IVF and Embryo Grading: How It Works

What is IVF?

Couples with blocked or damaged fallopian tubes, male infertility (like low sperm count or sperm with low motility), ovulation disorders, ovarian failure, uterine fibroids, or unexplained infertility may seek out in vitro fertilization. IVF is a fertility treatment option that allows couples to carry their children after they are unable to conceive naturally.

After egg and sperm retrieval, they are combined in a laboratory to create an embryo. Then, a number of embryos are inseminated back in the uterus to hopefully result in a healthy pregnancy.

However, there are some IVF side effects. The procedure may result in discharge, mild cramping and bloating, constipation, breast tenderness, or bowel/bladder damage, infection, or bleeding. The hormone treatment that precedes the procedure may result in headaches, mood swings, abdominal pain, hot flashes, and bloating.

If the IVF treatment is successful, the couple should be prepared for the increased likelihood of multiple pregnancies as well as ectopic pregnancies (especially when the woman has damaged fallopian tubes). IVF may also result in a child born premature or with low birth weight.

What is Embryo Grading?

For all you over-achievers out there - no, unfortunately embryo grading is not a way for your embryos to earn an A+.

After the egg and sperm are combined in the laboratory, they are observed and given a “grade” to ensure that the embryo transfer goes smoothly, and that the embryos inseminated are healthy and likely to result in a pregnancy.

On Day 3, the embryos are in their “cleavage stage,” which means that the cells are actively dividing. That fragmentation is what the specialists are looking for when they grade your embryos. The grade descriptions below were found via ARC Fertility:

●      Grade 1: Cells are of equal size; no fragmentation seen

●      Grade 2: Cells are of equal size; minor fragmentation only

●      Grade 2.5: Cells are mostly of equal size; moderate fragmentation

●      Grade 3: Cells are of unequal size; no fragmentation to moderate fragmentation

●      Grade 4: Cells are of equal or unequal size; fragmentation is moderate to heavy

Days 5/6 are more important, however, because this is the “blastocyst stage.” Embryos in this stage have a higher chance of implanting, which means you’ll need to implant fewer and the chance for multiple pregnancies decreases. Embryos that reach this stage also have a lower rate of chromosomal disorders. The grade descriptions below were found via Atlanta Infertility:

●      Grade 1:The embryo has the appropriate cell number for stage development and the cells are even in their size and shape. The embryos should have little or no fragmentation between cells.

●      Grade 2: The embryo has the correct development of cell numbers, with a small amount of fragmentation, or slight unevenness of blastomere sizes.

●      Grade 3: The embryo contains blastomeres that are uneven in size and has more than 30% fragmentation. Embryos developing slowly will also receive a grade of 2 or 3 even if they are normal otherwise.

●      Grade 4: The embryo contains very few, if any, viable appearing cells and has a high percent fragmentation.

The grade is based on a few other things in addition to fragmentation. Embryo expansion means their size and how it correlates to the fragments below (similar to their density - a large embryo with few fragmentations inside isn’t very strong). The inner cell mass specifies the most desireable cells that will eventually grow into a baby. The trophectoderm, on the other hand, specifies the most desireable cells that will eventually grow into the placenta and will initiate the implantation to the uterine wall.

Written by: Joanna Hynes

The Pros, Cons, and Costs Associated With In Vitro Fertilization

What is IVF?

“IVF [In Vitro Fertilization] is the process of fertilization by manually combining an egg and sperm in a laboratory dish, and then transferring the embryo to the uterus.” Couples who use this can often have blocked or damaged fallopian tubes, male factor infertility (like low sperm count or motility), ovulation disorders, ovarian failure, uterine fibroids, or unexplained infertility.

After making sure the couple is healthy and prepared for the procedure (typically the woman will go through hormone treatments), the eggs and sperm are retrieved and combined in a laboratory. They are kept in an environment suitable for fertilization and early growth. Those embryos (combined egg and sperm) are then placed in the uterus.

The Pros

IVF has a lot of great benefits. The treatment can help you to conceive, often times with your own egg and sperm. Even if you opt to use a donor egg or a donor sperm, IVF treatment allows many women to still carry the baby themselves. Most infertility issues in women come from the egg and not the uterus, so once the embryo is created, many women can then carry the child. If you’re a single woman or a same-sex female couple, this is also a great option to use a donor sperm but still carry the child.

According to American Pregnancy, you can see the average IVF success rates in the United States below:

●      41-34% for women under age 35

●      33-36% for women ages 35-37

●      23-27% for women ages 38-40

●      13-18% for women ages over 40

IVF is also more successful than most other treatments, such as IUI (Intrauterine Insemination), although if it’s unfortunately not successful, it can help the woman learn about her unexplained infertility and overall health.

Through IVF, couples can also screen for genetic diseases such as cystic fibrosis, Huntington’s disease, and muscular dystrophy. The process is called pre-implantation genetic diagnosis (PGD) and will ensure that the child will not suffer from these disorders. Pre-implantation genetic screening (PGS), and they can check embryos for chromosomal disorders such as Down Syndrome.

The Cons

Side effects of IVF include discharge (sometimes with a little blood), cramping, bloating, constipation, and breast tenderness. Severe symptoms (which warrant an immediate call to your doctor) include heavy bleeding, pelvic pain, blood in your urine, and a fever.

Side effects of the hormone treatments include headaches, mood swings, abdominal pain, hot flashes, and bloating.

There are also risks with IVF that you should be aware of. For example, the egg retrieval can result in bowel or bladder damage, infection, or bleeding. After an IVF treatment is successful, the chance of a multiple pregnancy increases since a number of embryos are inseminated, and multiple pregnancies carry more risks themselves. IVF also increases the risk of an ectopic pregnancy, especially when the woman has damaged fallopian tubes, or a child born premature and/or with low birth weight. If IVF is not successful, there’s an emotional factor that couples need to be prepared for.

Some argue that there’s an ethical issue here as well. Selecting embryos and potentially discarding others, especially while scanning/altering for diseases and disorders, doesn’t always sit well with everyone. Remember, this is your family you’re creating, so figure out what you are and are not comfortable with ahead of time.

Lastly, it’s pretty expensive...

The Cost

In Vitro Fertilization cost is different for everyone. It depends on your clinic, your insurance, the medications you take, whether your eggs are frozen or “fresh,” and many more factors. For a general idea, you can try this IVF Calculator.

Forbes ran an article by Jennifer Gerson Uffalussy titled “The Cost of IVF: 4 Things I Learned While Battling Infertility”. You can find her four points, generally, below, but her article is personal and poignant, so you should definitely give it a read if you’re thinking about IVF.

1.     IVF costs about $20,000 each round.

2.     There are multiple payment options, like credit cards, loan programs, and deductions.

3.     Many insurance companies will only cover the diagnosis phase of interfility and not the treatment. You can read about insurance laws specific to your state here.

4.     Be transparent with your clinic and insist they’re transparent with you. Don’t get caught up in surprise charges or “a la carte” fees.

If you want to compare the cost of IVF to other common infertility treatments, check out our other post: The Cost of Common Infertility Treatments.

Written by: Joanna Hynes