Morphokinetic analysis of early human embryonic development and its relationship to endometriosis resection: a retrospective time-lapse study using the KIDScore™ D3 and D5 implantation data algorithm

• Published in: Archives of gynecology and obstetrics Vol. 308; no. 2; pp. 587 - 597
• Main Authors: Herbert, Saskia-Laureen, Staib, Claudia, Wallner, Theresa, Löb, Sanja, Curtaz, Carolin, Schwab, Michael, Wöckel, Achim, Häusler, Sebastian
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-08-2023; Springer Nature B.V
• Subjects: Algorithms; Embryonic Development; Embryos; Endocrinology; Endometriosis; Endometriosis - surgery; Female; Fertilization in Vitro; Gynecologic Endocrinology and Reproductive Medicine; Gynecology; Human Genetics; Humans; Medicine; Medicine & Public Health; Obstetrics/Perinatology/Midwifery; Pregnancy; Pregnancy Rate; Retrospective Studies; Time-Lapse Imaging; Endometriosis; Complete resection; Time-lapse technology; KIDScore; Embryo quality
• ISSN: 1432-0711; 0932-0067; 1432-0711
• DOI: 10.1007/s00404-023-07008-6

Research question
Does complete resection of endometriosis improve embryo quality as assessed by morphokinetic parameters using time-lapse microscopy?
Design
For this retrospective study we analysed 237 fertilised, cultured and transferred embryos from 128 fresh IVF and/ or ICSI transfer cycles. Endometriosis was confirmed or excluded by laparoscopy. Patients were stimulated with recombinant FSH using GnRH agonist and antagonist protocols. After fertilisation, a time-lapse incubation system was used for observation. Embryo quality was assessed using the KIDScore™ D3 and D5 implantation data algorithm.
Results
The analysis showed a median KIDScore™ D5 of 2.6 (on a scale of 1 to 9.9) for embryos from patients with endometriosis without complete resection. The control group without endometriosis achieved a score of 6.8 (
p
 = 0.003). The median score for embryos from endometriosis patients with complete resection was 7.2, which was a significant increase compared to embryos from patients without complete resection (
p
 = 0.002). We observed an effect size of
r
 = 0.4 for complete resection versus no resection of endometriosis using the KIDScore™ D5. There were no differences in KIDScore™ D3 between the three patient groups. Pregnancy and miscarriage rates showed the same clinical trends. In three of our four case series of patients who underwent IVF/ ICSI cycles before and after complete resection, we found a marked improvement in embryo quality after complete resection.
Conclusions
Complete resection of endometriosis could significantly improve the otherwise poor embryo quality of patients undergoing IVF-procedures. The data, therefore, strongly support recommending surgery to patients with endometriosis prior to assisted reproduction.