contributions of AI reported in OB/GYN discipline journals. Methods The PubMed database was searched for citations indexed with “artificial intelligence” and at least one of the following medical subject heading (MeSH) terms between January 1, 2000, and April 30, 2020: “obstetrics”; “gynecology”; “reproductive techniques, assisted”; or “pregnancy.” All publications in OB/GYN core disciplines journals were considered. The selection of journals was based on disciplines defined in Web of Science. The publications were excluded if no AI process was used in the study. Review, editorial, and commentary articles were also excluded. The study analysis comprised (1) classification of publications into OB/GYN domains, (2) description of AI methods, (3) description of AI algorithms, (4) description of data sets, (5) description of AI contributions, and (6) description of the validation of the AI process. Results The PubMed search retrieved 579 citations and 66 publications met the selection criteria. All OB/GYN subdomains were covered: obstetrics (41%, 27/66), gynecology (3%, 2/66), assisted reproductive medicine (33%, 22/66), early pregnancy (2%, 1/66), and fetal medicine (21%, 14/66). Both machine learning methods (39/66) and knowledge base methods (25/66) were represented. Machine learning used imaging, numerical, and clinical data sets. Knowledge base methods used mostly omics data sets. The actual contributions of AI were method/algorithm development (53%, 35/66), hypothesis generation (42%, 28/66), or software development (3%, 2/66). Validation was performed on one data set (86%, 57/66) and no external validation was reported. We observed a general rising trend in publications related to AI in OB/GYN over the last two decades. Most of these publications (82%, 54/66) remain out of the scope of the usual OB/GYN journals. Conclusions In OB/GYN discipline journals, mostly preliminary work (eg, proof-of-concept algorithm or method) in AI applied to this discipline is reported and clinical validation remains an unmet prerequisite. Improvement driven by new AI research guidelines is expected. However, these guidelines are covering only a part of AI approaches (nonsymbolic) reported in this review; hence, updates need to be considered.
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Affiliation(s)
- Ferdinand Dhombres
- Sorbonne University, Armand Trousseau University hospital, Fetal Medicine department, APHP, Armand Trousseau University hospital, Fetal Medicine department, APHP26 AV du Dr Arnold Netter, Paris, FR.,INSERM, Laboratory in Medical Informatics and Knowledge Engineering in e-Health (LIMICS), Paris, FR
| | - Jules Bonnard
- Sorbonne University, Institute for Intelligent Systems and Robotics (ISIR), Paris, FR
| | - Kévin Bailly
- Sorbonne University, Institute for Intelligent Systems and Robotics (ISIR), Paris, FR
| | - Paul Maurice
- Sorbonne University, Armand Trousseau University hospital, Fetal Medicine department, APHP, Paris, FR
| | - Aris Papageorghiou
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, GB
| | - Jean-Marie Jouannic
- Sorbonne University, Armand Trousseau University hospital, Fetal Medicine department, APHP, Paris, FR.,INSERM, Laboratory in Medical Informatics and Knowledge Engineering in e-Health (LIMICS), Paris, FR
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Chen L, Li W, Liu Y, Peng Z, Cai L, Zhang N, Xu J, Wang L, Teng X, Yao Y, Zou Y, Ma M, Liu J, Lu S, Sun H, Yao B. Non-invasive embryo selection strategy for clinical in vitro fertilization to avoid wastage of potentially competent embryos. Reprod Biomed Online 2022; 45:26-34. [DOI: 10.1016/j.rbmo.2022.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/14/2021] [Accepted: 03/07/2022] [Indexed: 12/09/2022]
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12
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Enatsu N, Miyatsuka I, An LM, Inubushi M, Enatsu K, Otsuki J, Iwasaki T, Kokeguchi S, Shiotani M. A novel system based on artificial intelligence for predicting blastocyst viability and visualizing the explanation. Reprod Med Biol 2022; 21:e12443. [PMID: 35386375 PMCID: PMC8967284 DOI: 10.1002/rmb2.12443] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose The purpose of the study was to invent and evaluate the novel artificial intelligence (AI) system named Fertility image Testing Through Embryo (FiTTE) for predicting blastocyst viability and visualizing the explanations via gradient‐based localization. Methods The authors retrospectively analyzed 19 342 static blastocyst images with related inspection histories from 9961 infertile patients who underwent in vitro fertilization. Among these data, 17 984 cycles of single‐blastocyst transfer were used for training, and data from 1358 cycles were used for testing purposes. Results The prediction accuracy for clinical pregnancy achieved by a control model using conventional Gardner scoring system was 59.8%, and area under the curve (AUC) was 0.62. FiTTE improved the prediction accuracy by using blastocyst images to 62.7% and AUC of 0.68. Additionally, the accuracy achieved by an ensemble model using image plus clinical data was 65.2% and AUC was 0.71, representing an improvement in prediction accuracy. The visualization algorithm showed brighter colors with blastocysts that resulted in clinical pregnancy. Conclusions The authors invented the novel AI system, FiTTE, which could provide more precise prediction of the probability of clinical pregnancy using blastocyst images secondary to single embryo transfer than the conventional Gardner scoring assessments. FiTTE could also provide explanation of AI prediction using colored blastocyst images.
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Affiliation(s)
| | | | | | | | | | - Junko Otsuki
- Hanabusa Women’s Clinic Kobe Hyogo Japan
- Assisted Reproductive Technology Center Okayama University Okayama Japan
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Arsalan M, Haider A, Choi J, Park KR. Detecting Blastocyst Components by Artificial Intelligence for Human Embryological Analysis to Improve Success Rate of In Vitro Fertilization. J Pers Med 2022; 12:jpm12020124. [PMID: 35207617 PMCID: PMC8877842 DOI: 10.3390/jpm12020124] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/06/2022] [Accepted: 01/13/2022] [Indexed: 01/06/2023] Open
Abstract
Morphological attributes of human blastocyst components and their characteristics are highly correlated with the success rate of in vitro fertilization (IVF). Blastocyst component analysis aims to choose the most viable embryos to improve the success rate of IVF. The embryologist evaluates blastocyst viability by manual microscopic assessment of its components, such as zona pellucida (ZP), trophectoderm (TE), blastocoel (BL), and inner cell mass (ICM). With the success of deep learning in the medical diagnosis domain, semantic segmentation has the potential to detect crucial components of human blastocysts for computerized analysis. In this study, a sprint semantic segmentation network (SSS-Net) is proposed to accurately detect blastocyst components for embryological analysis. The proposed method is based on a fully convolutional semantic segmentation scheme that provides the pixel-wise classification of important blastocyst components that help to automatically check the morphologies of these elements. The proposed SSS-Net uses the sprint convolutional block (SCB), which uses asymmetric kernel convolutions in combination with depth-wise separable convolutions to reduce the overall cost of the network. SSS-Net is a shallow architecture with dense feature aggregation, which helps in better segmentation. The proposed SSS-Net consumes a smaller number of trainable parameters (4.04 million) compared to state-of-the-art methods. The SSS-Net was evaluated using a publicly available human blastocyst image dataset for component segmentation. The experimental results confirm that our proposal provides promising segmentation performance with a Jaccard Index of 82.88%, 77.40%, 88.39%, 84.94%, and 96.03% for ZP, TE, BL, ICM, and background, with residual connectivity, respectively. It is also provides a Jaccard Index of 84.51%, 78.15%, 88.68%, 84.50%, and 95.82% for ZP, TE, BL, ICM, and background, with dense connectivity, respectively. The proposed SSS-Net is providing a mean Jaccard Index (Mean JI) of 85.93% and 86.34% with residual and dense connectivity, respectively; this shows effective segmentation of blastocyst components for embryological analysis.
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Huang B, Zheng S, Ma B, Yang Y, Zhang S, Jin L. Using deep learning to predict the outcome of live birth from more than 10,000 embryo data. BMC Pregnancy Childbirth 2022; 22:36. [PMID: 35034623 PMCID: PMC8761300 DOI: 10.1186/s12884-021-04373-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 12/29/2021] [Indexed: 12/04/2022] Open
Abstract
Background Recently, the combination of deep learning and time-lapse imaging provides an objective, standard and scientific solution for embryo selection. However, the reported studies were based on blastocyst formation or clinical pregnancy as the end point. To the best of our knowledge, there is no predictive model that uses the outcome of live birth as the predictive end point. Can a deep learning model predict the probability of live birth from time-lapse system? Methods This study retrospectively analyzed the time-lapse data and live birth outcomes of embryos samples from January 2018 to November 2019. We used the SGD optimizer with an initial learning rate of 0.025 and cosine learning rate reduction strategy. The network is randomly initialized and trained for 200 epochs from scratch. The model is quantitively evaluated over a hold-out test and a 5-fold cross-validation by the average area under the curve (AUC) of the receiver operating characteristic (ROC) curve. Results The deep learning model was able to predict live birth outcomes from time-lapse images with an AUC of 0.968 in 5-fold stratified cross-validation. Conclusions This research reported a deep learning model that predicts the live birth outcome of a single blastocyst transfer. This efficient model for predicting the outcome of live births can automatically analyze the time-lapse images of the patient’s embryos without the need for manual embryo annotation and evaluation, and then give a live birth prediction score for each embryo, and sort the embryos by the predicted value. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04373-5.
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Affiliation(s)
- Bo Huang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Shunyuan Zheng
- School of Computer Science and Technology, Harbin Institute of Technology, Weihai, 264209, China
| | - Bingxin Ma
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Yongle Yang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Shengping Zhang
- School of Computer Science and Technology, Harbin Institute of Technology, Weihai, 264209, China.
| | - Lei Jin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
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15
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Barbounaki S, Vivilaki VG. Intelligent systems in obstetrics and midwifery: Applications of machine learning. Eur J Midwifery 2022; 5:58. [PMID: 35005483 PMCID: PMC8686058 DOI: 10.18332/ejm/143166] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Machine learning is increasingly utilized over recent years in order to develop models that represent and solve problems in a variety of domains, including those of obstetrics and midwifery. The aim of this systematic review was to analyze research studies on machine learning and intelligent systems applications in midwifery and obstetrics. METHODS A thorough literature review was performed in four electronic databases (PubMed, APA PsycINFO, SCOPUS, ScienceDirect). Only articles that discussed machine learning and intelligent systems applications in midwifery and obstetrics, were considered in this review. Selected articles were critically evaluated as for their relevance and a contextual synthesis was conducted. RESULTS Thirty-two articles were included in this systematic review as they met the inclusion and methodological criteria specified in this study. The results suggest that machine learning and intelligent systems have produced successful models and systems in a broad list of midwifery and obstetrics topics, such as diagnosis, pregnancy risk assessment, fetal monitoring, bladder tumor, etc. CONCLUSIONS This systematic review suggests that machine learning represents a very promising area of artificial intelligence for the development of practical and highly effective applications that can support human experts, as well the investigation of a wide range of exciting opportunities for further research.
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Affiliation(s)
- Stavroula Barbounaki
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Victoria G Vivilaki
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
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16
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AIM in Obstetrics and Gynecology. Artif Intell Med 2022. [DOI: 10.1007/978-3-030-64573-1_306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Riegler MA, Stensen MH, Witczak O, Andersen JM, Hicks SA, Hammer HL, Delbarre E, Halvorsen P, Yazidi A, Holst N, Haugen TB. Artificial intelligence in the fertility clinic: status, pitfalls and possibilities. Hum Reprod 2021; 36:2429-2442. [PMID: 34324672 DOI: 10.1093/humrep/deab168] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/21/2021] [Indexed: 12/15/2022] Open
Abstract
In recent years, the amount of data produced in the field of ART has increased exponentially. The diversity of data is large, ranging from videos to tabular data. At the same time, artificial intelligence (AI) is progressively used in medical practice and may become a promising tool to improve success rates with ART. AI models may compensate for the lack of objectivity in several critical procedures in fertility clinics, especially embryo and sperm assessments. Various models have been developed, and even though several of them show promising performance, there are still many challenges to overcome. In this review, we present recent research on AI in the context of ART. We discuss the strengths and weaknesses of the presented methods, especially regarding clinical relevance. We also address the pitfalls hampering successful use of AI in the clinic and discuss future possibilities and important aspects to make AI truly useful for ART.
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Affiliation(s)
- M A Riegler
- Department of Holistic Systems, Simula Metropolitan Center for Digital Engineering, Oslo, Norway
| | | | - O Witczak
- Department of Life Sciences and Health, Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - J M Andersen
- Department of Life Sciences and Health, Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - S A Hicks
- Department of Holistic Systems, Simula Metropolitan Center for Digital Engineering, Oslo, Norway.,Department of Computer Science, Faculty of Technology, Art and Design, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - H L Hammer
- Department of Holistic Systems, Simula Metropolitan Center for Digital Engineering, Oslo, Norway.,Department of Computer Science, Faculty of Technology, Art and Design, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - E Delbarre
- Department of Life Sciences and Health, Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - P Halvorsen
- Department of Holistic Systems, Simula Metropolitan Center for Digital Engineering, Oslo, Norway.,Department of Computer Science, Faculty of Technology, Art and Design, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - A Yazidi
- Department of Computer Science, Faculty of Technology, Art and Design, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - N Holst
- Fertilitetssenteret, Oslo, Norway
| | - T B Haugen
- Department of Life Sciences and Health, Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, Oslo, Norway
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18
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Zaninovic N, Rosenwaks Z. Artificial intelligence in human in vitro fertilization and embryology. Fertil Steril 2021; 114:914-920. [PMID: 33160513 DOI: 10.1016/j.fertnstert.2020.09.157] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023]
Abstract
Embryo evaluation and selection embody the aggregate manifestation of the entire in vitro fertilization (IVF) process. It aims to choose the "best" embryos from the larger cohort of fertilized oocytes, the majority of which will be determined to be not viable either as a result of abnormal development or due to chromosomal imbalances. Indeed, it is generally acknowledged that even after embryo selection based on morphology, time-lapse microscopic photography, or embryo biopsy with preimplantation genetic testing, implantation rates in the human are difficult to predict. Our pursuit of enhancing embryo evaluation and selection, as well as increasing live birth rates, will require the adoption of novel technologies. Recently, several artificial intelligence (AI)-based methods have emerged as objective, standardized, and efficient tools for evaluating human embryos. Moreover, AI-based methods can be implemented for other clinical aspects of IVF, such as assessing patient reproductive potential and individualizing gonadotropin stimulation protocols. As AI has the capability to analyze "big" data, the ultimate goal will be to apply AI tools to the analysis of all embryological, clinical, and genetic data in an effort to provide patient-tailored treatments. In this chapter, we present an overview of existing AI technologies in reproductive medicine and envision their potential future applications in the field.
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Affiliation(s)
- Nikica Zaninovic
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York.
| | - Zev Rosenwaks
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York
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19
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Ferrick L, Lee YSL, Gardner DK. Metabolic activity of human blastocysts correlates with their morphokinetics, morphological grade, KIDScore and artificial intelligence ranking. Hum Reprod 2021; 35:2004-2016. [PMID: 32829415 DOI: 10.1093/humrep/deaa181] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/18/2020] [Indexed: 01/15/2023] Open
Abstract
STUDY QUESTION Is there a relationship between blastocyst metabolism and biomarkers of embryo viability? SUMMARY ANSWER Blastocysts with higher developmental potential and a higher probability of resulting in a viable pregnancy consume higher levels of glucose and exhibit distinct amino acid profiles. WHAT IS KNOWN ALREADY Morphological and morphokinetic analyses utilized in embryo selection provide insight into developmental potential, but alone are unable to provide a direct measure of embryo physiology and inherent health. Glucose uptake is a physiological biomarker of viability and amino acid utilization is different between embryos of varying qualities. STUDY DESIGN, SIZE, DURATION Two hundred and nine human preimplantation embryos from 50 patients were cultured in a time-lapse incubator system in both freeze all and fresh transfer cycles. A retrospective analysis of morphokinetics, morphology (Gardner grade), KIDScore, artificial intelligence grade (EmbryoScore), glucose and amino acid metabolism, and clinical pregnancies was conducted. PARTICIPANTS/MATERIALS, SETTING, METHODS ICSI was conducted in all patients, who were aged ≤37 years and previously had no more than two IVF cycles. Embryos were individually cultured in a time-lapse incubator system, and those reaching the blastocyst stage had their morphokinetics annotated and were each assigned a Gardner grade, KIDScore and EmbryoScore. Glucose and amino acid metabolism were measured. Clinical pregnancies were confirmed by the presence of a fetal heartbeat at 6 weeks of gestation. MAIN RESULTS AND THE ROLE OF CHANCE Glucose consumption was at least 40% higher in blastocysts deemed of high developmental potential using either the Gardner grade (P < 0.01, n = 209), KIDScore (P < 0.05, n = 207) or EmbryoScore (P < 0.05, n = 184), compared to less viable blastocysts and in blastocysts that resulted in a clinical pregnancy compared to those that failed to implant (P < 0.05, n = 37). Additionally, duration of cavitation was inversely related to glucose consumption (P < 0.05, n = 200). Total amino acid consumption was significantly higher in blastocysts with an EmbryoScore higher than the cohort median score (P < 0.01, n = 185). Furthermore, the production of amino acids was significantly lower in blastocysts with a high Gardner grade (P < 0.05, n = 209), KIDScore (P < 0.05, n = 207) and EmbryoScore (P < 0.01, n = 184). LIMITATIONS, REASONS FOR CAUTION Samples were collected from patients who had ICSI treatment and from only one clinic. WIDER IMPLICATIONS OF THE FINDINGS These results confirm that metabolites, such as glucose and amino acids, are valid biomarkers of embryo viability and could therefore be used in conjunction with other systems to aid in the selection of a healthy embryo. STUDY FUNDING/COMPETING INTEREST(S) Work was supported by Virtus Health. D.K.G is contracted with Virtus Health. The other authors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Laura Ferrick
- School of BioSciences, University of Melbourne, Melbourne, VIC 3010, Australia
| | | | - David K Gardner
- School of BioSciences, University of Melbourne, Melbourne, VIC 3010, Australia.,Melbourne IVF, East Melbourne, Melbourne, VIC 3002, Australia
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20
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Letterie G. Three ways of knowing: the integration of clinical expertise, evidence-based medicine, and artificial intelligence in assisted reproductive technologies. J Assist Reprod Genet 2021; 38:1617-1625. [PMID: 33870475 DOI: 10.1007/s10815-021-02159-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/16/2021] [Indexed: 12/12/2022] Open
Abstract
Decision-making in fertility care is on the cusp of a significant frameshift. Online tools to integrate artificial intelligence into the decision-making process across all aspects of ART are rapidly emerging. These tools have the potential to improve outcomes and transition decision-making from one based on traditional provider centric assessments toward a hybrid triad of expertise, evidence, and algorithmic data analytics using AI. We can look forward to a time when AI will be the third part of a provider's tool box to complement expertise and medical literature to enable ever more accurate predictions and outcomes in ART. In their fully integrated format, these tools will be part of a digital fertility ecosystem of analytics embedded within an EMR. To date, the impact of AI on ART outcomes is inconclusive. No prospective studies have shown clear cut benefit or cost reductions over current practices, but we are very early in the process of developing and evaluating these tools. We owe it to ourselves to begin to examine these AI-driven analytics and develop a very clear idea about where we can and should go before we roll these tools into clinical care. Thoughtful scrutiny is essential lest we find ourselves in a position of trying to modulate and modify after entry of these tools into our clinics and patient care. The purpose of this commentary is to highlight the evolution and impact AI has had in other fields relevant to the fertility sector and describe a vision for applications within ART that could improve outcomes, reduce costs, and positively impact clinical care.
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Affiliation(s)
- Gerard Letterie
- Seattle Reproductive Medicine, 1505 Westlake Avenue, Suite 400, Seattle, WA, 98104, USA.
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21
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Coticchio G, Behr B, Campbell A, Meseguer M, Morbeck DE, Pisaturo V, Plancha CE, Sakkas D, Xu Y, D'Hooghe T, Cottell E, Lundin K. Fertility technologies and how to optimize laboratory performance to support the shortening of time to birth of a healthy singleton: a Delphi consensus. J Assist Reprod Genet 2021; 38:1021-1043. [PMID: 33599923 DOI: 10.1007/s10815-021-02077-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/18/2021] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Giovanni Coticchio
- 9.baby Family and Fertility Center, Via Dante, 15, 40125, Bologna, Italy.
| | - Barry Behr
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | - Dean E Morbeck
- Fertility Associates, Auckland, New Zealand
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Valerio Pisaturo
- Reproductive Medicine Department, International Evangelical Hospital, Genoa, Italy
| | - Carlos E Plancha
- Inst. Histologia e Biologia do Desenvolvimento, Faculdade de Medicina, Universidade de Lisboa and CEMEARE, Lisbon, Portugal
| | - Denny Sakkas
- Boston IVF, Waltham, MA, USA
- Department of Obstetrics and Gynecology, Yale University, New Haven, CT, USA
| | - Yanwen Xu
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Thomas D'Hooghe
- Department of Obstetrics and Gynecology, Yale University, New Haven, CT, USA
- Global Medical Affairs Fertility, R&D Biopharma, Merck KGaA, Darmstadt, Germany
- Department of Development and Regeneration, Biomedical Sciences Group, KU Leuven (University of Leuven), Leuven, Belgium
| | - Evelyn Cottell
- Global Medical Affairs Fertility, R&D Biopharma, Merck KGaA, Darmstadt, Germany
| | - Kersti Lundin
- Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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22
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AIM in Obstetrics and Gynecology. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-58080-3_306-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Sufriyana H, Husnayain A, Chen YL, Kuo CY, Singh O, Yeh TY, Wu YW, Su ECY. Comparison of Multivariable Logistic Regression and Other Machine Learning Algorithms for Prognostic Prediction Studies in Pregnancy Care: Systematic Review and Meta-Analysis. JMIR Med Inform 2020; 8:e16503. [PMID: 33200995 PMCID: PMC7708089 DOI: 10.2196/16503] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 06/22/2020] [Accepted: 10/24/2020] [Indexed: 02/06/2023] Open
Abstract
Background Predictions in pregnancy care are complex because of interactions among multiple factors. Hence, pregnancy outcomes are not easily predicted by a single predictor using only one algorithm or modeling method. Objective This study aims to review and compare the predictive performances between logistic regression (LR) and other machine learning algorithms for developing or validating a multivariable prognostic prediction model for pregnancy care to inform clinicians’ decision making. Methods Research articles from MEDLINE, Scopus, Web of Science, and Google Scholar were reviewed following several guidelines for a prognostic prediction study, including a risk of bias (ROB) assessment. We report the results based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were primarily framed as PICOTS (population, index, comparator, outcomes, timing, and setting): Population: men or women in procreative management, pregnant women, and fetuses or newborns; Index: multivariable prognostic prediction models using non-LR algorithms for risk classification to inform clinicians’ decision making; Comparator: the models applying an LR; Outcomes: pregnancy-related outcomes of procreation or pregnancy outcomes for pregnant women and fetuses or newborns; Timing: pre-, inter-, and peripregnancy periods (predictors), at the pregnancy, delivery, and either puerperal or neonatal period (outcome), and either short- or long-term prognoses (time interval); and Setting: primary care or hospital. The results were synthesized by reporting study characteristics and ROBs and by random effects modeling of the difference of the logit area under the receiver operating characteristic curve of each non-LR model compared with the LR model for the same pregnancy outcomes. We also reported between-study heterogeneity by using τ2 and I2. Results Of the 2093 records, we included 142 studies for the systematic review and 62 studies for a meta-analysis. Most prediction models used LR (92/142, 64.8%) and artificial neural networks (20/142, 14.1%) among non-LR algorithms. Only 16.9% (24/142) of studies had a low ROB. A total of 2 non-LR algorithms from low ROB studies significantly outperformed LR. The first algorithm was a random forest for preterm delivery (logit AUROC 2.51, 95% CI 1.49-3.53; I2=86%; τ2=0.77) and pre-eclampsia (logit AUROC 1.2, 95% CI 0.72-1.67; I2=75%; τ2=0.09). The second algorithm was gradient boosting for cesarean section (logit AUROC 2.26, 95% CI 1.39-3.13; I2=75%; τ2=0.43) and gestational diabetes (logit AUROC 1.03, 95% CI 0.69-1.37; I2=83%; τ2=0.07). Conclusions Prediction models with the best performances across studies were not necessarily those that used LR but also used random forest and gradient boosting that also performed well. We recommend a reanalysis of existing LR models for several pregnancy outcomes by comparing them with those algorithms that apply standard guidelines. Trial Registration PROSPERO (International Prospective Register of Systematic Reviews) CRD42019136106; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=136106
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Affiliation(s)
- Herdiantri Sufriyana
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,Department of Medical Physiology, College of Medicine, University of Nahdlatul Ulama Surabaya, Surabaya, Indonesia
| | - Atina Husnayain
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ya-Lin Chen
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Chao-Yang Kuo
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Onkar Singh
- Bioinformatics Program, Taiwan International Graduate Program, Institute of Information Science, Academia Sinica, Taipei, Taiwan.,Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
| | - Tso-Yang Yeh
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Wei Wu
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Emily Chia-Yu Su
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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24
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Leahy BD, Jang WD, Yang HY, Struyven R, Wei D, Sun Z, Lee KR, Royston C, Cam L, Kalma Y, Azem F, Ben-Yosef D, Pfister H, Needleman D. Automated Measurements of Key Morphological Features of Human Embryos for IVF. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION : MICCAI ... INTERNATIONAL CONFERENCE ON MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION 2020; 12265:25-35. [PMID: 33313603 PMCID: PMC7732604 DOI: 10.1007/978-3-030-59722-1_3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A major challenge in clinical In-Vitro Fertilization (IVF) is selecting the highest quality embryo to transfer to the patient in the hopes of achieving a pregnancy. Time-lapse microscopy provides clinicians with a wealth of information for selecting embryos. However, the resulting movies of embryos are currently analyzed manually, which is time consuming and subjective. Here, we automate feature extraction of time-lapse microscopy of human embryos with a machine-learning pipeline of five convolutional neural networks (CNNs). Our pipeline consists of (1) semantic segmentation of the regions of the embryo, (2) regression predictions of fragment severity, (3) classification of the developmental stage, and object instance segmentation of (4) cells and (5) pronuclei. Our approach greatly speeds up the measurement of quantitative, biologically relevant features that may aid in embryo selection.
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Affiliation(s)
- B D Leahy
- School of Engineering and Applied Sciences,Harvard University, Cambridge MA 02138, USA
- Department of Molecular and Cellular Biology,Harvard University, Cambridge MA 02138, USA
| | - W-D Jang
- School of Engineering and Applied Sciences,Harvard University, Cambridge MA 02138, USA
| | - H Y Yang
- Harvard Graduate Program in Biophysics, Harvard University, Cambridge MA 02138, USA
| | - R Struyven
- School of Engineering and Applied Sciences,Harvard University, Cambridge MA 02138, USA
| | - D Wei
- School of Engineering and Applied Sciences,Harvard University, Cambridge MA 02138, USA
| | - Z Sun
- School of Engineering and Applied Sciences,Harvard University, Cambridge MA 02138, USA
| | - K R Lee
- Department of Molecular and Cellular Biology,Harvard University, Cambridge MA 02138, USA
| | - C Royston
- Department of Molecular and Cellular Biology,Harvard University, Cambridge MA 02138, USA
| | - L Cam
- Department of Molecular and Cellular Biology,Harvard University, Cambridge MA 02138, USA
| | - Y Kalma
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - F Azem
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - D Ben-Yosef
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - H Pfister
- School of Engineering and Applied Sciences,Harvard University, Cambridge MA 02138, USA
| | - D Needleman
- School of Engineering and Applied Sciences,Harvard University, Cambridge MA 02138, USA
- Department of Molecular and Cellular Biology,Harvard University, Cambridge MA 02138, USA
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25
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Blank C, DeCroo I, Weyers B, van Avermaet L, Tilleman K, van Rumste M, de Sutter P, Mischi M, Schoot BC. Improvement instead of stability in embryo quality between day 3-5: A possible extra predictor for blastocyst selection. Eur J Obstet Gynecol Reprod Biol 2020; 253:198-205. [PMID: 32877773 DOI: 10.1016/j.ejogrb.2020.08.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the predictive value of the dynamic morphological development process between cleavage-stage and blastocyst-stage embryos. STUDY DESIGN A retrospective study was executed between 2015 and 2017 at Ghent University Hospital. A total of 996 first fresh IVF/ICSI cycles resulting in a single embryo transfer on day 5 were included. Embryos were scored on day 3 and day 5 as excellent, good, moderate or poor based on Alpha/ESHRE guidelines and Gardner and Schoolcraft scoring-system. If embryos changed category between day 3 and 5, the number of steps (between excellent; good; moderate; poor) in positive and negative direction was expressed. RESULTS On day 5, the ongoing pregnancy rate (OPR) of excellent embryos was 37.4 %. Univariate analyses showed that on day 5, both a higher cell stage, better inner cell mass and better trophectoderm were significantly associated with an ongoing pregnancy. In case of deterioration in quality of individual embryos between day 3 and day 5, the OPR was significantly lower. Conversely, improvement of embryo quality between day 3 and day 5 showed higher ongoing pregnancy rates (overall OPR of good day-3 embryos improving to excellent day-5 embryos: 30 %; moderate day 3 to excellent day 5: 50 %; poor day 3 to excellent day 5: 42 %; poor day 3 to good day 5: 20 %; poor day 3 to moderate day 5: 16 %). When embryos improved from poor on day 3 to excellent day 5 the OPR was significantly higher in comparison with embryos that did not change in quality scoring during development (steady embryos) (OR: 1.785, p < 0.05). CONCLUSION Our results suggest that it is more likely to achieve an ongoing pregnancy when transferring an embryo that has improved in quality between days 3 and 5 as opposed to one that has remained stable.
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Affiliation(s)
- C Blank
- Department of Electrical Engineering (Signal Processing Systems), Eindhoven University of Technology, Groene loper 19, Flux, Postbus 513, Eindhoven, 5600, MB, the Netherlands; Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium.
| | - I DeCroo
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium
| | - B Weyers
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium
| | - L van Avermaet
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium
| | - K Tilleman
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium
| | - M van Rumste
- Department of Obstetrics and Gynaecology, Catharina Hospital, Michelangelolaan 2, Eindhoven, 5623 EJ, the Netherlands
| | - P de Sutter
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium
| | - M Mischi
- Department of Electrical Engineering (Signal Processing Systems), Eindhoven University of Technology, Groene loper 19, Flux, Postbus 513, Eindhoven, 5600, MB, the Netherlands
| | - B C Schoot
- Department of Electrical Engineering (Signal Processing Systems), Eindhoven University of Technology, Groene loper 19, Flux, Postbus 513, Eindhoven, 5600, MB, the Netherlands; Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium; Department of Obstetrics and Gynaecology, Catharina Hospital, Michelangelolaan 2, Eindhoven, 5623 EJ, the Netherlands
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Fernandez EI, Ferreira AS, Cecílio MHM, Chéles DS, de Souza RCM, Nogueira MFG, Rocha JC. Artificial intelligence in the IVF laboratory: overview through the application of different types of algorithms for the classification of reproductive data. J Assist Reprod Genet 2020; 37:2359-2376. [PMID: 32654105 DOI: 10.1007/s10815-020-01881-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 07/03/2020] [Indexed: 12/18/2022] Open
Abstract
Over the past years, the assisted reproductive technologies (ARTs) have been accompanied by constant innovations. For instance, intracytoplasmic sperm injection (ICSI), time-lapse monitoring of the embryonic morphokinetics, and PGS are innovative techniques that increased the success of the ART. In the same trend, the use of artificial intelligence (AI) techniques is being intensively researched whether in the embryo or spermatozoa selection. Despite several studies already published, the use of AI within assisted reproduction clinics is not yet a reality. This is largely due to the different AI techniques that are being proposed to be used in the daily routine of the clinics, which causes some uncertainty in their use. To shed light on this complex scenario, this review briefly describes some of the most frequently used AI algorithms, their functionalities, and their potential use. Several databases were analyzed in search of articles where applied artificial intelligence algorithms were used on reproductive data. Our focus was on the classification of embryonic cells and semen samples. Of a total of 124 articles analyzed, 32 were selected for this review. From the proposed algorithms, most have achieved a satisfactory precision, demonstrating the potential of a wide range of AI techniques. However, the evaluation of these studies suggests the need for more standardized research to validate the proposed models and their algorithms. Routine use of AI in assisted reproduction clinics is just a matter of time. However, the choice of AI technique to be used is supported by a better understanding of the principles subjacent to each technique, that is, its robustness, pros, and cons. We provide some current (although incipient) and potential uses of AI on the clinic routine, discussing how accurate and friendly it could be. Finally, we propose some standards for AI research on the selection of the embryo to be transferred and other future hints. For us, the imminence of its use is evident, providing a revolutionary milestone that will impact the ART.
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Affiliation(s)
- Eleonora Inácio Fernandez
- Laboratory of Applied Mathematics, Department of Biological Sciences, São Paulo State University (UNESP), Campus Assis, Av. Dom Antônio, São Paulo, 2100, Brazil
| | - André Satoshi Ferreira
- Laboratory of Applied Mathematics, Department of Biological Sciences, São Paulo State University (UNESP), Campus Assis, Av. Dom Antônio, São Paulo, 2100, Brazil
| | - Matheus Henrique Miquelão Cecílio
- Laboratory of Applied Mathematics, Department of Biological Sciences, São Paulo State University (UNESP), Campus Assis, Av. Dom Antônio, São Paulo, 2100, Brazil
| | - Dóris Spinosa Chéles
- Laboratory of Applied Mathematics, Department of Biological Sciences, São Paulo State University (UNESP), Campus Assis, Av. Dom Antônio, São Paulo, 2100, Brazil.,Laboratory of Embryonic Micromanipulation, Department of Biological Sciences, São Paulo State University (UNESP), Campus Assis, Av. Dom Antônio, São Paulo, 2100, Brazil
| | - Rebeca Colauto Milanezi de Souza
- Laboratory of Applied Mathematics, Department of Biological Sciences, São Paulo State University (UNESP), Campus Assis, Av. Dom Antônio, São Paulo, 2100, Brazil
| | - Marcelo Fábio Gouveia Nogueira
- Laboratory of Embryonic Micromanipulation, Department of Biological Sciences, São Paulo State University (UNESP), Campus Assis, Av. Dom Antônio, São Paulo, 2100, Brazil
| | - José Celso Rocha
- Laboratory of Applied Mathematics, Department of Biological Sciences, São Paulo State University (UNESP), Campus Assis, Av. Dom Antônio, São Paulo, 2100, Brazil. .,Universidade Estadual Paulista Julio de Mesquita Filho, Assis, São Paulo, Brazil.
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Murugappan G, Kim JG, Kort JD, Hanson BM, Neal SA, Tiegs AW, Osman EK, Scott RT, Lathi RB. PROGNOSTIC VALUE OF BLASTOCYST GRADE AFTER FROZEN EUPLOID EMBRYO TRANSFER IN PATIENTS WITH RECURRENT PREGNANCY LOSS. F S Rep 2020; 1:113-118. [PMID: 33817669 PMCID: PMC8016183 DOI: 10.1016/j.xfre.2020.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Objective To determine if trophectoderm (TE) grade or inner cell mass (ICM) grade have predictive value after euploid frozen embryo transfer (euFET) among RPL patients. Design Retrospective cohort study. Setting Single fertility center, 2012-2018. Patients Patients with ≥ 2 prior pregnancy losses performing PGT-A with ≥1 euploid embryo for transfer. Interventions All patients underwent ICSI, trophectoderm biopsy, blastocyst grading and vitrification, and single euFET. Outcome of the first transfer was recorded. Main Outcome Measures Live birth (LB) and clinical miscarriage (CM) rates. Results 660 euFET were included. In a binomial logistic regression analysis accounting for age, BMI, AMH and day of blastocyst biopsy, ICM grade C was not significantly associated with odds of live birth (aOR 0.50, 95% CI 0.24-1.02 p=0.057), miscarriage (aOR 1.67, 95% CI 0.56-5.00, p=0.36) or biochemical pregnancy loss (aOR 1.58, 95% CI 0.53-4.75, p=0.42). TE grade C was significantly associated with odds of live birth (aOR 0.49, 95% CI 0.28-0.86, p=0.01) and was not associated with odds of miscarriage (aOR 2.00, 95% CI 0.89-4.47, p=0.09) or biochemical pregnancy loss (aOR 1.85, 95% CI 0.77-4.44, p=0.17). Blastocyst grade CC had significantly lower LB rate compared to all other blastocyst grades (p<0.05, chi-square analysis). Conclusion Embryo grade CC and TE grade C are associated with decrease in odds of LB after euFET in RPL patients. Embryo grade is not associated with odds of CM in this cohort of RPL patients, suggesting that additional embryonic or uterine factors may influence risk of pregnancy loss.
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Affiliation(s)
- Gayathree Murugappan
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, Stanford University
| | - Julia G Kim
- IVI/Reproductive Medicine Associates of New Jersey.,Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University
| | | | - Brent M Hanson
- IVI/Reproductive Medicine Associates of New Jersey.,Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University
| | - Shelby A Neal
- IVI/Reproductive Medicine Associates of New Jersey.,Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University
| | - Ashley W Tiegs
- IVI/Reproductive Medicine Associates of New Jersey.,Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University
| | - Emily K Osman
- IVI/Reproductive Medicine Associates of New Jersey.,Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University
| | - Richard T Scott
- IVI/Reproductive Medicine Associates of New Jersey.,Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University
| | - Ruth B Lathi
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, Stanford University
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Rad RM, Saeedi P, Au J, Havelock J. Trophectoderm segmentation in human embryo images via inceptioned U-Net. Med Image Anal 2020; 62:101612. [DOI: 10.1016/j.media.2019.101612] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 08/19/2019] [Accepted: 11/09/2019] [Indexed: 11/15/2022]
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Raudonis V, Paulauskaite-Taraseviciene A, Sutiene K, Jonaitis D. Towards the automation of early-stage human embryo development detection. Biomed Eng Online 2019; 18:120. [PMID: 31830988 PMCID: PMC6909649 DOI: 10.1186/s12938-019-0738-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/30/2019] [Indexed: 01/01/2023] Open
Abstract
Background Infertility and subfertility affect a significant proportion of humanity. Assisted reproductive technology has been proven capable of alleviating infertility issues. In vitro fertilisation is one such option whose success is highly dependent on the selection of a high-quality embryo for transfer. This is typically done manually by analysing embryos under a microscope. However, evidence has shown that the success rate of manual selection remains low. The use of new incubators with integrated time-lapse imaging system is providing new possibilities for embryo assessment. As such, we address this problem by proposing an approach based on deep learning for automated embryo quality evaluation through the analysis of time-lapse images. Automatic embryo detection is complicated by the topological changes of a tracked object. Moreover, the algorithm should process a large number of image files of different qualities in a reasonable amount of time. Methods We propose an automated approach to detect human embryo development stages during incubation and to highlight embryos with abnormal behaviour by focusing on five different stages. This method encompasses two major steps. First, the location of an embryo in the image is detected by employing a Haar feature-based cascade classifier and leveraging the radiating lines. Then, a multi-class prediction model is developed to identify a total cell number in the embryo using the technique of deep learning. Results The experimental results demonstrate that the proposed method achieves an accuracy of at least 90% in the detection of embryo location. The implemented deep learning approach to identify the early stages of embryo development resulted in an overall accuracy of over 92% using the selected architectures of convolutional neural networks. The most problematic stage was the 3-cell stage, presumably due to its short duration during development. Conclusion This research contributes to the field by proposing a model to automate the monitoring of early-stage human embryo development. Unlike in other imaging fields, only a few published attempts have involved leveraging deep learning in this field. Therefore, the approach presented in this study could be used in the creation of novel algorithms integrated into the assisted reproductive technology used by embryologists.
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Affiliation(s)
- Vidas Raudonis
- Department of Automation, Kaunas University of Technology, 51367, Kaunas, Lithuania
| | | | - Kristina Sutiene
- Department of Mathematical Modelling, Kaunas University of Technology, 51368, Kaunas, Lithuania.
| | - Domas Jonaitis
- Department of Automation, Kaunas University of Technology, 51367, Kaunas, Lithuania
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30
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Automatic grading of human blastocysts from time-lapse imaging. Comput Biol Med 2019; 115:103494. [PMID: 31630027 DOI: 10.1016/j.compbiomed.2019.103494] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Blastocyst morphology is a predictive marker for implantation success of in vitro fertilized human embryos. Morphology grading is therefore commonly used to select the embryo with the highest implantation potential. One of the challenges, however, is that morphology grading can be highly subjective when performed manually by embryologists. Grading systems generally discretize a continuous scale of low to high score, resulting in floating and unclear boundaries between grading categories. Manual annotations therefore suffer from large inter-and intra-observer variances. METHOD In this paper, we propose a method based on deep learning to automatically grade the morphological appearance of human blastocysts from time-lapse imaging. A convolutional neural network is trained to jointly predict inner cell mass (ICM) and trophectoderm (TE) grades from a single image frame, and a recurrent neural network is applied on top to incorporate temporal information of the expanding blastocysts from multiple frames. RESULTS Results showed that the method achieved above human-level accuracies when evaluated on majority votes from an independent test set labeled by multiple embryologists. Furthermore, when evaluating implantation rates for embryos grouped by morphology grades, human embryologists and our method had a similar correlation between predicted embryo quality and pregnancy outcome. CONCLUSIONS The proposed method has shown improved performance of predicting ICM and TE grades on human blastocysts when utilizing temporal information available with time-lapse imaging. The algorithm is considered at least on par with human embryologists on quality estimation, as it performed better than the average human embryologist at ICM and TE prediction and provided a slightly better correlation between predicted embryo quality and implantability than human embryologists.
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31
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Wang R, Pan W, Jin L, Li Y, Geng Y, Gao C, Chen G, Wang H, Ma D, Liao S. Artificial intelligence in reproductive medicine. Reproduction 2019; 158:R139-R154. [PMID: 30970326 PMCID: PMC6733338 DOI: 10.1530/rep-18-0523] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 04/10/2019] [Indexed: 12/16/2022]
Abstract
Artificial intelligence (AI) has experienced rapid growth over the past few years, moving from the experimental to the implementation phase in various fields, including medicine. Advances in learning algorithms and theories, the availability of large datasets and improvements in computing power have contributed to breakthroughs in current AI applications. Machine learning (ML), a subset of AI, allows computers to detect patterns from large complex datasets automatically and uses these patterns to make predictions. AI is proving to be increasingly applicable to healthcare, and multiple machine learning techniques have been used to improve the performance of assisted reproductive technology (ART). Despite various challenges, the integration of AI and reproductive medicine is bound to give an essential direction to medical development in the future. In this review, we discuss the basic aspects of AI and machine learning, and we address the applications, potential limitations and challenges of AI. We also highlight the prospects and future directions in the context of reproductive medicine.
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Affiliation(s)
- Renjie Wang
- Department of Obstetrics and Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College of HUST, Wuhan, Hubei, People’s Republic of China
| | - Wei Pan
- School of Economics and Management, Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Lei Jin
- Department of Obstetrics and Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College of HUST, Wuhan, Hubei, People’s Republic of China
| | - Yuehan Li
- Department of Obstetrics and Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College of HUST, Wuhan, Hubei, People’s Republic of China
| | - Yudi Geng
- Department of Obstetrics and Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College of HUST, Wuhan, Hubei, People’s Republic of China
| | - Chun Gao
- Department of Obstetrics and Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College of HUST, Wuhan, Hubei, People’s Republic of China
| | - Gang Chen
- Department of Obstetrics and Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College of HUST, Wuhan, Hubei, People’s Republic of China
| | - Hui Wang
- Department of Obstetrics and Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College of HUST, Wuhan, Hubei, People’s Republic of China
| | - Ding Ma
- Department of Obstetrics and Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College of HUST, Wuhan, Hubei, People’s Republic of China
| | - Shujie Liao
- Department of Obstetrics and Gynecology, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College of HUST, Wuhan, Hubei, People’s Republic of China
- Correspondence should be addressed to S Liao;
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Qiu J, Li P, Dong M, Xin X, Tan J. Personalized prediction of live birth prior to the first in vitro fertilization treatment: a machine learning method. J Transl Med 2019; 17:317. [PMID: 31547822 PMCID: PMC6757430 DOI: 10.1186/s12967-019-2062-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/06/2019] [Indexed: 01/08/2023] Open
Abstract
Background Infertility has become a global health issue with the number of couples seeking in vitro fertilization (IVF) worldwide continuing to rise. Some couples remain childless after several IVF cycles. Women undergoing IVF face greater risks and financial burden. A prediction model to predict the live birth chance prior to the first IVF treatment is needed in clinical practice for patients counselling and shaping expectations. Methods Clinical data of 7188 women who underwent their first IVF treatment at the Reproductive Medical Center of Shengjing Hospital of China Medical University during 2014–2018 were retrospectively collected. Machine-learning based models were developed on 70% of the dataset using pre-treatment variables, and prediction performances were evaluated on the remaining 30% using receiver operating characteristic (ROC) analysis and calibration plot. Nested cross-validation was used to make an unbiased estimate of the generalization performance of the machine learning algorithms. Results The XGBoost model achieved an area under the ROC curve of 0.73 on the validation dataset and showed the best calibration compared with other machine learning algorithms. Nested cross-validation resulted in an average accuracy score of 0.70 ± 0.003 for the XGBoost model. Conclusions A prediction model based on XGBoost was developed using age, AMH, BMI, duration of infertility, previous live birth, previous miscarriage, previous abortion and type of infertility as predictors. This study might be a promising step to provide personalized estimates of the cumulative live birth chance of the first complete IVF cycle before treatment.
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Affiliation(s)
- Jiahui Qiu
- Reproductive Medical Center of Gynecology and Obstetrics Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.,Key Laboratory of Reproductive Dysfunction Diseases and Fertility Remodeling of Liaoning Province, Shenyang, Liaoning, China
| | - Pingping Li
- Reproductive Medical Center of Gynecology and Obstetrics Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.,Key Laboratory of Reproductive Dysfunction Diseases and Fertility Remodeling of Liaoning Province, Shenyang, Liaoning, China
| | - Meng Dong
- Reproductive Medical Center of Gynecology and Obstetrics Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.,Key Laboratory of Reproductive Dysfunction Diseases and Fertility Remodeling of Liaoning Province, Shenyang, Liaoning, China
| | - Xing Xin
- Reproductive Medical Center of Gynecology and Obstetrics Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.,Key Laboratory of Reproductive Dysfunction Diseases and Fertility Remodeling of Liaoning Province, Shenyang, Liaoning, China
| | - Jichun Tan
- Reproductive Medical Center of Gynecology and Obstetrics Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China. .,Key Laboratory of Reproductive Dysfunction Diseases and Fertility Remodeling of Liaoning Province, Shenyang, Liaoning, China.
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Rad RM, Saeedi P, Au J, Havelock J. Predicting Human Embryos' Implantation Outcome from a Single Blastocyst Image. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2019; 2019:920-924. [PMID: 31946044 DOI: 10.1109/embc.2019.8857002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Only one-third of embryo transfer cycles via invitro fertilization, the most common fertility treatment, leads to a clinical pregnancy. Identifying embryos with the highest potentials for transfer is an essential step to optimize in-vitro fertilization outcome. However, human embryos are complicated by nature and some of their developmental aspects has still remained a mystery to expert biologists. In this paper, the first-ever attempt is made to estimate probability of implantation using a single blastocyst image. First, a semantic segmentation system is proposed for human blastocyst components in microscopic images. Second, a multi-stream classification model is proposed for the prediction of embryos' implantation outcome. The proposed classification model features an architectural component, Compact-Contextualize-Calibrate (C3) to guide the feature extraction process and a slow-fusion strategy to learn cross-modality features. Experimental results confirm that the proposed method delivers the first-reported implantation outcome prediction via a single blastocyst image to date with a mean accuracy of 70.9%.
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Abstract
Micromanipulation is the precise in vitro handling and study of individual biological cells, where the smallest error can be disastrous. One such example is the extraction of cellular material from multicellular organisms, such as cells from early stage embryos. In this paper, we propose automation methods for the extraction and retrieval of individual cells from a multicellular organism in vitro using the displacement method. Computer-controlled syringe pumps and micromanipulators combined with custom computer vision algorithms are used for automated cell extraction and retrieval. Automation feasibility is demonstrated through automated controlled extraction of one or two blastomeres from cleavage-stage embryos. Preliminary proof of concept blastomere extraction experiments involving mouse embryos obtained success rates ranging from 72% to 88% for the different extraction tasks: displacement, detection, and retrieval. These automated blastomere extraction experiments demonstrate that automated cell extraction is indeed feasible, but the process may still be improved. To the best of these authors' knowledge, this paper is the first to report the automation of single cell extraction from multicellular organisms using the displacement method, and especially for automated blastomere extraction from cleavage-stage embryos. These methods provide a set of tools for moving towards fully automated single cell surgery procedures.
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Chen TJ, Zheng WL, Liu CH, Huang I, Lai HH, Liu M. Using Deep Learning with Large Dataset of Microscope Images to Develop an Automated Embryo Grading System. FERTILITY & REPRODUCTION 2019. [DOI: 10.1142/s2661318219500051] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The assessment of embryo viability for in vitro fertilization (IVF) is mainly based on subjective visual analysis, with the limitation of intra- and inter-observer variation and a time-consuming task. In this study, we used deep learning with large dataset of microscopic embryo images to develop an automated grading system for embryo assessment. This study included a total of 171,239 images from 16,201 embryos of 4,146 IVF cycles at Stork Fertility Center (https://www.e-stork.com.tw) from March 6, 2014 to April 13, 2018. The images were captured by inverted microscope (Zeiss Axio Observer Z1) at 112 to 116 hours (Day 5) or 136 to 140 hours (Day 6) after fertilization. Using a pre-trained network trained on the ImageNet dataset as convolution base, we applied Convolutional Neural Network (CNN) on embryo images, using ResNet50 architecture to fine-tune ImageNet parameters. The predicted grading results was compared with the grading results from trained embryologists to evaluate the model performance. The images were labeled by trained embryologists, based on Gardner’s grading system: blastocyst development ranking from 3–6, ICM quality as A, B, or C; and TE quality as a, b, or c. After pre-processing, the images were divided into training, validation, and test groups, in which 60% were allocated to the training group, 20% to the validation group, and 20% to the test group. The ResNet50 algorithm was trained on the 60% images allocated to the training group, and the algorithm’s performance was evaluated using the 20% images allocated to the test group. The results showed an average predictive accuracy of 75.36% for the all three grading categories: 96.24% for blastocyst development, 91.07% for ICM quality, and 84.42% for TE quality. To the best of our knowledge, this is the first study of an automatic embryo grading system using large dataset from Asian population. Combing the promising results obtained in this study with time-lapse microscope system integrated with IVF Electronic Medical Record platform, a fully automated and non-invasive pipeline for embryo assessment will be achieved.
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Affiliation(s)
- Tsung-Jui Chen
- Binflux, Inc., Taipei, Taiwan
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | | | | | - Ian Huang
- Stork Fertility Center, Stork Ladies Clinic, Hsinchu City, Taiwan
| | - Hsing-Hua Lai
- Stork Fertility Center, Stork Ladies Clinic, Hsinchu City, Taiwan
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Deep learning enables robust assessment and selection of human blastocysts after in vitro fertilization. NPJ Digit Med 2019; 2:21. [PMID: 31304368 PMCID: PMC6550169 DOI: 10.1038/s41746-019-0096-y] [Citation(s) in RCA: 164] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 03/01/2019] [Indexed: 01/27/2023] Open
Abstract
Visual morphology assessment is routinely used for evaluating of embryo quality and selecting human blastocysts for transfer after in vitro fertilization (IVF). However, the assessment produces different results between embryologists and as a result, the success rate of IVF remains low. To overcome uncertainties in embryo quality, multiple embryos are often implanted resulting in undesired multiple pregnancies and complications. Unlike in other imaging fields, human embryology and IVF have not yet leveraged artificial intelligence (AI) for unbiased, automated embryo assessment. We postulated that an AI approach trained on thousands of embryos can reliably predict embryo quality without human intervention. We implemented an AI approach based on deep neural networks (DNNs) to select highest quality embryos using a large collection of human embryo time-lapse images (about 50,000 images) from a high-volume fertility center in the United States. We developed a framework (STORK) based on Google’s Inception model. STORK predicts blastocyst quality with an AUC of >0.98 and generalizes well to images from other clinics outside the US and outperforms individual embryologists. Using clinical data for 2182 embryos, we created a decision tree to integrate embryo quality and patient age to identify scenarios associated with pregnancy likelihood. Our analysis shows that the chance of pregnancy based on individual embryos varies from 13.8% (age ≥41 and poor-quality) to 66.3% (age <37 and good-quality) depending on automated blastocyst quality assessment and patient age. In conclusion, our AI-driven approach provides a reproducible way to assess embryo quality and uncovers new, potentially personalized strategies to select embryos.
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Curchoe CL, Bormann CL. Artificial intelligence and machine learning for human reproduction and embryology presented at ASRM and ESHRE 2018. J Assist Reprod Genet 2019; 36:591-600. [PMID: 30690654 DOI: 10.1007/s10815-019-01408-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/15/2019] [Indexed: 01/17/2023] Open
Abstract
Sixteen artificial intelligence (AI) and machine learning (ML) approaches were reported at the 2018 annual congresses of the American Society for Reproductive Biology (9) and European Society for Human Reproduction and Embryology (7). Nearly every aspect of patient care was investigated, including sperm morphology, sperm identification, identification of empty or oocyte containing follicles, predicting embryo cell stages, predicting blastocyst formation from oocytes, assessing human blastocyst quality, predicting live birth from blastocysts, improving embryo selection, and for developing optimal IVF stimulation protocols. This represents a substantial increase in reports over 2017, where just one abstract each was reported at ASRM (AI) and ESHRE (ML). Our analysis reveals wide variability in how AI and ML methods are described (from not at all or very generic to fully describing the architectural framework) and large variability on accepted dataset sizes (from just 3 patients with 16 follicles in the smallest dataset to 661,060 images of 11,898 human embryos in one of the largest). AI and ML are clearly burgeoning methodologies in human reproduction and embryology and would benefit from early application of reporting standards.
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Affiliation(s)
- Carol Lynn Curchoe
- San Diego Fertility Center, 11425 El Camino Real, San Diego, CA, 92130, USA.
| | - Charles L Bormann
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Gouveia Nogueira MF, Bertogna Guilherme V, Pronunciate M, Dos Santos PH, Lima Bezerra da Silva D, Rocha JC. Artificial Intelligence-Based Grading Quality of Bovine Blastocyst Digital Images: Direct Capture with Juxtaposed Lenses of Smartphone Camera and Stereomicroscope Ocular Lens. SENSORS 2018; 18:s18124440. [PMID: 30558278 PMCID: PMC6308431 DOI: 10.3390/s18124440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/21/2018] [Accepted: 11/30/2018] [Indexed: 12/17/2022]
Abstract
In this study, we developed an online graphical and intuitive interface connected to a server aiming to facilitate professional access worldwide to those facing problems with bovine blastocysts classification. The interface Blasto3Q, where 3Q refers to the three qualities of the blastocyst grading, contains a description of 24 variables that were extracted from the image of the blastocyst and analyzed by three Artificial Neural Networks (ANNs) that classify the same loaded image. The same embryo (i.e., the biological specimen) was submitted to digital image capture by the control group (inverted microscope with 40× magnification) and the experimental group (stereomicroscope with maximum of magnification plus 4× zoom from the cell phone camera). The images obtained from the control and experimental groups were uploaded on Blasto3Q. Each image from both sources was evaluated for segmentation and submitted (only if it could be properly or partially segmented) for automatic quality grade classification by the three ANNs of the Blasto3Q program. Adjustments on the software program through the use of scaling algorithm software were performed to ensure the proper search and segmentation of the embryo in the raw images when they were captured by the smartphone, since this source produced small embryo images compared with those from the inverted microscope. With this new program, 77.8% of the images from smartphones were successfully segmented and from those, 85.7% were evaluated by the Blasto3Q in agreement with the control group.
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Affiliation(s)
- Marcelo Fábio Gouveia Nogueira
- Laboratory of Embryonic Micromanipulation, Department of Biological Sciences, School of Sciences and Languages, São Paulo State University (UNESP), Assis, São Paulo 19.806-900, Brazil.
- Multiuser Facility (FitoFarmaTec), Department of Pharmacology, Biosciences Institute, São Paulo State University (UNESP), Botucatu, São Paulo 18.618-689, Brazil.
| | - Vitória Bertogna Guilherme
- Laboratory of Embryonic Micromanipulation, Department of Biological Sciences, School of Sciences and Languages, São Paulo State University (UNESP), Assis, São Paulo 19.806-900, Brazil.
| | - Micheli Pronunciate
- Laboratory of Embryonic Micromanipulation, Department of Biological Sciences, School of Sciences and Languages, São Paulo State University (UNESP), Assis, São Paulo 19.806-900, Brazil.
- Multiuser Facility (FitoFarmaTec), Department of Pharmacology, Biosciences Institute, São Paulo State University (UNESP), Botucatu, São Paulo 18.618-689, Brazil.
| | - Priscila Helena Dos Santos
- Laboratory of Embryonic Micromanipulation, Department of Biological Sciences, School of Sciences and Languages, São Paulo State University (UNESP), Assis, São Paulo 19.806-900, Brazil.
- Multiuser Facility (FitoFarmaTec), Department of Pharmacology, Biosciences Institute, São Paulo State University (UNESP), Botucatu, São Paulo 18.618-689, Brazil.
| | - Diogo Lima Bezerra da Silva
- Laboratory of Applied Mathematics, Department of Biological Sciences, School of Sciences and Languages, São Paulo State University (UNESP), Assis, São Paulo 19.806-900, Brazil.
| | - José Celso Rocha
- Laboratory of Applied Mathematics, Department of Biological Sciences, School of Sciences and Languages, São Paulo State University (UNESP), Assis, São Paulo 19.806-900, Brazil.
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Viggiano D, Speranza L, Crispino M, Bellenchi GC, di Porzio U, Iemolo A, De Leonibus E, Volpicelli F, Perrone-Capano C. Information content of dendritic spines after motor learning. Behav Brain Res 2018; 336:256-260. [DOI: 10.1016/j.bbr.2017.09.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/05/2017] [Accepted: 09/08/2017] [Indexed: 12/20/2022]
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40
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Morbeck DE. Blastocyst culture in the Era of PGS and FreezeAlls: Is a 'C' a failing grade? Hum Reprod Open 2017; 2017:hox017. [PMID: 30895231 PMCID: PMC6276670 DOI: 10.1093/hropen/hox017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 09/13/2017] [Accepted: 09/02/2017] [Indexed: 01/02/2023] Open
Affiliation(s)
- Dean E Morbeck
- Fertility Associates, Auckland, New Zealand.,Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
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41
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Saeedi P, Yee D, Au J, Havelock J. Automatic Identification of Human Blastocyst Components via Texture. IEEE Trans Biomed Eng 2017; 64:2968-2978. [PMID: 28991729 DOI: 10.1109/tbme.2017.2759665] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Choosing the most viable embryo during human in vitro fertilization (IVF) is a prime factor in maximizing pregnancy rate. Embryologists visually inspect morphological structures of blastocysts under microscopes to gauge their health. Such grading introduces subjectivity amongst embryologists and adds to the difficulty of quality control during IVF. In this paper, we introduce an algorithm for automatic segmentation of two main components of human blastocysts named: Trophectoderm (TE) and inner cell mass (ICM). We utilize texture information along with biological and physical characteristics of day-5 human embryos (blastocysts) to identify TE or ICM regions according to their intrinsic properties. Both these regions are highly textured and very similar in the quality of their texture, and they often look connected to each other when imaged. These attributes make their automatic identification and separation from each other a difficult task even for an expert embryologist. By automatically identifying TE and ICM regions, we offer the opportunity to perform more detailed assessment of blastocysts. This could help in analyzing, in a quantitative way, various visual/geometrical characteristics of these regions that when combined with the pregnancy outcome can determine the predictive values of such attributes. Our work aids future research in understanding why certain embryos have higher pregnancy success rates. This paper is tested on a set of 211 blastocyst images. We report an accuracy of 86.6% for identification of TE and 91.3% for ICM.
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Puga-Torres T, Blum-Rojas X, Blum-Narváez M. Blastocyst classification systems used in Latin America: is a consensus possible? JBRA Assist Reprod 2017; 21:222-229. [PMID: 28837032 DOI: 10.5935/1518-0557.20170043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To identify different blastocyst classification systems used by embryologists in Latin American countries and evaluate the possibility of establishing a consensus among these countries. METHODS An E-mail survey was carried out through the Latin American Network of Assisted Reproduction (REDLARA) aimed at embryologists from assisted reproduction centers in Latin countries. RESULTS Sixty surveys were collected from 12 Latin American countries, of which 66.7% had >10years of professional practice as embryologists. Seven different blastocyst classification systems were reported, of which 5 have previously been described in the literature. CONCLUSION Although the group of embryologists surveyed use different blastocyst classification systems, most in this group consider that the embryo score system should be unified in their countries as well as in the region.
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Affiliation(s)
| | - Xavier Blum-Rojas
- Assisted Reproduction National Center INNAIFEST - Guayaquil - Ecuador
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A Method Based on Artificial Intelligence To Fully Automatize The Evaluation of Bovine Blastocyst Images. Sci Rep 2017; 7:7659. [PMID: 28794478 PMCID: PMC5550425 DOI: 10.1038/s41598-017-08104-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 07/06/2017] [Indexed: 11/28/2022] Open
Abstract
Morphological analysis is the standard method of assessing embryo quality; however, its inherent subjectivity tends to generate discrepancies among evaluators. Using genetic algorithms and artificial neural networks (ANNs), we developed a new method for embryo analysis that is more robust and reliable than standard methods. Bovine blastocysts produced in vitro were classified as grade 1 (excellent or good), 2 (fair), or 3 (poor) by three experienced embryologists according to the International Embryo Technology Society (IETS) standard. The images (n = 482) were subjected to automatic feature extraction, and the results were used as input for a supervised learning process. One part of the dataset (15%) was used for a blind test posterior to the fitting, for which the system had an accuracy of 76.4%. Interestingly, when the same embryologists evaluated a sub-sample (10%) of the dataset, there was only 54.0% agreement with the standard (mode for grades). However, when using the ANN to assess this sub-sample, there was 87.5% agreement with the modal values obtained by the evaluators. The presented methodology is covered by National Institute of Industrial Property (INPI) and World Intellectual Property Organization (WIPO) patents and is currently undergoing a commercial evaluation of its feasibility.
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Ding J, Xu T, Tan X, Jin H, Shao J, Li H. Raman spectrum: A potential biomarker for embryo assessment during in vitro fertilization. Exp Ther Med 2017; 13:1789-1792. [PMID: 28565768 PMCID: PMC5443171 DOI: 10.3892/etm.2017.4160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 01/26/2017] [Indexed: 01/26/2023] Open
Abstract
The aim of the study was to investigate whether Raman spectrum is consistent with the morphological scoring of the embryo of day 3 during in vitro fertilization (IVF). The spent culture media of embryo of day 3 from 10 patients were collected and analyzed. The samples were analyzed using Raman spectroscopy and graded according to the standard embryo scoring system simultaneously. Data showed that the Raman spectra obtained from the droplet of media were useful, as they can act as the characteristic signature for protein and amino acids. The Raman biospectroscopy-based metabonomics profiling of spent media was consistent with the result of conventional morphological evaluation. In conclusion, this technology offers great potential for the development of tools allowing rapid non-invasive assessment of the quality of embryo of day 3 during IVF.
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Affiliation(s)
- Jiayi Ding
- Department of Clinical Laboratory Medicine, Nantong Maternity and Child Health Hospital, Nantong, Jiangsu 226018, P.R. China
| | - Tian Xu
- Department of Physics, School of Science, Nantong University, Nantong, Jiangsu 226019, P.R. China
| | - Xiaofang Tan
- Department of Clinical Laboratory Medicine, Nantong Maternity and Child Health Hospital, Nantong, Jiangsu 226018, P.R. China
| | - Hua Jin
- Department of Clinical Laboratory Medicine, Nantong Maternity and Child Health Hospital, Nantong, Jiangsu 226018, P.R. China
| | - Jun Shao
- Department of Clinical Laboratory Medicine, Nantong Maternity and Child Health Hospital, Nantong, Jiangsu 226018, P.R. China
| | - Haibo Li
- Department of Clinical Laboratory Medicine, Nantong Maternity and Child Health Hospital, Nantong, Jiangsu 226018, P.R. China
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Liu D, Mo G, Tao Y, Wang H, Liu XJ. Putrescine supplementation during in vitro maturation of aged mouse oocytes improves the quality of blastocysts. Reprod Fertil Dev 2017; 29:1392-1400. [DOI: 10.1071/rd16061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 05/12/2016] [Indexed: 12/14/2022] Open
Abstract
Mouse ovaries exhibit a peri-ovulatory rise of ornithine decarboxylase and its product putrescine concurrent with oocyte maturation. Older mice exhibit a deficiency of both the enzyme and putrescine. Peri-ovulatory putrescine supplementation in drinking water increases ovarian putrescine levels, reduces embryo resorption and increases live pups in older mice. However, it is unknown if putrescine acts in the ovaries to improve oocyte maturation. This study examined the impact of putrescine supplementation during oocyte in vitro maturation (IVM) on the developmental potential of aged oocytes. Cumulus–oocyte complexes from 9–12-month-old C57BL/6 mice were subjected to IVM with or without 0.5 mM putrescine, followed by in vitro fertilisation and culture to the blastocyst stage. Putrescine supplementation during IVM did not influence the proportion of oocyte maturation, fertilisation or blastocyst formation, but significantly increased blastocyst cell numbers (44.5 ± 1.9, compared with 36.5 ± 1.9 for control; P = 0.003). The putrescine group also had a significantly higher proportion of blastocysts with top-grade morphology (42.9%, compared with 26.1% for control; P = 0.041) and a greater proportion with octamer-binding transcription factor 4 (OCT4)-positive inner cell mass (38.3%, compared with 19.8% for control; P = 0.005). Therefore, putrescine supplementation during IVM improves egg quality of aged mice, providing proof of principle for possible application in human IVM procedures for older infertile women.
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Gardner DK, Balaban B. Assessment of human embryo development using morphological criteria in an era of time-lapse, algorithms and 'OMICS': is looking good still important? Mol Hum Reprod 2016; 22:704-718. [PMID: 27578774 DOI: 10.1093/molehr/gaw057] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 08/24/2016] [Indexed: 02/07/2023] Open
Abstract
With the worldwide move towards single embryo transfer there has been a renewed focus on the requirement for reliable means of assessing embryo viability. In an era of 'OMICS' technologies, and algorithms created through the use of time-lapse microscopy, the actual appearance of the human embryo as it progresses through each successive developmental stage to the blastocyst appears to have been somewhat neglected in recent years. Here we review the key features of the human preimplantation embryo and consider the relationship between morphological characteristics and developmental potential. Further, the impact of the culture environment on morphological traits, how key morphological qualities reflect aspects of embryo physiology, and how computer-assisted analysis of embryo morphology may facilitate a more quantitative approach to selection are discussed. The clinical introduction of time-lapse systems has reopened our eyes and given us a new vantage point from which to view the beauty of the initial stages of human life. Rather than a future in which the morphology of the embryo is deemed irrelevant, we propose that key features, such as multinucleation, cell size and blastocyst differentiation should be included in future iterations of selection/deselection algorithms.
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Affiliation(s)
- David K Gardner
- School of BioSciences, University of Melbourne, Victoria 3010, Australia
| | - Basak Balaban
- VKF American Hospital Assisted Reproduction Unit, Guzelbahce St. No. 20, Istanbul, Turkey
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Rocha JC, Passalia F, Matos FD, Maserati MP, Alves MF, Almeida TGD, Cardoso BL, Basso AC, Nogueira MFG. Methods for assessing the quality of mammalian embryos: How far we are from the gold standard? JBRA Assist Reprod 2016; 20:150-8. [PMID: 27584609 PMCID: PMC5264381 DOI: 10.5935/1518-0557.20160033] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Morphological embryo classification is of great importance for many laboratory
techniques, from basic research to the ones applied to assisted reproductive
technology. However, the standard classification method for both human and
cattle embryos, is based on quality parameters that reflect the overall
morphological quality of the embryo in cattle, or the quality of the individual
embryonic structures, more relevant in human embryo classification. This
assessment method is biased by the subjectivity of the evaluator and even though
several guidelines exist to standardize the classification, it is not a method
capable of giving reliable and trustworthy results. Latest approaches for the
improvement of quality assessment include the use of data from cellular
metabolism, a new morphological grading system, development kinetics and
cleavage symmetry, embryo cell biopsy followed by pre-implantation genetic
diagnosis, zona pellucida birefringence, ion release by the embryo cells and so
forth. Nowadays there exists a great need for evaluation methods that are
practical and non-invasive while being accurate and objective. A method along
these lines would be of great importance to embryo evaluation by embryologists,
clinicians and other professionals who work with assisted reproductive
technology. Several techniques shows promising results in this sense, one being
the use of digital images of the embryo as basis for features extraction and
classification by means of artificial intelligence techniques (as genetic
algorithms and artificial neural networks). This process has the potential to
become an accurate and objective standard for embryo quality assessment.
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Affiliation(s)
- José C Rocha
- Department of Biological Science, Faculty of Sciences and Languages, São Paulo State University (UNESP)
| | - Felipe Passalia
- Department of Biological Science, Faculty of Sciences and Languages, São Paulo State University (UNESP)
| | - Felipe D Matos
- Institut de Biologie de l École Normale Supérieure de Paris, Paris, France
| | | | | | | | | | | | - Marcelo F G Nogueira
- Department of Biological Science, Faculty of Sciences and Languages, São Paulo State University (UNESP)
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48
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Wang Z, Ang WT. Automatic Dissection Position Selection for Cleavage-Stage Embryo Biopsy. IEEE Trans Biomed Eng 2016; 63:563-70. [DOI: 10.1109/tbme.2015.2466098] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Wang Z, Ang WT, Tan SYM, Latt WT. Automatic segmentation of zona pellucida and its application in cleavage-stage embryo biopsy position selection. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:3859-64. [PMID: 26737136 DOI: 10.1109/embc.2015.7319236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A very important step of Pre-implantation genetic diagnosis (PGD) is embryo biopsy, in which process the zona pellucida (ZP) is cut open partially and a part of cellular material is extracted from the embryo. Recognition of the ZP is necessary not only for embryo biopsy, but also for other applications such as zona pellucida thickness variation (ZPTV), embryo dissection, etc. The ZP opening position is closely related to the cell survival rate after the biopsy. Selection of an unsuitable position may cause blastomere lysis after the ZP opening. Normal procedures of ZP recognition and biopsy position selection involve a skilled human embryologist. In order to make the process automatic, we introduce an automatic segmentation method for ZP recognition by using edge detection and ellipse fitting with a value adjustment algorithm in this paper. An application of ZP recognition in embryo biopsy position selection is also introduced. Our ZP recognition algorithm was able to correctly segment 43 out of 45 sample embryo images, achieving a success rate of 96%. Its application in embryo biopsy position selection achieved a success rate of 93%.
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Ebner T, Tritscher K, Mayer RB, Oppelt P, Duba HC, Maurer M, Schappacher-Tilp G, Petek E, Shebl O. Quantitative and qualitative trophectoderm grading allows for prediction of live birth and gender. J Assist Reprod Genet 2015; 33:49-57. [PMID: 26572782 DOI: 10.1007/s10815-015-0609-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/28/2015] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Prolonged in vitro culture is thought to affect pre- and postnatal development of the embryo. This prospective study was set up to determine whether quality/size of inner cell mass (ICM) (from which the fetus ultimately develops) and trophectoderm (TE) (from which the placenta ultimately develops) is reflected in birth and placental weight, healthy live-birth rate, and gender after fresh and frozen single blastocyst transfer. METHODS In 225 patients, qualitative scoring of blastocysts was done according to the criteria expansion, ICM, and TE appearance. In parallel, all three parameters were quantified semi-automatically. RESULTS TE quality and cell number were the only parameters that predicted treatment outcome. In detail, pregnancies that continued on to a live birth could be distinguished from those pregnancies that aborted on the basis of TE grade and cell number. Male blastocysts had a 2.53 higher chance of showing TE of quality A compared to female ones. There was no correlation between the appearance of both cell lineages and birth or placental weight, respectively. CONCLUSIONS The presented correlation of TE with outcome indicates that TE scoring could replace ICM scoring in terms of priority. This would automatically require a rethinking process in terms of blastocyst selection and cryopreservation strategy.
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Affiliation(s)
- Thomas Ebner
- Department of Gynecological Endocrinology and Kinderwunsch Zentrum, Landes- Frauen- und Kinderklinik, Krankenhausstr. 26-30, 4020, Linz, Upper Austria, Austria. .,Department of Gynecology and Obstetrics, Kepler University Hospital, Krankenhausstr. 26-30, 4020, Linz, Upper Austria, Austria.
| | - Katja Tritscher
- Institute of Human Genetics, Medical University, Harrachgasse 21/8, 8010, Graz, Styria, Austria
| | - Richard B Mayer
- Department of Gynecological Endocrinology and Kinderwunsch Zentrum, Landes- Frauen- und Kinderklinik, Krankenhausstr. 26-30, 4020, Linz, Upper Austria, Austria.,Department of Gynecology and Obstetrics, Kepler University Hospital, Krankenhausstr. 26-30, 4020, Linz, Upper Austria, Austria.,Institute of Human Genetics, Medical University, Harrachgasse 21/8, 8010, Graz, Styria, Austria.,Department of Human Genetics, Landes- Frauen- und Kinderklinik, Krankenhausstr. 26-30, 4020, Linz, Upper Austria, Austria.,Department for Mathematics and Scientific Computing, Karl-Franzens-University Graz, Universitätsstr. 15, 8010, Graz, Styria, Austria
| | - Peter Oppelt
- Department of Gynecological Endocrinology and Kinderwunsch Zentrum, Landes- Frauen- und Kinderklinik, Krankenhausstr. 26-30, 4020, Linz, Upper Austria, Austria.,Department of Gynecology and Obstetrics, Kepler University Hospital, Krankenhausstr. 26-30, 4020, Linz, Upper Austria, Austria
| | - Hans-Christoph Duba
- Department of Human Genetics, Landes- Frauen- und Kinderklinik, Krankenhausstr. 26-30, 4020, Linz, Upper Austria, Austria
| | - Maria Maurer
- Department of Human Genetics, Landes- Frauen- und Kinderklinik, Krankenhausstr. 26-30, 4020, Linz, Upper Austria, Austria
| | - Gudrun Schappacher-Tilp
- Department for Mathematics and Scientific Computing, Karl-Franzens-University Graz, Universitätsstr. 15, 8010, Graz, Styria, Austria
| | - Erwin Petek
- Institute of Human Genetics, Medical University, Harrachgasse 21/8, 8010, Graz, Styria, Austria
| | - Omar Shebl
- Department of Gynecological Endocrinology and Kinderwunsch Zentrum, Landes- Frauen- und Kinderklinik, Krankenhausstr. 26-30, 4020, Linz, Upper Austria, Austria.,Department of Gynecology and Obstetrics, Kepler University Hospital, Krankenhausstr. 26-30, 4020, Linz, Upper Austria, Austria
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