Blast grading - what does it really mean? **PAIF & SAIF welcome!

pblge · July 2014

So we just got the list of grades about our remaining blasts, and we do have some of good quality, so we're very happy. But I've realized that I'm a bit confused, so I thought I'd check the collective wisdom on this forum. I'd love to hear anything that you know about all this.

1. Which of these is better: 6BB or 5AA? Meaning, what is the general principle of which of these three grades means the most? Does the further stage of development mean more than the ABC grade? Or are those more important? Similarly, does anyone know if there's a preference between 5AB or 5BA?
2. What are the chances for an embryo with something like a 5BC grade? Low? Still pretty good? Unknown?
3. Does the speed of embryo development matter? So we had some that made it to the blast stage on day 5 and others that took until day 6. The doctor told me it doesn't matter, but I've heard other people say here that it does. What have you ladies heard?

Any wisdom you ladies can share would be great. I've tried googling this, but the websites don't say all that much.

Thanks!

RunCC37 · July 2014

From what I've gathered, the two letters stand for the part of the blast that will become the baby and the past that becomes the placenta. If it is a freeze all, the slow growers shouldn't make any difference. On a fresh transfer, they could be out of sync with the uterus and miss their window of implantation. Personally, I'd rather see quality over size. But that's coming from someone who has never seen quality

pblge · July 2014

@RunCC37 said:

On a fresh transfer, they could be out of sync with the uterus and miss their window of implantation.

VERY interesting. I wonder if they do things differently during a FET based on this? If "syncing" is a potential problem, then it seems like they should.

pblge · July 2014

IFinTN said:

Ok, went back and pulled my CCS results and it looks like they put them in order of transfer recommendations:

grade 4AA (DAY 5 blast)

grade 4BA (DAY 5 blast)

grade 4AB (DAY 5 blast)

grade 3AB (Day 5 blast)

grade 4BB (day 5 blast)

grade 4AA (Day 6 blast)

grade 5BA (DAY 6 Blast)

I had a 5 day 4AB, 6 day 5BB and 6 day 4BC that were not normal.

Hope that helps!

That's very helpful! They have mine numbered by the embryo. :-/

poohniki · July 2014

My favorite Blastocyst website: https://www.advancedfertility.com/blastocystimages.htm

pblge · July 2014

Okay, I did some more searching and found a bit more info. This page describes two studies, one of which echoes what @IFinTN wrote above about the trophectodrm grade:
https://www.vitrolife.com/en/Fertility/Together/Studies_Research/New-thesis-shows-trophectoderm-cells-to-be-stronger-predictor-for-live-birth-than-inner-cell-mass/

That page also references this study, which clearly contains the probabilities of success for 1 v 2 blasts that many of us have heard.
https://www.ncbi.nlm.nih.gov/pubmed/10856474
I'm going to get the full text of that if anyone wants to read it.

Puzzlefuz · July 2014

***************************siggy warning***************************************

My fresh cycle turned into a freeze all, so my experiences are based upon that.

1. My clinic doesn't grade the expansion of the blast using the number. They just use two letters to grade the development of the baby and the placenta, so in my case they would consider the 5AA better since the letter grading is better.
2. When we did our FET we transferred a BA and a CB. The BA was hatching at the time of transfer. We did have success with both embryos. One split into identical twins, but the twins stopped developing at about 6 weeks. I have no idea if the baby i'm carrying now is the better or poorer embryo.
3. My clinic didn't address the speed of the embryo development. Like pp have mentioned I think that it could make a difference in the fresh transfer and the embryo could miss the implantation window. Both of the embryos we put back were day 6 embryos. We have 4 day 5 embryos frozen. I never found out why they chose the two they did to put back. I suspect it was either because 1) the one embryo was hatching or 2) we were putting back 2 and those two were frozen together as they didn't think the CB embryo would survive the vitrification process in its own pipet, so it was just easier to take those two.

zeynsom · July 2014

Thanks for starting this thread as I also have questions about this. I have one frozen embryo from last cycle. We transferred three of the best embryos on day 3 (due to my low embryo numbers), and the slowest fourth one survived to the sixth day and froze as 2BA. Now I understand that the BA is a good grade but 2 seems to me as a very slow grower, am I right? I understand that letters are important but does anyone know whether the number is important at all? Let's say this cycle I get just one 5BA on day 5 (let's just pretend for a second), if they put that 5BA and 2BA together, what happens? One is clearly in a more advanced stage.

zeynsom · July 2014

@IFinTN that's a great point. I have to check with them. I always assumed that the grades are universal but maybe not

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