Summary of findings 3.
TLS utilising embryo selection software compared to conventional incubation and assessment for embryo incubation and assessment in assisted reproduction
| TLS utilising embryo selection software compared to conventional incubation and assessment for embryo incubation and assessment in assisted reproduction | ||||||
| Patient or population: couples undergoing ART Setting: fertility clinic Intervention: TLS utilising embryo selection software Comparison: conventional incubation and assessment | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with conventional incubation and assessment | Risk with TLS utilising embryo selection software | |||||
| Live birth | 381 per 1,000 | 461 per 1,000 (365 to 586) | OR 1.21 (0.96 to 1.54) | 1017 (2 RCTs) | ⊕⊝⊝⊝ Very lowa | |
| Miscarriage | 94 per 1,000 | 70 per 1,000 (48 to 101) | OR 0.73 (0.49 to 1.08) | 1351 (3 RCTs) | ⊕⊝⊝⊝ Very lowb | |
| Stillbirth | 0 per 1000 | 0 per 1000 | not estimable | 0 RCTs | ||
| Clinical pregnancy | 545 per 1,000 | 584 per 1,000 (530 to 635) | OR 1.17 (0.94 to 1.45) | 1351 (3 RCTs) | ⊕⊝⊝⊝ Very lowc | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the mean risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; OR: Odds ratio; TLS: time‐lapse system | ||||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
a We downgraded our assessment of the quality of evidence for live birth twice for risk of bias and once for indirectness. All included studies are at high risk of performance bias owing to lack of blinding or incomplete blinding. There was also high risk of selection bias. In one study, the randomisation of participants was undertaken by the principal investigator and allocation concealment was not described. In another study, some patients could request the intervention and this request was granted. The indirectness was due to one included study undertaking multiple embryo transfers per woman, and included women receiving donor oocytes from younger women. b We downgraded our assessment of the quality of evidence for miscarriage twice for risk of bias, as outlined above, and once for indirectness secondary to one included study including miscarriages of biochemical as well as clinical pregnancies. These miscarriage data could not be separated by the authors of the study. c We downgraded our assessment of the quality of evidence for clinical pregnancy twice for risk of bias and once for indirectness secondary to the day of embryo transfer being variable between studies. One study had blastocyst transfers, one had varied days of transfer and one had day‐three transfer for the intervention arm and day‐five transfer for the control arm.