1 Replies
Dannye - June 15

Dr. Smith,

I know you must get a ton of these questions, and I realize that every patient is different, and there are multitudes of factors to weigh in on.....but can't stop myself from asking anyway!

I'm 31, husband is 32. No miscarriages, no strong diagnosis for why we were not achieving pregnancy. After several failed attempts at IUI, we did a round of IVF. We had 8 eggs retrieved, 6 were fertilized. Of the 6, 3 looked good (2 were 8-cell at day 3). We transferred those 2, but had no success. Three of the remaining 4 stopped developing, and the remaining embryo was excessively fragmented. After taking some time off, we went on to round 2.

Medications were slightly adjusted with the hope of getting more mature eggs. I also started taking heprin and prednisone. The morning of the retrieval, I felt myself starting to ovulate a few hrs before the procedure, so I may have lost an egg or two. We ended up with 8 eggs retrieved, but only 4 were mature. Of those 4, 3 fertilized. On day 3 (today), our RE said one did not look good (did not give details), but he said the other 2 were "growing well", saying one was "grade 5", and the other "grade 4". The pics they gave us show what appears to be one 7-cell embryo, and one 5 cell. We did the transfer this morning.

When I look at several different websites, it seems that grading embryos at a 5 or 4 means they are NOT good embryos. So my first question is, do some clinics flip the scale around in their grading scheme?

Second question is the obvious one: if you had a patient with these numbers, what would you guess the chances to be for a successful pregnancy? I understand that grading embryos is not a "perfect" science and all, but what's the average cell count for a day 3 embryo? I've heard anything from 4-10 can be good...more the merrier, of course.

Thanks, and have a great day!!!


Dr Smith - June 16

Actually, the original grading system for cell-stage embryos was on a scale of 5-1, with 5 being the best. Although most programs have reversed that scale and made a 1 the best (sounds better to patient), some old-schoolers continue to use the original grading system. So, in this case, a 4 and a 5 are O.K. grade-wise.

Embryos with good developmental potential reach the 8-cell stage by the morning of Day 3. Many embryos arrest development between the 4 and 8-cell stage, so it is impossible to predict the developmental potential of embryos that have less than 8 cells on Day 3. They may have arrested, or they may not. This "unknown factor" is the reason I promote blastocyst transfer. Waiting for blastocyst development elliminates the "unknown factor". Embryos that reach the blastocyst stage have proven their developmental potential and are capable of immediate implantation following transfer. See http://www.sharedjourney.com/articles/3vs5.html



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