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Embryo Grading

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    Embryo Grading

    Embryo grading is a process that evaluates the quality and development of embryos during IVF treatment in order to determine their health and likelihood of successful implantation.

    What is Embryo Grading in IVF?

    Embryo grading is a process used in in-vitro fertilization (IVF) to evaluate the quality of embryos before they are transferred to the woman’s uterus. Embryo grading is typically performed on the third day after fertilization, when embryos have developed to the 6-8 cell stage, or on the fifth or sixth day after fertilization, when embryos have developed to the blastocyst stage.

    During embryo grading, embryologists examine the size, shape, and symmetry of the cells, as well as the presence and quality of certain structures within the embryo, such as the zona pellucida (the protective outer layer of the embryo) and the blastocoel (the fluid-filled cavity within the embryo).

    Embryo Grading

    Based on these criteria, embryos are assigned a grade or score that reflects their quality and likelihood of implantation and subsequent development into a healthy pregnancy.

    The grading system varies between clinics and embryologists, but generally, embryos are graded on a scale of 1 to 4, with 1 being the highest quality and 4 being the lowest. Embryos with the highest quality grades are typically selected for transfer to the woman’s uterus, with the goal of improving the chances of a successful pregnancy. However, it’s important to note that embryo grading is not a perfect predictor of success, and some lower-quality embryos may still result in a healthy pregnancy.

    Embryo Grading Process

    During the process of Embryo Implantation in IVF, the embryos are cultured for around six days and during that period they receive quality grades every day.

    Egg Retrieval and Insemination Day 0

    The maturity of the egg is important as a mature egg has the best chance of getting fertilized. The three different stages of egg maturation are:

    • Germinal vesicle (GV): It is the stage where the egg has not begun meiosis till now and is thus considered immature.
    • Metaphase I (MI): This is the first phase of the egg is meiosis, but is not completely mature yet as it has not entered the second phase of meiosis. This type of immature egg matures after being in temperature-controlled incubation for a couple of hours.
    • Metaphase II (MII): This is the second phase of meiosis of the egg, which is mature by now. Eggs at this stage are ready for fertilization and have the following characteristics.


    • Clear cytoplasm/normal shape
    • Single differentiated polar body
    • Thin/clear zona pellucid

    Fragmented/abnormal polar body

    • Slightly pigmented/amorphous zona
    • Fragmented/abnormal polar body
    • Slightly pigmented/amorphous zona
    • Cytoplasmic bodies
    • PV debris


    • Dark/grainy cytoplasm/misshapen
    • >1 polar body structure
    • Pigmented/thickened zona
    • Vacuoles
    • PV debris

    Egg Retrieval and Insemination Day-0

    Fertilization Check Day One

    Fertilization can be seen clearly after 16 to 22 hours after the process of insemination. Normal fertilization can be seen by exactly two pronuclei in the center of a one-celled zygote. Fertilization is not abnormal when there is a single pronucleus and when there are more than two pronuclei present. 

    Multicell Grading Day Two/Three

    On day two the single-cell zygote should divide into an embryo (approx. two to four cells). On day three the embryo should continue to divide (four to eight cells). 

    Embryo Quality:

    • Good: have a clear cytoplasm with symmetrical cells
    • Fair: these cells are slightly asymmetrical having slight cytoplasmic irregularities
    • Poor: these cells are quite asymmetrical and might have grainy and dark cytoplasm
    • A = No fragmentation
    • B = <10% fragmentation
    • C = 10-35% fragmentation
    • D = >35% fragmentation

    Day Four

    On the 4th day, the transition of embryos begins from a multi-cell embryo to a highly advanced developmental stage. Embryos then start compacting and forming morulae. Cells of a morula-stage embryo are not quite distinct like the previous days, and hence these embryos fail to receive quality grades.

    Day Five/Six Blastocyst Stage

    A blastocyst is a developed embryo that comprises two different cell types: one group of cells is referred to as the inner cell mass, which forms the fetal tissue, and another group of cells, known as the trophectoderm, helps in the formation of the placenta. Blastocysts are graded on the basis of their expansion (early, expanding, expanded, and hatching) as well as on the basis of the quality of these two different cell types (graded on a good-fair-poor scale). Blastocysts that are good or even fair in quality can be frozen.

    Importance of Embryo Grading

    Embryo grading is an essential process in the field of assisted reproductive technology (ART) where embryos are evaluated based on their quality and developmental stage. Here are some reasons why embryo grading is important:

    • Selection of the best embryos: Embryo grading allows embryologists to select the best embryos for transfer or cryopreservation. The grading system takes into account various factors such as the number of cells, cell symmetry, fragmentation, and degree of compaction. By selecting the best quality embryos, the chances of a successful pregnancy and live birth are increased.
    • Optimization of transfer timing: Embryo grading also helps to determine the optimal time for embryo transfer. Embryos are typically transferred into the uterus at a specific developmental stage, and grading can help ensure that embryos are transferred at the right time for the highest chance of success.
    • Cost-effectiveness: Embryo grading can be cost-effective because it allows embryologists to identify the most viable embryos for transfer, reducing the need for multiple rounds of IVF or other ART procedures.
    • Ethical considerations: Embryo grading can help to reduce the number of embryos that are discarded, as only the best quality embryos are selected for transfer or cryopreservation. This can be an important consideration for couples who may have ethical or religious objections to discarding unused embryos.

    Embryo grading is an important tool in the field of ART that can increase the chances of a successful pregnancy and live birth, optimize the timing of embryo transfer, reduce costs, and address ethical concerns related to embryo selection.


    Embryo grading is the process of evaluating the quality of embryos during in vitro fertilization (IVF) or other assisted reproductive technologies (ART). The grading system assigns a score based on the appearance of the embryo, including its cell number, size, and symmetry. Embryo grading is important because it helps fertility specialists select the best embryos for transfer, which can increase the chances of a successful pregnancy.

    In embryo grading, the most important factors to consider are the morphology or appearance of the embryos and their developmental stage. The morphology of an embryo is evaluated based on factors such as the size, shape, and organization of its cells, as well as the presence of any abnormalities. The developmental stage of the embryo refers to the number of days that have elapsed since fertilization and the degree of cell division that has occurred.

    Embryo grading is typically performed by embryologists who specialize in ART. They use a microscope to examine the embryos and evaluate their appearance based on established grading criteria. The grading system can vary depending on the fertility clinic, but it typically involves assigning a letter or number grade to the embryo based on its quality.

    Several factors can affect embryo grading, including the age and health of the woman undergoing IVF or other ART, as well as the quality of the sperm used for fertilization. Other factors that can impact embryo grading include the method used to culture the embryos, the timing of embryo transfer, and any additional procedures performed during the IVF cycle.

    While embryo grading can help fertility specialists select the best embryos for transfer, it cannot guarantee a successful pregnancy. Many factors can influence the success of IVF, including the health of the woman’s reproductive system, the quality of the sperm used for fertilization, and the timing of embryo transfer. However, studies have shown that higher-quality embryos are more likely to result in a successful pregnancy than lower-quality embryos.

    Embryo grading is a non-invasive procedure that does not pose any significant risks to the woman or the embryos. However, there is a small risk that the grading process could damage or disturb the embryos, although this risk is generally considered to be low. Fertility specialists take precautions to minimize any potential risks associated with embryo grading, such as using sterile equipment and handling the embryos carefully.

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