Practitioner’s Forum Report: Embryo Evaluation Session

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Published on: December 19, 2013

2013-AETA-WebBannerDuring this year’s joint AETA and CETA meeting in Reno, Nevada we tackled the topic of embryo evaluation. This interactive session allowed participants to answer questions in real-time about embryo quality and stage of development using the iClicker technology. Answers to each question were recorded and are presented in a summary document, which can be found here.

The session began with a few basic questions to define the audience (role in the embryo transfer industry, years of experience and current method for evaluating embryos). While it was no surprise that the majority of the audience members were embryo transfer practitioners, it was encouraging to note that 22% of the attendees had fewer than 5 years of experience, which suggests that there are new practitioners entering the embryo transfer arena.

The embryo grading quiz provided some interesting results. During the session, participants were asked to use the IETS system of grading where a grade 1 is an excellent to good quality embryo, grade 2 a fair quality embryo, grade 3 a poor quality embryo and grade 4 is given to dead or degenerate embryos. Even after reviewing the guidelines for using this grading system some embryos were surprisingly downgraded by a number of participants. For example the early blastocyst shown in question 5 is an excellent quality embryo (grade 1) yet 13% of participants called it a fair quality embryo (grade 2) and 5% of participants gave it a lower grade still. It is difficult to interpret how any experience ET practitioner would downgrade this embryo from grade 1, and in fact from anything but excellent quality with no obvious problems in any aspect of its’ morphology.

In question 8,  a late stage morula with several extruded cells is shown. The morula constitutes at least 75% of the original mass, so this embryo, although downgraded from excellent, could be classified with justification as ‘good’, which would still put it into the number 1 grade for IETS.  However, since the embryo in a photo cannot be examined in any other planes, downgrading it to a 2 or ‘fair’ embryo, is not without some justification. It would be interesting to know what criteria the 4 respondents with >20 y used to knock it all the way down to grade 4, which is unjustified in our opinion.

Some questions addressed the issues of stage of development in grading embryos. For example, the morula stage IVF embryo in question 19 should be more advanced by this day of culture, thus it should be downgraded by 1 grade to a grade 2, which 46% of participants did. There is decent compaction in the embryo, although there appeared to be some loose, perhaps extruded material. This embryo deserves transfer, although the pregnancy rate would, on the average, be lower than a day 7 blast, which would not be the case with a day 7 in vivo-produced morula compared to an early or mid-blastocyst (stage 5 or 6). Although 72% of participants graded this embryo a 1 or 2, 91% would transfer this embryo, which means that some practitioners are willing to transfer poor quality embryos.

A couple of points that were brought up in discussion are the need to develop a different grading system for in vitro-produced embryos and a potential labeling indication for collapsed, expanded blastocysts. The limitations of a quiz like this were also noted in that you cannot accurately grade an embryo without being able to roll it around and see it from multiple angles. We propose that future embryo evaluation sessions integrate videos of embryos being rolled to see if the responses of participants are more in agreement.

Jennifer P. Barfield and John F. Hasler

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