Embryo Grading and Your Surrogacy Journey

Embryo grading is a critical aspect of in vitro fertilization (IVF) procedures, helping fertility specialists determine the best embryos for transfer to optimize the chances of a successful pregnancy during your surrogacy journey. This process involves assessing various parameters of the embryos to evaluate their quality and potential for implantation. In this article, we will delve into the details of embryo grading, its significance, and the various factors that are considered during the assessment.

The Significance of Embryo Grading

Embryo grading is conducted to identify the embryos with the highest potential for implantation and successful development into a healthy fetus. By selecting the best quality embryos, fertility specialists aim to increase the chances of achieving a successful pregnancy while minimizing the risk of miscarriage and other complications. This is particularly important in cases where there are a limited number of embryos available for transfer.

Parameters Assessed During Embryo Grading

Embryo grading is typically conducted on Day 3 or Day 5/6 post-fertilization, depending on the protocol followed by the fertility clinic. The assessment involves evaluating various parameters, which may include:

Cell Number: On Day 3, a healthy embryo should ideally consist of 6-10 cells. The cell number provides insight into the embryo’s rate of division and development.

Cell Symmetry: Symmetry of the cells is another important criterion. Embryos with evenly sized cells are generally considered to be of higher quality.

Fragmentation: Fragmentation refers to the presence of small pieces of cellular material in the embryo. Less fragmentation is associated with better embryo quality.

Zona Pellucida Thickness: The zona pellucida is the outer shell of the embryo. Its thickness can affect the embryo’s ability to hatch and implant in the uterine lining.

Blastocyst Development (Day 5/6): For embryos cultured to Day 5 or 6, the development of the blastocyst (a more advanced stage of development) is assessed. This includes evaluating the size of the blastocyst, the development of the inner cell mass (which becomes the fetus), and the trophectoderm (which becomes the placenta and surrounding tissues).

Grading Systems

Different fertility clinics may use varying grading systems to assess embryos. Some common systems include:

The Gardner System

The Gardner System is a widely-used method for grading blastocysts during in vitro fertilization (IVF) procedures. Developed by Dr. David K. Gardner, this system provides a detailed assessment of the blastocyst’s quality, helping embryologists and fertility specialists decide which embryos have the highest potential for successful implantation and pregnancy.

The Gardner System grades blastocysts based on three main criteria:

1) Blastocyst Expansion and Hatching Status:
Grade 1: Early blastocyst, the blastocoel (fluid-filled cavity) is less than half the volume of the embryo.
Grade 2: Blastocyst, the blastocoel is more than half the volume of the embryo.
Grade 3: Full blastocyst, the blastocoel completely fills the embryo.
Grade 4: Expanded blastocyst, the blastocoel volume is larger than that of the early embryo, and the zona pellucida (outer shell) has begun to thin.
Grade 5: Hatching blastocyst, the blastocyst is escaping from the zona pellucida.
Grade 6: Hatched blastocyst, the blastocyst has completely escaped from the zona pellucida.

2) Inner Cell Mass (ICM) Quality:
Grade A: Tightly packed, many cells.
Grade B: Loosely grouped, several cells.
Grade C: Very few cells.

3) Trophectoderm (TE) Quality (the outer layer of cells that develops into the placenta and surrounding tissues):
Grade A: Many cells forming a cohesive epithelium.
Grade B: Few cells forming a loose epithelium.
Grade C: Very few large cells.

Example of Gardner Grading:
A blastocyst might be graded as 4AA, where the first number (4) represents the expansion and hatching status, and the two letters (AA) represent the ICM and TE quality, respectively. In this example, a 4AA blastocyst would be an expanded blastocyst with a high-quality inner cell mass and trophectoderm.

Importance of the Gardner System:
The Gardner System’s detailed grading criteria allow for a comprehensive evaluation of the blastocyst’s potential for successful implantation. High-grade blastocysts (e.g., those with AA or AB grades for ICM and TE) are more likely to implant successfully and result in a healthy pregnancy. However, it’s important to note that even blastocysts with lower grades can still result in successful pregnancies, and the final decision on which embryo to transfer should be made in consultation with a fertility specialist.

The Cummins System

The Cummins grading system is another methodology used to evaluate the quality of embryos, typically on Day 3 of development, which is an earlier stage compared to the Day 5 or 6 assessment in the Gardner system for blastocysts. This system was developed by Cummins et al. in 1986 and is focused on three key aspects of the embryo’s appearance:

  1. Cell Number: The ideal number of cells for a Day 3 embryo is between 6 and 10. This suggests that the embryo is dividing at an appropriate rate.
  2. Cell Symmetry: In high-quality embryos, the cells (blastomeres) should be mostly uniform and symmetrical in size. Asymmetrical division or varied cell sizes can be indicative of developmental issues.
  3. Degree of Fragmentation: Fragmentation refers to the presence of small, extracellular fragments of cytoplasm that have budded off from the blastomeres. In the Cummins system, fragmentation is categorized by the percentage of the embryo volume that is occupied by these fragments.
    1. Grade 0: No fragmentation
    2. Grade 1: Minor fragmentation, occupying less than 10% of the embryo’s volume.
    3. Grade 2: Moderate fragmentation, comprising 10–25% of the embryo’s volume.
    4. Grade 3: Severe fragmentation, where fragments make up 25–50% of the embryo volume.
    5. Grade 4: Extreme fragmentation, with more than 50% of the embryo’s volume.

Embryos are also assessed for other morphological criteria such as the presence of multinucleation in the cells, which is considered an abnormality and usually results in a lower grade.

Decoding the Role of Embryo Grading in Enhancing IVF Success

Embryo grading is a crucial step in the IVF process, providing invaluable information to help fertility specialists select the best embryos for transfer. By understanding the various parameters involved in embryo assessment and the grading systems used, patients can have a better grasp of the process and feel more informed and involved in their fertility journey. As with any medical procedure, it is important to have open and transparent communication with your fertility specialist to ensure that you understand the embryo grading results and how they impact your treatment plan.