An artificial intelligence tool predicts blastocyst development from static images of fresh mature oocytes

•An artificial intelligence model was developed and validated for non-invasive assessment of mature oocyte quality.•The model displayed a robust and generalizable performance for diverse IVF demographics.•Higher oocyte scores assigned by the model correlated with blastocyst formation and quality.•Static images assessed by the model provided insight into IVF oocyte quality. Can a deep learning image analysis model be developed to assess oocyte quality by predicting blastocyst development from images of denuded mature oocytes? A deep learning model was developed utilizing 37,133 static oocyte images with associated laboratory outcomes from eight fertility clinics (six countries). A subset of data (n = 7807) was allocated to test model performance. External model validation was conducted to assess generalizability and robustness on new data (n = 12,357) from two fertility clinics (two countries). Performance was assessed by calculating area under the curve (AUC), balanced accuracy, specificity and sensitivity. Subgroup analyses were performed on the test dataset for age group, male factor and geographical location of the clinic. Model probabilities of the external dataset were converted to a 0–10 scoring scale to facilitate analysis of correlation with blastocyst development and quality. The deep learning model demonstrated AUC of 0.64, balanced accuracy of 0.60, specificity of 0.55 and sensitivity of 0.65 on the test dataset. Subgroup analyses displayed the highest performance for age group 38–39 years (AUC 0.68), a negligible impact of male factor, and good model generalizability across geographical locations. Model performance was confirmed on external data: AUC of 0.63, balanced accuracy of 0.58, specificity of 0.57 and sensitivity of 0.59. Analysis of the scoring scale revealed that higher scoring oocytes correlated with higher likelihood of blastocyst development and good-quality blastocyst formation. The deep learning model showed a favourable performance for the evaluation of oocytes in terms of competence to develop into a blastocyst, and when the predictions were converted into scores, they correlated with blastocyst quality. This represents a significant first step in oocyte evaluation for scientific and clinical applications. [Display omitted]