Summary of findings 2. TLS utilising embryo selection software compared to TLS with conventional morphological assessment of still TLS images for embryo incubation and assessment in assisted reproduction.
| TLS utilising embryo selection software compared to TLS with conventional morphological assessment of still TLS images for embryo incubation and assessment in assisted reproduction | ||||||
| Patient or population: couples undergoing assisted reproductive technology Setting: fertility clinic Intervention: TLS utilising embryo selection software Comparison: TLS with conventional morphological assessment of still TLS images | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with TLS with conventional morphological assessment of still TLS images | Risk with TLS utilising embryo selection software | |||||
| Live birth or ongoing pregnancy | 472 per 1000 | 353 per 1000 (222 to 517) | OR 0.61 (0.32 to 1.20) | 163 (1 RCT) | Very lowa | The outcome was ongoing pregnancy; no live‐birth data were available. |
| Miscarriage | 54 per 1000 | 74 per 1000 (35 to 147) | OR 1.39 (0.64 to 3.01) | 463 (2 RCTs) | Very lowb | |
| Stillbirth | No studies reported this outcome. | ‐ | ‐ | ‐ | ‐ | |
| Clinical pregnancy | 537 per 1000 | 529 per 1000 (437 to 622) | OR 0.97 (0.67 to 1.42) | 463 (2 RCTs) | Very lowc | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; OR: odds ratio; RCT: randomised controlled trial; TLS: time‐lapse system | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: 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 quality: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low quality: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
aWe downgraded our assessment of the quality of the evidence for live birth or ongoing pregnancy once for serious risk of performance bias and twice for very serious imprecision due to there being only one RCT with a small number of events (64) and wide confidence intervals compatible with a benefit in either group. bWe downgraded our assessment of the quality of the evidence for miscarriage once for serious risk of performance bias; once for serious indirectness (heterogeneity between the study designs: one included study involved removing embryos for benchtop microscopy daily in both the intervention and control arms, whereas the other study left embryos in the intervention and control arms undisturbed); and once for serious imprecision (wide confidence intervals compatible with a benefit in either group and a low number of events overall (N = 29)). cWe downgraded our assessment of the quality of the evidence for clinical pregnancy once for serious risk of performance bias, once for serious indirectness (as described above), and once for serious imprecision (wide confidence intervals compatible with a benefit in either group).