P–202 Past embryo viability is not always a good predictor of future pregnancy: dynamic viability suggests video has limited benefit over static images for AI assessment

Study question Does embryo quality/viability change over time, suggesting the use of video for AI-based embryo quality assessment has limited benefit over single point-in-time images? Summary answer AI assessment of single static embryo images at multiple time-points indicates embryo viability is dynamic, and past viability is a limited predictor of future pregnancy. What is known already Artificial Intelligence (AI) has been applied to the problem of embryo quality (viability) assessment using either video or single static images. However, whether historical data within video provide an additional advantage over single static images of embryos (at the time of transfer) for assessing embryo viability is not known. This applies to both manual and AI-based embryo assessment. If embryo viability changes over time prior to transfer, then the implication is that the assessment of future pregnancy using historical embryo data from videos would provide limited additional value over single static images taken immediately prior to transfer. Study design, size, duration Retrospective dataset of single embryo images taken at up-to three time-points prior to transfer: Early Day 5, Late Day 5 (8 hours later), and Early Day 6 (16 hours later), with corresponding fetal heartbeat (pregnancy) outcomes. The AI assessed the viability of each embryo at its available timepoints. Viability prediction was compared with pregnancy outcome to assess viability predictiveness at each timepoint prior to transfer, and assess the variability of viability over time. Participants/materials, setting, methods Single static images of 173 embryos were taken using time-lapse incubators from a single IVF clinic. 116 embryos were viable (led to a pregnancy) and 57 were non-viable (did not lead to a pregnancy). The AI was trained on thousands of Day 5 static embryo images taken from multiple IVF laboratories and countries, but was not trained on data from this clinic. Main results and the role of chance When embryos were assessed as viable by the AI immediately prior to transfer (no delay), the AI accuracy (sensitivity) in predicting pregnancy was 88.1% (59/67) for Early Day 5, 84.8% (28/33) for Late Day 5 and 87.5% (14/16) for Early Day 6. When the delay between AI assessment and transfer is 8 hours, 16 hours and 24 hours, the the accuracy drops to 66.7% (22/33), 31.3% (5/16) and 12.5% (2/16), respectively. These results indicate that the viability of the embryo is dynamic, and therefore time series analysis, i.e. using video, may not be well suited for embryo viability assessment because past viability is not necessarily a good predictor of future viability or pregnancy outcome. The viability of the embryo immediately prior to transfer, from a single static image, is a reliable predictor of viability. This is consistent with the current clinical practice of using Gardner score end-point assessment for embryo quality. Results also suggest significant benefits from using time-lapse with AI, where AI continually assesses embryo viability over time using static images. The time point at which the embryo should be transferred to maximize pregnancy outcome is when the embryo has the greatest AI viability score. Limitations, reasons for caution Although evidence suggests past embryo viability is a limited predictor of future pregnancy, a side-by-side comparison of video versus single static image AI assessment would further verify that the historical or change in embryo development or viability has minimal impact on embryo viability assessment at the time prior to transfer. Wider implications of the findings: Time-lapse and AI can beneficially change the way embryos are assessed. Continual AI monitoring of embryos enables optimization of which embryo to transfer and when, to ultimately improve pregnancy outcomes for patients. The findings also suggest that static end-point AI assessment is sufficient for predicting embryo implantation potential. Trial registration number Not applicable