Background: Selecting the blastocyst with the highest potential for live birth from a cohort is crucial for the success of in vitro fertilization (IVF). While the Gardner and Schoolcraft morphological grading system, ...
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Background: Selecting the blastocyst with the highest potential for live birth from a cohort is crucial for the success of in vitro fertilization (IVF). While the Gardner and Schoolcraft morphological grading system, commonly known as the Gardner grading system, is widely used by embryologists worldwide, blastocysts having similar or the same inner cell mass (ICM) and trophectoderm (TE) grades cause challenges for embryologists in decision-making. Furthermore, human assessment is subjective and inconsistent in predicting which blastocysts have higher potential to result in live birth. This study aims to develop an interpretable, quantitative method aligned with the Gardner grading system, providing continuous scores that correlate with live birth outcomes, thereby assisting embryologists in improving blastocyst selection. Methods: In this retrospective study, we developed GardnerNet, an interpretable deep learning model that outputs expansion degree grade and continuous scores quantifying a blastocyst's ICM morphology and TE morphology, based on the Gardner grading system. The continuous ICM and TE scores were calculated by weighting each base grade's predicted probability and summing the predicted probabilities. To represent each blastocyst's overall potential for live birth, we combined the ICM and TE scores using their odds ratios (ORs) for live birth. We further assessed the correlation between the ICM score, TE score, and the OR-combined score (adjusted for expansion degree) with live birth rates by applying GardnerNet to blastocysts with known live birth outcomes. To test its generalizability, we also applied GardnerNet to an external IVF institution, accounting for variations in imaging conditions, live birth rates, and embryologists' experience levels. Findings: GardnerNet was developed using data from 2760 blastocysts with majority-voted grades for expansion degree, ICM, and TE. The model achieved mean area under the receiver operating characteristic curve
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