Received September 09, 2017
Accepted May 15, 2018

Objective: Our primary aim was to compare the morphology and morphokinetics on inter- and intra-observer agreement for blastocyst with known implantation out- come. Our secondary aim was to validate the morphoki- netic parameters' ability to predict pregnancy using a pre- vious published selection algorithm, and to compare this to standard morphology assessments. Methods: Two embryologists made independent blind- ed annotations on two occasions using time-lapse images and morphology evaluations using the Gardner Schoolcraft criteria of 99 blastocysts with known implantation out- come. Inter- and intra-observer agreement was calculated and compared using the two methods. The embryos were grouped based on their morphological score, and on their morphokinetic class using a previous published selection algorithm. The implantation rates for each group was cal- culated and compared. Results: There was moderate agreement for morphol- ogy, with agreement on the same embryo score in 55 of 99 cases. The highest agreement rate was found for ex- pansion grade, followed by trophectoderm and inner cell mass. Correlation with pregnancy was inconclusive. For morphokinetics, almost perfect agreement was found for early and late embryo development events, and strong agreement for day-2 and day-3 events. When applying the selection algorithm, the embryo distributions were uneven, and correlation to pregnancy was inconclusive. Conclusions: Time-lapse annotation is consistent and accurate, but our external validation of a previously pub- lished selection algorithm was unsuccessful.