Embryology with precision: effective quality control in the in vitro fertilization laboratory.

The purpose of this review is to address the critical need for standardization and clarity in the use of key performance indicators (KPIs) within the realm of in vitro fertilization (IVF), particularly emphasizing the integration of preimplantation genetic testing (PGT) processes. This review is timely and relevant given the persistently modest success rates of IVF treatments, which stand at approximately 30%, and the growing complexity of IVF procedures, including PGT practices. The review synthesizes recent findings across studies focusing on technical and clinical KPIs in embryology and genetic laboratories, identifying gaps in current research and practice, particularly the lack of standardized KPIs and terminology. Recent findings highlighted include the critical evaluation of technical KPIs such as Intracytoplasmic Sperm Injection (ICSI) fertilization rates, embryo development rates, and laboratory performance metrics, alongside clinical KPIs like the proportion of mature oocytes and clinical pregnancy rates. Notably, the review uncovers a significant gap in integrating and standardizing KPIs for PGT applications, which is essential for improving IVF outcomes and genetic diagnostic accuracy. The implications of these findings are profound for both clinical practice and research. For clinical practice, establishing a standardized set of KPIs, especially for PGT, could significantly enhance the success rates of IVF treatments by providing clearer benchmarks for quality and performance. For research, this review underscores the necessity for further studies to close the identified gaps, promoting a more integrated and standardized approach to KPIs in IVF and PGT processes. This comprehensive approach will not only aid in improving clinical outcomes but also in advancing the field of reproductive medicine.

Code of Ethics and Conduct of the Brazilian Association of Embryologists - PRONÚCLEO.

For more than three decades, Brazilian Clinical Embryologists have been working without specific regulations and following the standards adopted by other healthcare professionals. This document aims to guide behavior and decision-making, while providing directions to embryologist with the purpose of aiding professionals involved with assisted reproduction procedures and their patients. The Code of Ethics and Conduct is an important breakthrough and the first step toward regulating Clinical Embryology as a profession.

Terminologia embryologica y placenta: propuesta de términos embriológicos en español / Terminologia embryologica and placenta: proposal of embryological terms in Spanish

RESUMEN: En el área de la embriología, y en relación al uso de Terminologia Embryologica (TE), existen términos que son utilizados y que no se corresponden con ésta última. Pero a esta situación clásica, desde el origen de Nomina Anatomica de Basilea en 1895, se suma la ausencia de términos embriológicos en TE y que son diariamente reconocidos y nombrados en la práctica clínica. Además, no existe aún traducción oficial al español de TE. El objetivo de este trabajo consistió en realizar una propuesta de términos en español correspondientes a los términos incluídos en Paraplacenta [E6.0.2.4.0.1.], Placenta [E5.11.3.1.1.0.5] y Anomaliae placentae [E6.0.2.5.1.0.1], a partir de Terminologia Embryologica (TE) publicada por el Federal International Programme on Anatomical Terminologies en 2013, y en la cual sólo se encuentra la traducción al idioma inglés. La importancia de todos los trabajos relacionados con el buen uso de las terminologías y su correcta traducción al idioma vernáculo, radica en que la aplicación de un lenguaje único y común permitirá una mejor y mayor difusión de las investigaciones en el área de las ciencias morfológicas.

SUMMARY: In embryology, and in reference to the use of Terminologia Embryologica (TE), a number of terms used do not apply to TE., Since the origins of the Nomina Anatomica of Basel in 1895, the absence of embryological terms in TE is noted, even though these terms are commonly used in clinical practice. Furthermore, to date there is no official Spanish translation of TE. The aim of this work was to present a proposal of terms in Spanish, for the structures of the chapter Adnexa embryonica et fetalia; Membranae extraembryonicae et fetales corresponding to the terms included in Paraplacenta [E6.0.2.4.0.1.], Placenta [E5.11.3.1.1.0.5] and Anomaliae placentae [E6.0.2.5.1.0.1], from Terminologia Embryologica (TE) published by the Federal International Program on Anatomical Terminologies in 2013, wherein only the English translation can be found. The importance of all the articles related to the good use of terminologies and their correct translation into the vernacular language, is that the application of a unique and common language will allow a better and greater diffusion of the research in the area of the morphological sciences.

Blastocyst classification systems used in Latin America: is a consensus possible?

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.

'By the work, one knows the workman': the practice and profession of the embryologist and its translation to quality in the embryology laboratory.

The embryologist presides over the fulfillment of a patient's treatment in the laboratory for IVF through use of assisted reproduction techniques, and is in a unique position to impart quality to the process. Although the technical skill of the embryologist is critical, the embryologist's contribution to quality is equally conveyed through a knowledge of reproductive biology, keen observation and judgment, astute decision-making, the 'grit' to work under pressure and time constraints, and a sense of mission in the provision and continual development of a safe and effective laboratory. The embryologist also ensures that the laboratory complies with the regulations of federal, state, local and institutional authorities and the recommendations and guidelines of professional associations. In these roles, the embryologist assumes unique responsibilities counterbalanced by the unique rewards of assisting patients in having a family. This article aspires to illuminate this singular profession for those who may be contemplating a career in embryology and act as a resource for those who seek insight into this amalgam of basic science, technical proficiency, and managerial skill and acumen that characterize the practice of clinical embryology and the myriad of ways that practitioners contribute to the quality of assisted reproduction techniques and patient care.

Quality control and standardization of embryo morphology scoring and viability markers.

A so-called 'good-quality embryo' may be defined as an embryo that has the potential to implant into the uterine endometrium and give rise to the birth of a healthy child. A standardized and objective scoring of embryo 'quality' is therefore crucial in the classification and selection of embryos. However, embryo scoring is still being performed mainly via ocular evaluation, which often results in different interpretations of embryo quality. The addition of viability markers, such as measuring gene expression or the uptake/release of metabolites, proteins or RNA/DNA molecules in the culture media, would increase the possibility of standardized measurements. However, no single biomarker has yet been introduced into standard clinical practice, mainly due to the complexity of the techniques and the influence of biological variations and differences in culture conditions. In this paper different methods for the scoring of embryos and the possibility of standardizing and implementing quality control systems are discussed.

European view of subspecialty training on behalf of the European Society of Human Reproduction and Embryology (ESHRE).

Specialist training in reproductive medicine within Europe continues to evolve. Recent revisions, updates, and initiatives have helped to refine the core educational needs for the specialist trainee.

[EEQ in clinical embryology: a starting program]. / Évaluation externe de la qualité en embryologie clinique : intérêt, mise en place et retour d'expérience.

Every laboratory including those working in assisted reproductive technologies have to be accredited EN ISO 15189 before 2020. This standardisation includes an external quality evaluation (EQE). In order to work out an EQE tool, we used images extracted from our own database developed during daily practice. We achieved an easily online tool called: "EEQ en embryologie clinique", developed on Biologie prospective web site with ART French biologists Association (Blefco) expertise in evaluation of early human embryonic stages. In 2013, 38 ART laboratories participate to the first program with more than 90% of appropriates results. The present article aims at describing this tool and discussing its limits.

Recommended practices for the management of embryology, andrology, and endocrinology laboratories: a committee opinion.

This document provides a general overview for physicians of the qualities and conditions necessary for good management practices within the endocrinology, andrology, and embryology laboratories in the United States. It is intended as an addendum to previously published guidelines that further detail these responsibilities.

External quality control for embryology laboratories.

Participation in external quality control (EQC) programmes is recommended by various scientific societies. Results from an EQC programme for embryology laboratories are presented. This 5-year programme consisted of the annual delivery of (i) materials to test toxicity and (ii) a DVD/CD-ROM with images of zygotes and embryos on days 2 and 3, on the basis of which the participants were asked to judge the embryo quality and to take a clinical decision. A high degree of agreement was considered achieved when over 75% of the laboratories produced similar classifications. With respect to the materials analysed, the specificity was 68% and the sensitivity was 83%. Concerning embryo classification, the proportion of embryos on which a high degree of agreement was achieved increased during this period from 35% to 55%. No improvement was observed in the degree of agreement on the clinical decision to be taken. Day-3 embryos produced a higher degree of agreement (58%) than did day-2 embryos (32%) (P<0.05). Participation in EQC increased the degree of inter-laboratory agreement on embryo classification, but not the corresponding agreement on clinical decision taking. It is necessary to introduce measures aimed at standardizing decision taking procedures in embryology laboratories.

Interobserver and intraobserver variation in day 3 embryo grading.

OBJECTIVE: Variations in pregnancy rates (PR) between IVF programs are due to multiple factors, including embryo quality. Standardized embryo grading systems have been developed to improve communication between embryologists and clinicians. However, these grading systems have not been validated. We sought to quantify both interobserver and intraobserver variability using a standardized day 3 embryo grading system (Veeck scale). DESIGN: Prospective, sample-randomized, controlled, blinded study. SETTING: University hospital. PATIENT(S): Twenty-six practicing embryologists. INTERVENTION(S): Observation and grading of 35 video clips of day 3 embryos. MAIN OUTCOME MEASURE(S): Interobserver and intraobserver variability. Embryologists were also assessed by education level, years of experience, size of IVF program, and type of grading system used. Kappa scores and intraclass correlation coefficients were calculated. RESULT(S): Practicing embryologists differed from control (Lucinda Veeck) by as much as two grades, despite using the same grading system (Kappa = 0.24, interclass correlation coefficient = 0.98). There was also variability in grading the same embryo (Kappa = 0.69, interclass correlation coefficient = 0.88). Programs with higher cycle numbers per year had lower variability. CONCLUSION(S): There is substantial interobserver variability and moderate intraobserver variability among embryologists. Such variability could alter both the expected quality of embryos transferred, as well as the number transferred, both of which directly impact IVF program success.