FertAid's Proficiency Scheme for Embryo Ranking - Information for Clinicians and Scientists.

FertAid has developed a proficiency EQA scheme to explore an important and critical aspect of current embryology. This scheme seeks to provide tools to allow Medical and Scientific Directors to have confidence in the capacity of embryologists to rank and select the same embryo for transfer and the ranking for their future management.

It is generally accepted that relatively few embryos created have the potential for pregnancy and in previous periods when multiple embryos were transferred, embryologists did not have to make difficult decisions about which embryos to transfer since in all probability the "few" embryos would be among those selected. In more recent times, even with lesser number of embryos generated, the transfer of a single embryo creates significant problems for clinics to ensure that regardless of which embryologist was making the decisions, the same embryo would be selected for transfer.

Variation in the choice of embryos has significant implications for the clinic and their clients. Even though one may argue that if a Pregnant causing embryo is not selected, it will be frozen and transferred in subsequent cycles. Not withstanding arguments that there may be advantages in transferring embryos in an FET cycle, cryopreservation has risks and the potential to diminish the potential of embryos. If given the choice, few clients would elect to not have the "best" embryo transferred.

Previous releases in the early cleavage and blastocyst stage Proficiency/EQA schemes by QAPonline have highlighted considerable variation in the ranking of 3-4 embryo when the quality is not dissimilar. It is against this background that a new proficiency/EQA scheme has been developed by QAPonline specifically focused on the ranking of embryos. The first release of this scheme is in 2012 and available for subscription. It is coded as HER series.

Like all of QAPonline's schemes, the HER contains monthly releases for completion. Each release will contain images or videos of up to 10 embryo. Participants are asked to rank them on order of quality from best to worst. Additional questions on whether an embryo would be frozen may be included but at present not included in the ranking. Relative to all other professional embryologists, a score (%) is calculated from the agreement of embryo between a individual's selection and the majority of all other selections. Each embryo is weighted so that the best embryo is weighted by a factor of 10, the second best by a factor of 9, etc. A score is allocated if an embryo agrees with the majority of other replies and summed for all embryos and expressed as a ranking out of 100. A score of 100% means that each embryo selected agreed with the majority of all participants while a score of 0% means that there was total disagreement

QAPonline does not intend for this ranking to used to specifically define an embryologists ranking skills and accepts no liability for its use. It is intended to provide a tool to individual embryologists and the senior scientist and clinicians if any staff differs significantly from others in the ranking criteria and further investigations.

QAPonline has provided and is developing further workshop tools to explore how an individual clinic may vary form the majority and this may be used for internal auditing and accreditation purposes.

How does one enroll the laboratory staff in the Ranking scheme?

If your clinic already susbcribes to QAPonline, then the HER scheme is part of the global enrolments.