P-759 Discard, or not discard, that is the question. An international survey among 117 embryologists about their decision on 50 poor-quality/day7 blastocysts cultured in time-lapse incubators.

Abstract Study question Are decisions on day7 and/or poor-quality blastocysts’ (PQB; <Gardner’s BB) use consistent among embryologists of diverse European countries and what factors influence them? Summary answer “Discard” choice prevalence was ≈40%, however inter-rater agreement just fair (Fleiss-k=0.26). Country practice, maternal age number sibling embryos each decision. What is known already Blastocyst morphokinetics morphological quality are associated with competence used to make clinical decisions, even though evaluations poorly reproducible across embryologists. Moreover, the increasing utilization PQB adoption culture beyond 144 hours-post-insemination further challenging decision-making process. Previous surveys reported limited concordance in “discard”/“use” choices made for based single 2D-pictures without cycle/patient information. However, instance whole embryo preimplantation development, reproductive history, embryos, can Different regulations mindsets may these require investigation. design, size, duration Anonymous survey Microsoft-Forms run within a large IVF-network. Each laboratory-director shared link his/her colleagues via 3 e-mails sent weekly between 22/12/2023 12/1/2023. 117 participated representing 6 Countries, 9 IVF-groups, 28 centers. Raters inspected EmbryoScope videos 50 PQBs development decided whether “use” (“transfer-fresh”/“cryopreserve”/“biopsy cryopreserve”) or “discard” them. Inter-rater measured Fleiss-k. Participants/materials, setting, methods Couples’ information (age, infertility diagnosis, previous attempts, sperm analysis, blastocysts obtained) were provided, participants asked their years experience, center location, average cycles age, colleagues, presence time-lapse-incubators. The AI-score (CHLOE-EQ, Fairtility iDAScore v1.0, Vitrolife), chromosomal diagnosis outcomes all by one embryologist not involved survey, but blinded Main results role chance Participants Italian (40%,N=47), Spanish (24%,N=28), Portuguese (5%,N=6), Czech Swedish (23%,N=27) Icelandic (3%,N=3). 2263(38.7%) 3587(61.3%) recorded. Czech, Portuguese, expressed lower (17±7%,23±14% 27±18%), intermediate (37±16%), Nordic higher (67±11%) decision rates.The responses per 37.4±24.2%(2-87). larger embryologists’ propensity PQBs/day7 (unstandardized coefficient-B:+4.4%,95%CI:+0.9 + 7.9,p=0.015). most prevalent “biopsy cryopreserve” (33.1±21.7%,2-78). Maternal coefficient-B:+2.2%,95%CI:+1.3 3.8,p<0.01) coefficient-B:-9.2%,95%CI:-15.2% -3.3%,p<0.01) influenced this rate.Overall, 0.26 (standard-error:0.003;“fair”), “moderate” (0.41,standard-error:0.037), “fair” (0.38,standard-error:0.007), (0.28,standard-error:0.006 0.009).CHLOE-EQ v1.0 decisions. No difference shown AI-scores euploid versus aneuploid (CHLOE-EQ: 0.2±0.32,0-0.9 0.2±0.29,0-0.93; v1.0: 4.2±1.6,2.2-6.7 4.3±1.5,2.1-9), while more often chose latter group (28.3±21%,9-71 41.6±24.8%,2-87). Five transferred implanted 0.001,0.416 0.003; 2.6,5.0 6.6; rates: 19%,15% 10%). Limitations, reasons caution All decide regardless regulation enforced (e.g., PGT-A forbidden, discarding viable allowed). Nonetheless, legislative, social, background might still have affected choice. included only private IVF clinics located Europe. Wider implications findings regarding PQB/day-7 inconsistent. Mostly, legislative/clinical cycles’ characteristics practice has implications, especially poor-prognosis patients. Artificial-Intelligence improve reproducibility removing intrinsic human subjectivity. it currently underpowered assess outlier Trial registration Not applicable