MellowoodMedical Online Help
Configuration - Embryo Scoring Templates
- Mhairi West
An Embryo Scoring template is a built-in system in IDEAS which allows your laboratory to standardize egg and embryo Observations and produce a computer generated Grading result for all egg/embryo Observations. Existing clinic assessment schemes can be incorporated into your IDEAS bespoke scheme.
Use of the Embryo scoring system is optional. You can simply record each embryo’s Observation in the column view assessment area for each egg/embryo observed, or use the built-in Embryo scoring scheme your laboratory has created.
Advantages of the Embryo Scoring Scheme
The IDEAS Embryo Scoring system enables your clinic to:
Create a scoring template to replicate the scheme in use at your clinic. Schemes can be imported and exported to other clinics which use IDEAS allowing clinics to share scoring data.
Apply a numerical value to each Observation type. That data can be used by the Query designer to perform research studies and produce statistical analysis reports.
Sum the Attached values (numerical values attached to each Observation type) to provide an objective Sum of Values
Use photographs or graphic images for each Observation type. This can help standardize observations within your laboratory and aid in training junior staff
Take a photograph of each embryo (per Observation type). This can aid in training and also intra lab grading QC
Multiple Events (with their associated Observations) can be added per day
Allow for an unlimited number of observation types
Default IDEAS Grading Scheme
The default embryo grading scheme in IDEAS is ‘Excellent, Good, Average, Poor’. The Sum of Values represents a number which will fall between the highest and lowest possible Sum of Values. IDEAS allows the user to set three threshold values which divide the total range into four sections. The four grades are Poor, Average, Good and Excellent.
The threshold values are not usually linear when more than two Observations are made per Event. It is usual to use a model which represents your laboratory’s interpretation of proven scientific evidence for each observation. The following graph represents a typical non-linear approach to grading.
Other schemes can be configured. To use an alternative scheme, e.g Gardner this should be indicated in System Options System Options - Embryology Tab.
For more information on Lab Events which utilise embryo scoring schemes click here IDS4708 Lab Events - Embryo Scoring
With the button scoring you can import or export data. The arrow buttons gives you the opportunity to browse the column. You can also use the arrows on your keyboard, with the difference that it doesn't save changes.
Once configured, these scoring schemes will then be available on the appropriate lab events when clicking on the ‘Embryo Scoring’ at the bottom of the lab event page.
You can define different scoring items for each day or procedure
You can assign pictures to your scheme to aid users
To set embryo scoring parameters go to File>System Configuration>Embryo Scoring - We recommend you ask Mellowood for help in configuring your embryo scoring scheme.
E.g. Here is an example configuration for "blastocyst grading" on Day 5.
Numerical thresholds are set by your laboratory. These usually relate to your existing embryo scoring scheme for any particular Event. Over time, these thresholds can be altered to accommodate experience and/or research evidence. However, any historical data recorded in IDEAS, recorded prior to the adoption of a new embryo scoring scheme, will not change. These egg and embryo Observations will retain their original scores and grades even after a new Embryo scoring scheme is put into use.
Configuration - Embryo scoring template library and designer window
if you wish an embryo scoring scheme to be available for a particular lab event, you must work with Mellowood to configure those lab events appropriately
determine if you wish to use the IDEAS default scheme or use a Gardner type of scheme which can be customised. If the latter , tick that option in System Options System Options - Embryology Tab
The embryo scoring templates are held in File>System Configuration>Embryo Scoring. The library of template names are seen in the Description column.
Double click the template name to open the Embryo scoring designer window.
Your procedure for entering "Scoring items" and their related "Scoring" is to first enter a scoring item descriptive in the first blank row of the left grid and then move into the right-hand grid to record the observations and their points values.
Once you have completed the entry of a "Scoring item" and its related "Scoring" then you may repeat the process for the next scoring item.
Fields in the embryo scoring template
Description | this name should be chosen to allow you to easily identify the scoring system defined here. |
Type  | There are 4 options:
The last 3 options will ignore what is filled in the System options. The first option is default because then it will not change anything in existing scoring systems. The last option - Points (Substract from perfect) will open the Base points box.  |
‘Start date’ & ‘End date’ ranges | These dates specify the time period in which the scoring system defined here will be in effect. If the date of the lab event is not within this range, this scheme will not be available to use. If another scoring system replaces this one fill in the end date, so it won’t be used again. |
‘Day’ | In day-to-day usage of embryo scoring in the lab IDEAS will calculate the "Day" for the embryo being scored, based on the luteal Day 0 and will display the factors defined for this system for the scorer's use. IDEAS will calculate the "day" in the lab event embryo being scored and will display the corresponding scheme choices defined here If the user selects "Embryo scoring" button and IDEAS detect that no defined scoring system 'fits' the "Day:" then there will be an error message as follows: "No valid scoring system has been defined for the selected day. Please enter a valid scoring system in the Other files". |
GRADING GRID  | |
'Grading categories #' | This limits the number of rows that may be entered into the "Scoring" grid highlighted by E. |
Event type dropdown: | Here you can fill in the Event type, This could be handy when there are two different events on one day. |
SCORING ITEM COLUMN GRID  | |
Item | Specify the scoring aspect |
Database Field |
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Delete |
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SCORING CHOICES GRID 
| |
| This is where a scoring outcome is named and the (cumulative) "points" that will constitute that outcome. IDEAS will accumulate the "points" relevant to each observation recorded by the lab technician to determine the outcome (name) to be applied as the score. to see the scoring associated with he different items in the grid, click on the item e.g ‘less than a morula’, and the possible scoring observations for that item can be seen . |
Rating |
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Points | In Points you can fill in the thresholds of the outcome - Fill in how many points you give per option. |
Image | Select an image that will be seen on the button of the embryo scoring scheme in the lab event |
Delete |
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Scoring item column: | Here you fill in the observation types and their associated database fields. |
Designing an Embryo Scoring Scheme
To design your Embryo scoring Scheme you will need the following:
A list of which lab events in your system you wish to associate with a scoring scheme.
A list of Observations per Event Type. These can be any number of morphological observations or measurements. Examples might be the number of pronuclei, zona thickness, variation in the size of blastomeres etc.
An Attached Value for each Observation. This should be an evidence based value relating to the Observation. An example might be a zona thickness, where assisted hatching is be indicated.
A Sum of Values for each Event Type. This total determines how IDEAS assigns an embryo’s Grade.
By default the grading scheme available in IDEAS is a 4 choice, points based
Configuration - Creating a scoring scheme using the default grading scheme (no alternative grading)
E.g. Day 3 Embryo Assessment will be described.
To see this scheme in use follow this link IDS4708 Lab Events - Embryo Scoring | In practice Embryo Grading using Default scheme
File > System configuration > Embryo scoring)
Create a new record by clicking the New… icon.
Fill in the description:
Because there are 4 Grading categories the Grading section should look like this:
Add scoring item ( in this example ‘call number’
Complete the ‘Scoring Choices’ table with all the options you wish to be able to choose form for ‘cell number’
Complete a related number of points
If desired, associate an image by clicking … and choosing from folder
Add another scoring item (in this case ‘fragmentation score’) and add related scoring choices as before
Add as many items as you wish to score for this particular lab event, and their associated scoring choices
E.G. Configuration - Creating a scoring scheme with alternative grading (Alt grade)
Day 1-2 Event type from Association Clinical Embryologists grading scheme will be described, for assessing fertilisation status
File > System configuration > Embryo scoring
Create a new record by clicking the New… icon.
Description - a name which describes the Event you wish to create.
Start date - the date the scheme is put into use.
Day - Luteal day (or range of days) when the scheme will be available to use.
Event type you intend to use - this drop down will be a list of all your lab events
Define the item - (in this example Pronuclei) by adding to the scoring item column
Complete the Scoring items and grade.
the scoring items are completely configurable by the user clinic
Add a rating for each possible choice for grading a pronuclei (use the arrows to get to the next line)
in this e.g. If you are scoring at fertilisation check, the item is pronuclei, and you want to make the options ‘0PN, 1PN, 2PN, 3PN, NEC, >3PN, GV’ available to choose from
Add an associated Alt Grade - this will show in the Alt Grade column once the embryo grading has been completed.
If desired, add an image by clicking on the … and select from the folder
‘
Repeat for the cell number part of the grade by using the down arrows to add a new item, and then add the associates ratings i.e all possibilities that you wish to choose from when assessing Cell number;
Repeat to add another item ‘Blastomere size’
And for the Fragmentation.
Configuration - Creating a scoring scheme with alternative grading USA
E.g. Day 2 Assessment will be described - to see this scheme in practice follow this link IDS4708 Lab Events - Embryo Scoring | In Practice Using the embryo scoring scheme with alternative grading
File > System configuration > Embryo scoring
Create a new record by clicking the New… icon.
Fill in the description:
Enter observation types and their scoring data.
Fill in the scoring choices for Cell stage:
Fill in the scoring choices for Fragmentation:
Fill in the scoring choices for Symmetry:
Fill in the scoring choices for Multinucleation:
Fill in the scoring choices for Vacuole:
Fill in the scoring choices for zona thickness:
You can add images to every scoring choice.
Configuration - Creating a scoring scheme without alternative grading USA
E.g. Day 2 Observation will be described.
File > System configuration > Embryo scoring
Create a new record by clicking the New… icon.
Complete the description, appropriate luteal day and lab event where you wish this scheme to be available
Now complete the Grading categories.
It is usual to choose 4 categories. The Points assigned to each category are applied in the right-most column. Using a scale of 1 to 100 points will usually provide sufficient sensitivity.
Note; while the total number of points assigned to your scheme is 100, the number of points your laboratory assigns to each observation will depend on its relative importance in the overall grading Event. It is up to each laboratory to prioritize Observations within each grading Event and assign the point values.
Enter observation items and their associated scoring data.
Always click save after creating an embryo scoring template
Detailed information on the principles of the default IDEAS embryo grading scheme
An Embryo Scoring scheme is a built-in system in IDEAS which allows your laboratory to standardize egg and embryo Observations and produce a computer generated Grading result for all egg/embryo Observations. Existing clinic assessment schemes can be incorporated into your IDEAS bespoke scheme.
Use of the Embryo scoring system is optional. You can simply record each embryo’s Observation in the column view assessment area for each egg/embryo observed, or use the built-in Embryo scoring scheme your laboratory has created. To use the built-in system the Laboratory/Scientific Director (or their delegate) will need to design each Observation type
Scoring Scheme – a bespoke scoring scheme for each Event type. This includes all Observations associated with their corresponding Archetypes, Attached Values and ultimately a Sum of Values to produce a Grading for each Event Type.
Event Type – any group of Observations relating to eggs or embryos (i.e. Fertilization check, early cleavage check, day 2 observation, etc).
Observation – a single characteristic of an egg or embryo which best matches its associated Archetype. (i.e. fragmentation, blastomere size, zona thickness etc).
Archetype – a representative photograph or drawing of an egg or embryo’s attribute (i.e. photos or drawings of fragmentation, blastomere size, zona thickness etc).
Attached value – the Attached Value which your clinic has assigned to each Observation (along with its associated Archetype). This value is usually decided upon by your laboratory’s senior staff and is usually supported by scientific evidence. This value should represent the importance (positive, neutral or negative) for any given Observation. The Attached Value of each Observation will form part of the overall Sum of Values. The embryos Grade depends on the three thresholds set within the Sum of Values. It is usual to grade an embryo out of a total score of 100, although the total Sum of Values can be set to any range your laboratory wishes. Please note that attached values can also be negative integers. These values will lower an embryo’s grading.
Sum of Values – the sum of all the Attached Values (associated with all Observations for an individual embryo). The Sum of Values is often a number between 0 -100 but can be a range between 0 and any positive value. IDEAS will calculate a Grade (from the Sum of Values) for each embryo once it has been completely assessed by the embryologist. The grading is internally calculated from three set thresholds within the Sum of Values. The grades are Poor, Average, Good and Excellent. The thresholds for each Grade are set by your laboratory’s senior staff. The three thresholds, defined when the scoring scheme was created, should represent an evidence based assessment of the embryo and its likelihood of producing a pregnancy. IDEAS uses these thresholds to determine a grade for each scored oocyte or embryo.
Grading – the Sum of Values represents a number which will fall between the highest and lowest possible Sum of Values. IDEAS allows the user to set three threshold values which divide the total range into four sections. The four grades are Poor, Average, Good and Excellent.