Artificial intelligence-derived MAGENTA™ oocyte scores are associated with embryo development and cumulative freeze-all ICSI outcomes.

RESEARCH QUESTION: Are artificial intelligence (AI)-derived MAGENTA™ oocyte scores associated with embryo development and cumulative outcomes after freeze-all intracytoplasmic sperm injection (ICSI), and do they add information beyond the embryo Known Implantation Data score (KIDScore)? DESIGN: Retrospective cohort including 2183 consecutive freeze-all ICSI cycles conducted between 2019 and 2024, comprising 13,786 injected mature oocytes with valid MAGENTA™ scores. Mixed-effects logistic regression evaluated embryo-level outcomes. Retrieval-level summaries were assessed against cumulative outcomes. An additional analysis evaluated clinical pregnancy after adjustment for maternal age, KIDScore and number of embryos transferred. RESULTS: Each one-point increase in MAGENTA™ score was associated with higher odds of fertilization (OR 1.26, 95% CI 1.23 to 1.30), blastocyst development (OR 1.23, 95% CI 1.21 to 1.25) and high-quality blastocyst (≥3BB, Gardner criteria) formation (OR 1.09, 95% CI 1.07 to 1.11) (all P < 0.001). The association with euploidy was not significant (OR 1.03, 95% CI 1.00 to 1.06). At retrieval level, maximum and 90th-percentile scores were most consistently associated with cumulative clinical pregnancy and implantation rates; significant single-summary associations remained significant after false-discovery-rate adjustment. In 1129 eligible retrieval cycles, source-oocyte MAGENTA™ remained associated with clinical pregnancy after adjustment for maternal age, KIDScore and number of embryos transferred (OR 1.51, 95% CI 1.23 to 1.87, P < 0.001), improving model fit and discrimination. CONCLUSION: Higher MAGENTA™ scores were associated with improved embryo development but not significantly with euploidy. Retrieval-level summaries were associated mainly with cumulative clinical pregnancy and implantation, whereas source-oocyte MAGENTA™ added information beyond the KIDScore. Prospective external validation is required before clinical implementation.