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LoLam - November 10th, 2006 3:58 PM

Hi!
I am new to this forum, but have questions about embryo grading.

I am 30 years old, have had endometriosis removed twice, last time was with laser this past August. We have been TTC for 3 years now, and have never been pregnant. My husband has sperm motility issues, but excellent DNA fragmentation. We are amidst our first IVF/ICSI cycle.
I had 21 eggs retrieved 3 days ago (which was day 12 of my cycle). We are planning blastocyst transfer. I am also drinking a lot of gatorade because of high risk of OHSS.
Today, (Day 3), we have 11 embryos left, and 2 of those are at the 7-8 cell stage and 5 at the 9+ cell stage. 4 Embryos have 5 cells or less.
However, ALL of the embryos have been given a Grade 3, out of 5 (1 being strongest and 5 being weakest).

What does this mean? Are the embryos abnormal in some way? (I was told they wouldn't be, but don't necessarily believe this.) Could it mean that it is 'iffy' if they make it to blastocycsts? If any make it to blastocysts, does that mean they would be okay? Could this mean that implantation is less likely? Could it mean that miscarriage could be more likely if pregnancy occurred? What does fragmentation mean?

Any information would be greatly appreciated!!
Lola :o ???

LoLam - November 11th, 2006 11:41 AM


I guess an update here...

Today is day 4, and we have 7 Morulas, and 4 that are not morulas yet (a bit behind). Tomorrow is our transfer.

They don't grade the Morulas though..does that mean that it doesn't matter anymore that they were at a Grade 3 yesterday? As long as they make it to Blastocyst?

Tomorrow they will let me know the quality of the Blastocysts and which ones can be put back, and which ones can be frozen.

Any info would be great!

LoLam - November 13th, 2006 2:57 PM


Another update...only 3 of all of the embryos made it to blastocysts. 2 were transferred, and only 1 could be frozen.

Based on previous info, will my blasts be of good quality? What could our chances be of having this go on to a baby, or twins? Do the Day 3 Embryos being of grade 3 quality have any bearing on the blastocysts that were transferred? My RE does not grade blastocysts.

Thanks in advance,
Lola

Dr Smith - November 16th, 2006 11:51 AM

Blastocysts should be graded in order to predict outcome. Witout that information, I can't really say one way or another. Not grading blastocyst sounds like BS to me. As far as I'm aware, EVERY lab that cultures embryos to the blastocyst stage grades them in some way. The grading systems may vary from lab to lab, but it is virtually unheard of to transfer ungraded blastocyst stage embryos (at least expanded or not). If they truely do not grade blastocycts, it it would appear that they are trying to cover something up. Ask for your lab records. The grade should be on there. Yes, you are entitled to the lab records as part of your treatment. Again, if the refuse or drag their feet, this is a bad sign. If you are not pregnant, move on.


LoLam - November 16th, 2006 7:03 PM

Wow, I had no idea, this is upsetting me a bit. No one would even explain to me what exactly it meant to have a Grade 3 embryo either. And I asked a lot of questions!

I asked the Dr., and the nurse at different occasions about the quality of the blastocysts. I guess I will be calling tomorrow to get this information.
I was just told that once it reaches blastocyst, they are doing fine.

I hope I can ask again effectively to get some answers!
Thanks so much for your reply.

Lola

Dr Smith - November 17th, 2006 9:13 AM

I don't know what a Grade 3, Day 3 embryo is in your lab. As I mentioned, grading systems vary from lab to lab (I wish we embryologists could agree on a universal grading system, but alas...). Some labs use Grade 1 to indicate the best, some use Grade 4. Since your Grade 3 embryo made it to the blastocyst stage, I would presume that a 4 is the best in your lab. If that's the case, then it is not unusual for Grade 3 embryos (second string) to make it to the blastocyst stage. They may have a small amount of fragmentation (hence Grade 3 instead of 4), but the fragments are just pushed out to the edge of the embryo when the blastocyst begins to expand. It does not necessarily indicate compromised development.

However, blastocyst grading systems usually assess the size/shape of the inner cell mass. The inner cell mass is the group stem cells located inside the fluid-filled cavity of the blastocyst. Assessing the size/shape of the inner cell mass is important because it is the stem cells that become the baby. The other cells of the blastocyst become the fetal portion of the placenta (not as important as the stem cells). Without knowing the size/shape of the inner cell mass, it is impossible to predict the developmental potential of the blastocyst stage embryo. All blastocysts are not created equal and developmental potential differs depending on the size/shape of the inner cell mass.

As an aside, don't expect to get detailed answers about embryo quality from docs or nurses. They often try to insulate the patient from that information. The rationale for withholding this information is that when the patient knows that their embryos were of less-than-optimal developmental potential, this will lead to questions which will lead to more questions, etc, etc. They are too busy to get into detailed explanations. Also, they want to avoid the "blame game". Easier to say "Everything looked fine...". If you want a straight answer about embryo quality/grade, talk directly to the embryologist. If they are allowed to speak freely to the patient (and many aren't), they wil give you a more detailed answer.

LoLam - November 17th, 2006 1:05 PM

Thanks for your reply Dr. Smith.
As I previously stated, our clinic rates 1 as the best, and 5 as the 'least strongest', and my embryos were graded at 3..right in the middle. I spoke with Dr., Nurses etc., and couldn't get any concrete info on what this meant.
As for my Blastocysts, they only said they 'looked fine too', and that they didn't 'grade them'. They just said that the fact they made it to blastocysts is good enough.

I have put in a call to my clinic asking for how my Blastocysts were rated, I stated that I heard that this is what most clinics did. I also asked, based on this info, what specific chances of success they predict for us based on this info.

I'll let you know when I hear!

I really feel frustrated that I can't get all the information that I should be entitled to.

Thanks again,
Lola

LoLam - November 17th, 2006 4:53 PM


Hi Dr. Smith,

Thanks for your messages by the way.

I found out from my clinic that my blastocysts were graded as 'hatching blastocysts', and were of very good quality. This was the same as the blastocyst that they froze. This is the only info I could get, but it sounds good to me. What do you think?


Lola

Dr Smith - November 20th, 2006 10:11 AM

"Hatching" is a type grading. The final stage of blastocyst deveopment prior to implantation is the "hatching" process. Hatching refers to when the blastocyst breaks through the protein coat (zona pellucia) that completely encloses the embryo. Hatching is necessary for the embryo to make direct cell-cell contact with the endometrium. Hatching is a good sign, but embryos with very few stem cells also "hatch", implant and develop for a short time (chemical pregnancies, etc). They infer that "good quality" blastocysts have an adequate numer of stems, but, unfortunaely, they do not provide an objective, quantitative grading.

Based on the rather vauge description they provided, your chances appear to be "good". Your age cetainly weighs in your favor and you are in the best prognosis group. Dr S's crystal ball says about a 50-60% chance of taking home a baby from the hospital. Best of luck.


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