Embryo Grading

patchen30

Do you know how embryologists grade embryos?  What are they looking for?  For my last two IVFs my embryos have been "good".  My first IVF they didn't grade them b/c they were blast/cavitating morula, and this IVF they told me they were grade 2 on a scale of 1-5 - 1 being perfect and 3 being average.  They said they don't see "perfect" embryos very often...but I see people posting here about perfect embryos all the time.  Maybe Cornell is just really strict w/ grading?  I'm just wondering what all these different ratings really mean. 

LCB34

Every clinic does it differently.

My clinic follows the grading explained on this website:  Link

theworms

Every clinic has their own grading system.

At my 5dt I had an expanded blast grade 1 and a blast grade 2.  Grade 1 is the highest but I don't know what their low # is b/c I never asked.  RE did say that most of his success stories are with grade 2 embies.

GL

GenRN45

every clinic grades differently.

My RE says no one at his clinic gets a  "perfect" score... but knowing my embryos were already compacting at day 3, and there was no fragmentation was enough for ME to call them perfect. 

patchen30

GenRN45:

every clinic grades differently.

My RE says no one at his clinic gets a  "perfect" score... but knowing my embryos were already compacting at day 3, and there was no fragmentation was enough for ME to call them perfect. 

Interesting...so how many cells is an embryo if it's compacting?

GenRN45

patchen30:

GenRN45:

every clinic grades differently.

My RE says no one at his clinic gets a  "perfect" score... but knowing my embryos were already compacting at day 3, and there was no fragmentation was enough for ME to call them perfect. 

Interesting...so how many cells is an embryo if it's compacting?

more than 8  - it's on the way to blast, about 1 day ahead in growth.

The one on the left, which looks undefined and smooshy, is actually the one that's compacted, on it's way to blast.

The one on the right is 8 cells (grade 2, per my RE), but minimal fragmentation.

cookie_queen

The way CCRM explained it to us yesterday was the number refers to the shell of the embryo with 1 being thick and 6 being already hatched. For a 5dt they want a 4 meaning it's very thin and if it stayed in the lab they would see the embryo hatch by the end of the day. Then they use two letter grades A-D, one for the baby cells and one for the placenta cells. So by what they want our 4 AA embryos were perfect for a day 5 transfer. They won't freeze anything less than a 3 BB.

patchen30

GenRN45:

patchen30:

GenRN45:

every clinic grades differently.

My RE says no one at his clinic gets a  "perfect" score... but knowing my embryos were already compacting at day 3, and there was no fragmentation was enough for ME to call them perfect. 

Interesting...so how many cells is an embryo if it's compacting?

more than 8  - it's on the way to blast, about 1 day ahead in growth.

The one on the left, which looks undefined and smooshy, is actually the one that's compacted, on it's way to blast.

The one on the right is 8 cells (grade 2, per my RE), but minimal fragmentation.

This stuff is so crazy!  My embryos for this IVF were 10 and 9 cells - I wonder if that would be considered compacting then?  Are they morulas at that stage then?  (Sorry if I'm asking too many questions, I'm just curious!)

GenRN45

patchen30:

This stuff is so crazy!  My embryos for this IVF were 10 and 9 cells - I wonder if that would be considered compacting then?  Are they morulas at that stage then?  (Sorry if I'm asking too many questions, I'm just curious!)

Do you have pictures of them? You can tell if they're compacting by looking at the picture. If the cells aren't clearly defined, like the ones in my embryo on the left, then yes, they're compacting.

I think the stages go compacting then morula and then blast.

Fundoh21

Below is the grading scale my clinic uses:

Blastocysts are graded according to the method of Gardner

EB1 - Early blastocyst 1 - The fluid filled cavity is < half the volume of the embryo.
EB2 - Early blastocyst 2 - The fluid filled cavity is > = half of the volume of the embryo.
3 ----- Full blastocyst ----- The fluid filled cavity completely fills the embryo.
4 ----- Expanded blastocyst - The fluid filled cavity volume is larger than that of the early embryo and the zona pellucida is thinning.
5 ----- Hatching blastocyst -The trophectoderm has started to herniate through zona pellucida.
6 ----- Hatched blastocyst - The blastocyst has completely escaped from the zona pellucida.

For blastocysts graded as 3 to 6, the development of the inner cell mass (ICM) and trophectoderm are also assessed.

The ICM grading is as follows:
A ----- Tightly packed, many cells;
B ----- Loosely grouped, several cells;
C ----- Very few cells.

The trophectoderm grading is as follows:
A ------ Many cells forming a tightly knit epithelium;
B ------ Few cells;
C ------ Very few cells forming a loose epithelium.

General comments:
We have seen no difference in pregnancy rates whether an embryo is aa, ab, ba, or bb
We have seen no differnece in pregnancy rates whether an embryo is 3,4 or 5. We rarely see a 6

 

patchen30

GenRN45:

patchen30:

This stuff is so crazy!  My embryos for this IVF were 10 and 9 cells - I wonder if that would be considered compacting then?  Are they morulas at that stage then?  (Sorry if I'm asking too many questions, I'm just curious!)

Do you have pictures of them? You can tell if they're compacting by looking at the picture. If the cells aren't clearly defined, like the ones in my embryo on the left, then yes, they're compacting.

I think the stages go compacting then morula and then blast.

I'll look at the pic when I get home!

Ali212

Every clinic/embryologist has a different approach / scale.  One of my clinics was really limited....basically 3 grades (excellent, good, poor)....they said they rarely saw excellent.  My other clinic never really divulged their exact grading...they didn't like to give it out.  I do think REs sometimes use 'perfect' as euphenism....it may not be graded as the best ever but they're saying it's a good one that they think has a good shot.