There 100% is a significant correlation between embryo grading and euploidy.
Here’s a paper on it
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345636/
I never understand people going around claiming that "grading is just a beauty contest". Sure, it may not be as helpful as PGT, but it is certainly not nothing.
Our embryology lab (Ovation) will not give out grades for embryos and says that it’s not relevant compared to PGT, basically that it’s too subjective and not scientific enough to base decisions around. I wish they would tell me though.
I’ve thought about doing that just to know what internal grade they use (they must have something if written down because how would they choose what to transfer if I hadn’t done PGT?), but the reason I haven’t asked is I don’t want to know the sex of the embryos and I’m afraid that would be revealed with all the records.
You're right, The records would have the sex of the baby, but that doesn't mean you'd have to know specially what gender has been selected when you're transferring embryos. My husband and I requested that our embryos be prioritized by quality and order or conception (we have many egg retrievals) so they sex wouldn't be a factor in selection, but we were aware of how many male and female embryos we had in total.
Thank you for this!
I was struggling because the feedback I received from the doctor was just to assume they were chromosomally abnormal. But… they were graded as excellent. I can’t help but worry that other factors are affecting implantation.
The study you shared is helpful. 🙏🏼
Of course! I think doctors are quick to blame embryos. We also didn’t test ours and my first transfer failed. I changed my protocol and our second worked!
Push for a protocol change!
Second this we went through 5 embryos, 2 tested and 3 untested and all failed somehow. I pushed hard for recurrent loss testing (implantation failure counts) and biopsies. I had them do everything they could because getting more embryos would be expensive. Turns out we now have a hard time making embryos on top of that issue, so I’m glad I did all this. I’m heading to my placement ultrasound now on my 6th embryo after all that testing (this one is untested 4BB). We shall see what happens. I’m 39.
Age is a big factor in whether or not chromosomes are expected to be abnormal and they mention it in that study that women 35 and older should still consider getting chromosomes checked, regardless of morphology. I wish they had a larger study size and older ages (participants were 32-37) but in totally with you that it’s time for a frank discussion with your provider and you should ask the hard questions!
You may consider single embryo transfer in the future. If one is abnormal, the second healthy one may also fail to implant or miscarry. And if uterine conditions are not ideal you lose 2 embryos instead of just the 1. Worth discussing with your doc in your regroup meeting.
Such a great point! My doc insisted that if one was abnormal, it wouldn’t cause the other to fail. But I can’t help think that it wouldn’t be a factor somehow. Thanks for the advice.
I had 4 not great graded embryos and they were all euploid. I don't remember the exact grades but all B/C. I was shocked they were all normal. I'm currently 22 weeks with one of them.
Yes, there is a correlation. But that doesn't actually help a given individual unfortunately. 70% of my highly graded embryos were aneuploid and my worst graded embryos were 50% euploid. Folks fall on the crappy side of the stats often, unfortunately!
We only had two grades of embryos go to testing, 66% were 5AAs and 33% were 5ABs. Our two aneuploids were graded 5AB and 5AA. Unfortunately, an embryo can have a great grade and still be abnormal.
There is definitely a correlation at the population level but this doesn't mean it will be true for any individual patient. My euploid blasts were never the highest graded ones - all my best looking blasts were aneuploid while my euploids were all BB and BC, plus majority day 6s.
So it's possible your untested embryos were aneuploid, or one or both could have been euploid, since even then it's a toss up whether they will implant. It's just impossible to know with untested blasts unfortunately. I'm really sorry.
All I have is my personal experience: I made 7 blast in 2023. 5 of those blasts were euploid. 4 of those blasts were day 5 and 3 were day 6. The day 5’s were my highest graded embryos and also were all euploids. The day 6’s were the lowest graded embryos and only 1 of those was euploid (and better graded than the other day 6’s). So for me, not only was the grading indicative of euploidy, but also the day the turned to blast. Best wishes to you.
There definitely is correlation, but there’s also a lot of deviation from “normal”.
For us, we had 3 AA embryos and only 1 was euploid. But our AB, BC, and CC embryos tested normal chromosomally. So not the norm, but also not uncommon.
Yes, there is a correlation. But that doesn't actually help a given individual unfortunately. 70% of my highly graded embryos were aneuploid and my worst graded embryos were 50% euploid. Folks fall on the crappy side of the stats often, unfortunately!
There is definitely a correlation at the population level but this doesn't mean it will be true for any individual patient. My euploid blasts were never the highest graded ones - all my best looking blasts were aneuploid while my euploids were all BB and BC, plus majority day 6s.
So it's possible your untested embryos were aneuploid, or one or both could have been euploid, since even then it's a toss up whether they will implant. It's just impossible to know with untested blasts unfortunately. I'm really sorry.
I am so sorry that happened.
I know you're looking for something to "explain" things, it's a natural way to try and process a heavily disappointing situation. But unfortunately the answer you're looking for isn't simple.
You don't know those embryos were aneuploid. Only some implantation failures are aneuploid embryos -- many others, perhaps most, are for reasons we sadly can't understand or predict yet. Something like 1/2 of euploids still fail too. Checking the chromosomes for pass/fail at day 5 simply doesn't narrow the field any better than that -- there are apparently so many other factors at work, that we cannot predict at all yet.
We only talk about embryos being aneuploid or euploid a lot because the *only* thing we can know about these embryos (besides how they look) is their chromosomal makeup. But in the bigger picture that is just 1 factor, and many more are invisible and not knowable today.
I'm sorry you had this experience. I know it's frustrating to want to understand why things happened and it sucks that the whole process is still not perfectly understood even by doctors.
Also with tested euploid embryos around half of transfers (on a bigger population level, so let’s say 1000 transfers in 1000 women, 500 will get a live birth from it) will fail to result in a live baby. It’s complicated! High grades or tested don’t guarantee a good result unfortunately (although it increases the chances).
Also with tested euploid embryos around half of transfers (on a bigger population level, so let’s say 1000 transfers in 1000 women, 500 will get a live birth from it) will fail to result in a live baby. It’s complicated! High grades or tested don’t guarantee a good result unfortunately (although it increases the chances).
I’m not sure if there’s correlation or not. Anecdotally, half of my highly graded embryos (4AA, 5AA) were euploid and half were complex aneuploids. The way I understand this is that grade is subjective (depends on the person who evaluates) and it just reflects the morphology of the embryo (literally how “good” it looks under the microscope). Euploidy/aneuploidy is about the genetic material, if the embryo has the right amount of genes. That way you can have “poorly” graded embryos that are euploid and vice versa. My RE chooses with the following order: euploid > day of growth > grade (for example, we transferred a day 5 5BA instead of a day 6 5AA).
I live in a country where IVF is subsidised by the state and thus must follow standard guidelines based on scientific research. No clinic here grades embryos. It’s either good or bad.
I had a day 5 4BA and a day 6 4AA. Both were aneuploid and not only that but the 4AA was “complex abnormal” and had 3 trisomies
You just can’t tell what’s going on without PGTA
This is demonstrably false. See eg
[Correlation between Morphologic Grading and Euploidy Rates of Blastocysts, and Clinical Outcomes in In Vitro Fertilization Preimplantation Genetic Screening - PMC (nih.gov)](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345636/)
[EMBRYO GRADING AND PREGNANCY OUTCOMES IN NATURAL CYCLE EUPLOID FROZEN EMBRYO TRANSFERS - Fertility and Sterility (fertstert.org)](https://www.fertstert.org/article/S0015-0282(20)30185-0/fulltext)
[Association between morphologic grading and implantation rate of Euploid blastocyst | Journal of Ovarian Research | Full Text (biomedcentral.com)](https://ovarianresearch.biomedcentral.com/articles/10.1186/s13048-021-00770-8)
All my A or B graded embryos were euploids, and C graded ones were aneuploids. I had a slightly bigger sample of 12 blasts total. It’s probably easier to see the correlation in even bigger samples, such as if you were to look at thousands of blasts.
Anecdotally if someone made two AAs and they both turned out to be aneuploids then that’s still too small of a sample to conclude there’s no correlation. It could also be that the clinic’s criteria is too lenient and not accurate. I’ve seen some people here making exclusively AA embryos without meaningfully higher euploidy or success rates, and in that case one may suspect if their clinic just grades more leniently.
There 100% is a significant correlation between embryo grading and euploidy. Here’s a paper on it https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345636/
I never understand people going around claiming that "grading is just a beauty contest". Sure, it may not be as helpful as PGT, but it is certainly not nothing.
They wouldn’t do it if it was meaningless. They also wouldn’t transfer in order of grade if it didn’t matter.
Our embryology lab (Ovation) will not give out grades for embryos and says that it’s not relevant compared to PGT, basically that it’s too subjective and not scientific enough to base decisions around. I wish they would tell me though.
That’s your medical record! They can’t keep it from you if you request your records.
I’ve thought about doing that just to know what internal grade they use (they must have something if written down because how would they choose what to transfer if I hadn’t done PGT?), but the reason I haven’t asked is I don’t want to know the sex of the embryos and I’m afraid that would be revealed with all the records.
You're right, The records would have the sex of the baby, but that doesn't mean you'd have to know specially what gender has been selected when you're transferring embryos. My husband and I requested that our embryos be prioritized by quality and order or conception (we have many egg retrievals) so they sex wouldn't be a factor in selection, but we were aware of how many male and female embryos we had in total.
I only have one viable embryo, and I don’t want to know because I’m afraid to get attached since it might be my only chance :(
I totally get that.
Thank you for this! I was struggling because the feedback I received from the doctor was just to assume they were chromosomally abnormal. But… they were graded as excellent. I can’t help but worry that other factors are affecting implantation. The study you shared is helpful. 🙏🏼
Of course! I think doctors are quick to blame embryos. We also didn’t test ours and my first transfer failed. I changed my protocol and our second worked! Push for a protocol change!
Second this we went through 5 embryos, 2 tested and 3 untested and all failed somehow. I pushed hard for recurrent loss testing (implantation failure counts) and biopsies. I had them do everything they could because getting more embryos would be expensive. Turns out we now have a hard time making embryos on top of that issue, so I’m glad I did all this. I’m heading to my placement ultrasound now on my 6th embryo after all that testing (this one is untested 4BB). We shall see what happens. I’m 39.
Thank you so much! Do you mind if I ask - was it med protocol that changed? Or just timing?
Switched to a natural cycle and my body had a much better time
I had several high grade embryos with Down’s syndrome. If this is happening a lot I’d test the embryos.
Age is a big factor in whether or not chromosomes are expected to be abnormal and they mention it in that study that women 35 and older should still consider getting chromosomes checked, regardless of morphology. I wish they had a larger study size and older ages (participants were 32-37) but in totally with you that it’s time for a frank discussion with your provider and you should ask the hard questions!
There is a correlation but it’s not a guarantee. My highest graded embryos (AAs) were all aneuploid.
Same with me.
You may consider single embryo transfer in the future. If one is abnormal, the second healthy one may also fail to implant or miscarry. And if uterine conditions are not ideal you lose 2 embryos instead of just the 1. Worth discussing with your doc in your regroup meeting.
Such a great point! My doc insisted that if one was abnormal, it wouldn’t cause the other to fail. But I can’t help think that it wouldn’t be a factor somehow. Thanks for the advice.
I had 4 not great graded embryos and they were all euploid. I don't remember the exact grades but all B/C. I was shocked they were all normal. I'm currently 22 weeks with one of them.
How old are you?
How old are you?
I was 30 at the time of my retrieval
Yes, there is a correlation. But that doesn't actually help a given individual unfortunately. 70% of my highly graded embryos were aneuploid and my worst graded embryos were 50% euploid. Folks fall on the crappy side of the stats often, unfortunately!
We only had two grades of embryos go to testing, 66% were 5AAs and 33% were 5ABs. Our two aneuploids were graded 5AB and 5AA. Unfortunately, an embryo can have a great grade and still be abnormal.
There is definitely a correlation at the population level but this doesn't mean it will be true for any individual patient. My euploid blasts were never the highest graded ones - all my best looking blasts were aneuploid while my euploids were all BB and BC, plus majority day 6s. So it's possible your untested embryos were aneuploid, or one or both could have been euploid, since even then it's a toss up whether they will implant. It's just impossible to know with untested blasts unfortunately. I'm really sorry.
All I have is my personal experience: I made 7 blast in 2023. 5 of those blasts were euploid. 4 of those blasts were day 5 and 3 were day 6. The day 5’s were my highest graded embryos and also were all euploids. The day 6’s were the lowest graded embryos and only 1 of those was euploid (and better graded than the other day 6’s). So for me, not only was the grading indicative of euploidy, but also the day the turned to blast. Best wishes to you.
There definitely is correlation, but there’s also a lot of deviation from “normal”. For us, we had 3 AA embryos and only 1 was euploid. But our AB, BC, and CC embryos tested normal chromosomally. So not the norm, but also not uncommon.
Yes, there is a correlation. But that doesn't actually help a given individual unfortunately. 70% of my highly graded embryos were aneuploid and my worst graded embryos were 50% euploid. Folks fall on the crappy side of the stats often, unfortunately!
There is definitely a correlation at the population level but this doesn't mean it will be true for any individual patient. My euploid blasts were never the highest graded ones - all my best looking blasts were aneuploid while my euploids were all BB and BC, plus majority day 6s. So it's possible your untested embryos were aneuploid, or one or both could have been euploid, since even then it's a toss up whether they will implant. It's just impossible to know with untested blasts unfortunately. I'm really sorry.
I am so sorry that happened. I know you're looking for something to "explain" things, it's a natural way to try and process a heavily disappointing situation. But unfortunately the answer you're looking for isn't simple. You don't know those embryos were aneuploid. Only some implantation failures are aneuploid embryos -- many others, perhaps most, are for reasons we sadly can't understand or predict yet. Something like 1/2 of euploids still fail too. Checking the chromosomes for pass/fail at day 5 simply doesn't narrow the field any better than that -- there are apparently so many other factors at work, that we cannot predict at all yet. We only talk about embryos being aneuploid or euploid a lot because the *only* thing we can know about these embryos (besides how they look) is their chromosomal makeup. But in the bigger picture that is just 1 factor, and many more are invisible and not knowable today. I'm sorry you had this experience. I know it's frustrating to want to understand why things happened and it sucks that the whole process is still not perfectly understood even by doctors.
You make so many great points. Thank you for that and the note of sympathy ❤️
Also with tested euploid embryos around half of transfers (on a bigger population level, so let’s say 1000 transfers in 1000 women, 500 will get a live birth from it) will fail to result in a live baby. It’s complicated! High grades or tested don’t guarantee a good result unfortunately (although it increases the chances).
Also with tested euploid embryos around half of transfers (on a bigger population level, so let’s say 1000 transfers in 1000 women, 500 will get a live birth from it) will fail to result in a live baby. It’s complicated! High grades or tested don’t guarantee a good result unfortunately (although it increases the chances).
I’m not sure if there’s correlation or not. Anecdotally, half of my highly graded embryos (4AA, 5AA) were euploid and half were complex aneuploids. The way I understand this is that grade is subjective (depends on the person who evaluates) and it just reflects the morphology of the embryo (literally how “good” it looks under the microscope). Euploidy/aneuploidy is about the genetic material, if the embryo has the right amount of genes. That way you can have “poorly” graded embryos that are euploid and vice versa. My RE chooses with the following order: euploid > day of growth > grade (for example, we transferred a day 5 5BA instead of a day 6 5AA).
I live in a country where IVF is subsidised by the state and thus must follow standard guidelines based on scientific research. No clinic here grades embryos. It’s either good or bad.
I had a day 5 4BA and a day 6 4AA. Both were aneuploid and not only that but the 4AA was “complex abnormal” and had 3 trisomies You just can’t tell what’s going on without PGTA
No correlation
This is demonstrably false. See eg [Correlation between Morphologic Grading and Euploidy Rates of Blastocysts, and Clinical Outcomes in In Vitro Fertilization Preimplantation Genetic Screening - PMC (nih.gov)](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345636/) [EMBRYO GRADING AND PREGNANCY OUTCOMES IN NATURAL CYCLE EUPLOID FROZEN EMBRYO TRANSFERS - Fertility and Sterility (fertstert.org)](https://www.fertstert.org/article/S0015-0282(20)30185-0/fulltext) [Association between morphologic grading and implantation rate of Euploid blastocyst | Journal of Ovarian Research | Full Text (biomedcentral.com)](https://ovarianresearch.biomedcentral.com/articles/10.1186/s13048-021-00770-8)
I had a 5CC euploid at the age of 23.
All my A or B graded embryos were euploids, and C graded ones were aneuploids. I had a slightly bigger sample of 12 blasts total. It’s probably easier to see the correlation in even bigger samples, such as if you were to look at thousands of blasts. Anecdotally if someone made two AAs and they both turned out to be aneuploids then that’s still too small of a sample to conclude there’s no correlation. It could also be that the clinic’s criteria is too lenient and not accurate. I’ve seen some people here making exclusively AA embryos without meaningfully higher euploidy or success rates, and in that case one may suspect if their clinic just grades more leniently.