Artificial intelligence-powered assisted ranking of sibling embryos to increase first cycle pregnancy rate.

RESEARCH QUESTION: Could EMBRYOLY, an artificial intelligence embryo evaluation tool, assist embryologists to increase first cycle pregnancy rate and reduce cycles to pregnancy for patients? DESIGN: Data from 11,988 embryos were collected via EMBRYOLY from 2666 egg retrievals (2019-2022) across 11 centres in France, Spain and Morocco using three time-lapse systems (TLS). Data from two independent clinics were also examined. EMBRYOLY's transformer-based model was applied to transferred embryos to evaluate ranking performances against pregnancy and birth outcomes. It was applied to cohorts to rank sibling embryos (including non-transferred) according to their likelihood of clinical pregnancy and to compute the agreement with the embryologist's highest ranked embryo. Its effect on time to pregnancy and first cycle pregnancy rate was evaluated on cohorts with multiple single blastocyst transfers, assuming the embryologist would have considered EMBRYOLY's ranking on the embryos favoured for transfer. RESULTS: EMBRYOLY's score correlated significantly with clinical pregnancies and live births for cleavage and blastocyst transfers. This held true for clinical pregnancies from blastocyst transfers in two independent clinics. In cases of multiple single embryo transfers, embryologists achieved a 19.8% first cycle pregnancy rate, which could have been improved to 44.1% with the adjunctive use of EMBRYOLY (McNemar's test: P < 0.001). This could have reduced cycles to clinical pregnancy from 2.01 to 1.66 (Wilcoxon test: P < 0.001). CONCLUSIONS: EMBRYOLY's potential to enhance first cycle pregnancy rates when combined with embryologists' expertise is highlighted. It reduces the number of unsuccessful cycles for patients across TLS and IVF centres.

[Treatment of excretory azoospermia. Biological aspects of surgery]. / Le traitement de l'azoospermie excrétoire. La chirurgie face à la biologie.

The therapeutical strategy for excretory azoospermia is very efficient at the present time. It is represented by two complementary methods very different both in their concept and their practical aspects. The surgery for recanalisation of the seminal tract is the old method, associated with reproducible and validated results providing a sophisticated operative methodology which implies microsurgery. The recent introduction of the assisted reproduction technics with better or at least equal results than those of surgery and with a growing therapeutical power already nowadays offers satisfying opportunities of treatment in some selected indications. The evolution of the therapeutical strategy is analyzed through our proper practice and the data of the literature.