grading of frozen embryos?

grading of frozen embryos?

smrc
smrc

January 25th, 2012, 4:59 am #1

Hi there - I am patiently waiting to do a FET at C.orn.ell - we had a chem pg in early Jan and C.orn.ell wanted me to wait 2 cycles before doing the FET.

We have 3 frozen.

I have asked both the nurses and the RE what quality/grade the 3 frozen are, and the only response I have gotten so far is "Grade?" (like I'm crazy to be asking about this!) and "fairly good."

Is this normal information to get? Are all frozen embies generally graded?

I trust C.orn.ell and its labs, etc. just thought I would get more info.

SMRC
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DeeinNYC
DeeinNYC

January 25th, 2012, 5:53 am #2

Hi SMRC,

Yes...I do think its normal to get a grading of your embryos. Some clinics are more detailed than others. My clinic has their own system of grading on Day 3 from 0-100 and grades blasts (Day 5 or 6) from 1-3 with 1 being the highest grade. Many other clinics have a more complex grading system which is made up of three components...level of expansion of the embryo, quality of the blasts inner cell mass, and quality of the rest of the blast...this roughly explains it but the following site explains the grading system that many use for blasts:

advancedfertility.com/blastocystimages.htm

If they will not give you a grade, what you want to know is were your embies expanded or hatching blasts or were they still morulas on Day 5. A hatching blast is essentially as good as a blast can get. A morula is the stage just before blast. You also want to know if your embies made it to blast on day 5 or 6 and whether they were expanded or not. Ideally they should be expanded by Day 5 but some don't expand until Day 6. I think knowing the stage of growth when frozen and how long it took your embryos to expand will give you a lot of information.

I heard that Cornell has very strict freezing requirements so my guess is that you have very good embryos. Also keep in mind that they start growing again upon the thaw and before they are put back in. Good luck!!
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Joined: April 27th, 2007, 10:46 am

January 25th, 2012, 1:01 pm #3

Our twins were the result of 2 late stage morulas that were implanted on Day 5, and I also know of quite a few people that were unsuccessful with blasts. Remember, grading criteria varies with the clinic. Don't be too concerned if earlier stage embryos are implanted.
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DeeinNYC
DeeinNYC

January 25th, 2012, 2:01 pm #4

Without a doubt...people have success with morulas but statistically, they have more success with blasts. I would want to know if I were putting back 3 hatching blasts for example as opposed to three morulas in making a decision as to how many to put back. The one thing that grading can't tell us is whether we have a genetically normal embryo or not. As you say however, everything can be perfect...yet no pregnancy result. Imperfect embryos often make perfect babies!! Congrats on your twins.

Just an FYI, my clinic will not freeze any embryo that has not expanded by at least day 6 or that is not at least a grade 2...and I THINK Cornell has even higher standards....so...I think the OP is in great shape.
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Sharon
Sharon

January 25th, 2012, 2:58 pm #5

Hi there - I am patiently waiting to do a FET at C.orn.ell - we had a chem pg in early Jan and C.orn.ell wanted me to wait 2 cycles before doing the FET.

We have 3 frozen.

I have asked both the nurses and the RE what quality/grade the 3 frozen are, and the only response I have gotten so far is "Grade?" (like I'm crazy to be asking about this!) and "fairly good."

Is this normal information to get? Are all frozen embies generally graded?

I trust C.orn.ell and its labs, etc. just thought I would get more info.

SMRC
One of my worst frozen embryos (a 3BB) was the one that stuck, so don't pay too much attention to the grading. Hard to do, I know!
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Anonymous
Anonymous

January 25th, 2012, 4:10 pm #6

Hi there - I am patiently waiting to do a FET at C.orn.ell - we had a chem pg in early Jan and C.orn.ell wanted me to wait 2 cycles before doing the FET.

We have 3 frozen.

I have asked both the nurses and the RE what quality/grade the 3 frozen are, and the only response I have gotten so far is "Grade?" (like I'm crazy to be asking about this!) and "fairly good."

Is this normal information to get? Are all frozen embies generally graded?

I trust C.orn.ell and its labs, etc. just thought I would get more info.

SMRC
You can ask about different things depending on which day they were frozen.

Yes I would definitely ask to see the embryologist's full report, I think you should be entitled to the information. Maybe call and ask to speak with or set up an appointment with an embryologist (or if you aren't allowed, the RE). Of course there is documented info on each and every embryo, the nurses may not be the best source for the info and may not be used to interpreting the data.

The reason I would want to know and not have it glossed over: to find out specifically what was transferred before, what was frozen, then you can ask what the clinic's typical success rates are for each type of visually-graded embryo. Of course you don't count any of them out, but that kind of information can certainly help you decide how many to transfer.
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Joined: March 25th, 2008, 8:46 pm

January 25th, 2012, 6:28 pm #7

Hi there - I am patiently waiting to do a FET at C.orn.ell - we had a chem pg in early Jan and C.orn.ell wanted me to wait 2 cycles before doing the FET.

We have 3 frozen.

I have asked both the nurses and the RE what quality/grade the 3 frozen are, and the only response I have gotten so far is "Grade?" (like I'm crazy to be asking about this!) and "fairly good."

Is this normal information to get? Are all frozen embies generally graded?

I trust C.orn.ell and its labs, etc. just thought I would get more info.

SMRC
I did know one was hatching, one expanding, one early, and two generic middle of the road blasts. I still wish I knew what became of the ones they did not transfer to me. They told ME they did not make it but in the medical journal referencing our case study, it said all five survived. I am pretty sure the hatching one was transferred to me but I honestly do not know about which of the other two were. My betas were so low though maybe it turned out to be the two of the slower growers who were transferred and succeeded?
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thesameboat
thesameboat

January 25th, 2012, 7:29 pm #8

Hi there - I am patiently waiting to do a FET at C.orn.ell - we had a chem pg in early Jan and C.orn.ell wanted me to wait 2 cycles before doing the FET.

We have 3 frozen.

I have asked both the nurses and the RE what quality/grade the 3 frozen are, and the only response I have gotten so far is "Grade?" (like I'm crazy to be asking about this!) and "fairly good."

Is this normal information to get? Are all frozen embies generally graded?

I trust C.orn.ell and its labs, etc. just thought I would get more info.

SMRC
before they were graded?
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smrc
smrc

January 26th, 2012, 12:56 am #9

Hi there - I am patiently waiting to do a FET at C.orn.ell - we had a chem pg in early Jan and C.orn.ell wanted me to wait 2 cycles before doing the FET.

We have 3 frozen.

I have asked both the nurses and the RE what quality/grade the 3 frozen are, and the only response I have gotten so far is "Grade?" (like I'm crazy to be asking about this!) and "fairly good."

Is this normal information to get? Are all frozen embies generally graded?

I trust C.orn.ell and its labs, etc. just thought I would get more info.

SMRC
for this extremely helpful information- I at least know what to ask if/when I get the opportunity.

They were frozen on at least day 5 (but also possibly later - did I mention I have no info? )

I expect C.or.nell's standards to be high/strict but I absolutely hate being in the dark. And feel dumb for not knowing more.

I guess much will turn on how the embies do when thawed in any case.

Will post again if I get more info.

And I'm always amazed at the knowledge on this board... Thanks again.

SMRC
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Anonymous
Anonymous

January 26th, 2012, 1:40 am #10

Different clinics have their own codes for grading blasts (usually a series of numbers and letters), one indicates how far along the embryo is, one indicates the inner cell mass, one indicates the outer cell mass. I'm sure Cornell has a shorthand for these things too with specific criteria on how each area is labeled. Otherwise how would they have a methodology to indicate which ones get frozen and which are not?

For example at my clinic a group of blasts could be labeled "3BA, 4AB, 3BB, 5BC, 4AA" where the number is on a scale of 1-5 with 5 being the most advanced/ most hatched, the first letter is the inner cell mass destined to be the fetus with A being the best grade, and the second letter is the outer cell mass destined to be the placenta with A being the best grade. HOWEVER this is a well-known clinic that does a lot of CGH testing on blasts, and they are finding that some of the lesser-graded ones are turning out to have normal chromosomes, as other posters have noted.
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