{"id":1104,"date":"2020-01-25T13:54:32","date_gmt":"2020-01-25T13:54:32","guid":{"rendered":"https:\/\/staging.theduff.co.uk\/?p=1104"},"modified":"2020-11-06T10:01:45","modified_gmt":"2020-11-06T10:01:45","slug":"embryo-grading-day-3-day-5","status":"publish","type":"post","link":"https:\/\/theduff.co.uk\/embryo-grading-day-3-day-5\/","title":{"rendered":"<strong>Embryo grading for Day 3 &#038; Day 5 embryos:<\/strong> your questions answered"},"content":{"rendered":"\n<p><strong>VISIT ANY FACEBOOK IVF GROUP (DON'T. PLEASE DON'T)<\/strong> and you'll see countless posts about embryo grading. Usually, people are after anecdotes and reassurance that a &#8220;poorly&#8221; graded embryo can become a healthy baby. <\/p>\n\n\n\n<p>But, as you'll realise once you've read this, it'd probably be better if FB IVF groups stuck to a remit of &#8220;posting photos of babies surrounded by IVF needles&#8221; and &#8220;writing inspirational messages about how you can DO THIS and you GOT THIS&#8221;. <\/p>\n\n\n\n<p>Snarky? Me? OK maybe a little bit&#8230; but only because I've seen just what damaging nonsense appears whenever someone asks about embryo grades (or myriad other vaguely sciencey IVF-related topics). <\/p>\n\n\n\n<p>So rather than go down a loooooong rabbit hole that'll benefit Zuckerberg way more than it'll benefit you, read this article instead. It'll give you answers to everything you wanted to know, including: <\/p>\n\n\n\n<ul><li>What does embryo grading do? How does it work? <\/li><li>What's the difference between Day 3 and Day 5 embryo grading? <\/li><li>How do I interpret the results? <\/li><li>What's the &#8220;perfect&#8221; embryo grade? <\/li><li>What's a &#8220;bad&#8221; embryo grade? <\/li><li>Does a &#8220;bad&#8221; embryo grade mean it definitely won't implant\/survive? <\/li><\/ul>\n\n\n\n<p>Aaaaaand START! <\/p>\n\n\n<style>.elementor-572 .elementor-element.elementor-element-189190b1{padding:0% 36% 8% 22%;}.elementor-572 .elementor-element.elementor-element-6b407887 > .elementor-element-populated{margin:0% 3.2% 0% 14%;--e-column-margin-right:3.2%;--e-column-margin-left:14%;}.elementor-572 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.elementor-toc__list-wrapper {\n    margin: -1em 0em 0em 0em;\n}\n\n.elementor-toc__list-items--collapsible li:not(:last-of-type) {\n    margin: 1.2em 0em;\n    padding-bottom: 1.2em;\n    border-bottom: 0.5px solid #007595;\n}\n}\/* End custom CSS *\/<\/style>\t\t<div data-elementor-type=\"section\" data-elementor-id=\"572\" class=\"elementor elementor-572\" data-elementor-post-type=\"elementor_library\">\n\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-189190b1 elementor-section-stretched elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"189190b1\" data-element_type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-6b407887\" data-id=\"6b407887\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-65191d58 elementor-toc--minimized-on-none elementor-widget elementor-widget-table-of-contents\" data-id=\"65191d58\" data-element_type=\"widget\" data-settings=\"{&quot;exclude_headings_by_selector&quot;:[],&quot;collapse_subitems&quot;:&quot;yes&quot;,&quot;min_height&quot;:{&quot;unit&quot;:&quot;vh&quot;,&quot;size&quot;:48,&quot;sizes&quot;:[]},&quot;headings_by_tags&quot;:[&quot;h2&quot;],&quot;minimized_on&quot;:&quot;none&quot;,&quot;marker_view&quot;:&quot;bullets&quot;,&quot;icon&quot;:{&quot;value&quot;:&quot;fas fa-circle&quot;,&quot;library&quot;:&quot;fa-solid&quot;},&quot;minimize_box&quot;:&quot;yes&quot;,&quot;hierarchical_view&quot;:&quot;yes&quot;,&quot;min_height_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;min_height_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]}}\" data-widget_type=\"table-of-contents.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-toc__header\">\n\t\t\t<h4 class=\"elementor-toc__header-title\">\n\t\t\t\tContents\t\t\t<\/h4>\n\t\t\t\t\t\t\t<div class=\"elementor-toc__toggle-button elementor-toc__toggle-button--expand\" role=\"button\" tabindex=\"0\" aria-controls=\"elementor-toc__65191d58\" aria-expanded=\"true\" aria-label=\"Open table of contents\"><i aria-hidden=\"true\" class=\"fas fa-chevron-down\"><\/i><\/div>\n\t\t\t\t<div class=\"elementor-toc__toggle-button elementor-toc__toggle-button--collapse\" role=\"button\" tabindex=\"0\" aria-controls=\"elementor-toc__65191d58\" aria-expanded=\"true\" aria-label=\"Close table of contents\"><i aria-hidden=\"true\" class=\"fas fa-chevron-up\"><\/i><\/div>\n\t\t\t\t\t<\/div>\n\t\t<div id=\"elementor-toc__65191d58\" class=\"elementor-toc__body elementor-toc__list-items--collapsible\">\n\t\t\t<div class=\"elementor-toc__spinner-container\">\n\t\t\t\t<i class=\"elementor-toc__spinner eicon-animation-spin eicon-loading\" aria-hidden=\"true\"><\/i>\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t<\/div>\n\t\t\n\n\n<h2 class=\"wp-block-heading\"><strong>What's the difference between a Day 3 and a Day 5 embryo? <\/strong><\/h2>\n\n\n\n<p><a href=\"\/day-3-vs-day-5-embryos\/\">Read this article on Day 3 vs Day 5 embryos<\/a>. <\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>What\u2019s the purpose of embryo grading?<\/strong><\/h2>\n\n\n\n<p>Embryo grading is a largely subjective assessment of the \u201cmorphology\u201d (the visual appearance) of embryos under a microscope. When embryologists grade each embryo, they\u2019re looking out for certain visual characteristics that imply it has a better chance of implantation, pregnancy, and birth.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>What does it mean when an embryo has a good grade?<\/strong><\/h2>\n\n\n\n<p>If you\u2019re smugly downloading Oxbridge scholarship forms while playing classical music to the morphologically perfect embryo in your uterus, you can wipe that self-satisfied smile off your face right now! An embryo grade can do one thing and one thing only: assess its potential for becoming a baby one day.&nbsp;<\/p>\n\n\n\n<p>Your baby\u2019s intelligence and gorgeousness have nothing to do with embryo grade. And remember that chromosomal normality is <em>also <\/em>separate: a stunning embryo could still be chromosomally abnormal. More on this next.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Does embryo grading discover chromosomal abnormalities too?<\/strong><\/h2>\n\n\n\n<p>An embryo that has the best grade possible could still be \u201caneuploid\u201d \u2013 that is, it could have the wrong number of chromosomes. Aneuploid embryos are far more likely to end in miscarriage or a failed treatment cycle \u2013 or, if a baby <em>is<\/em> born, it\u2019s far more likely to have a condition like Down\u2019s Syndrome.&nbsp;&nbsp;<\/p>\n\n\n\n<p>A poorly graded embryo that\u2019s chromosomally normal (\u201ceuploid\u201d) has a greater chance of survival than a highly graded embryo that\u2019s chromosomally abnormal (\u201caneuploid\u201d).&nbsp;<\/p>\n\n\n\n<p>Unfortunately, embryo grading <em>can\u2019t<\/em> determine whether the embryos have any chromosomal abnormalities. To find out about the state of your embryos\u2019 chromosomes, you need to do something called <a href=\"\/pgs-testing-ivf\/\">\u201cpre-implantation genetic screening\u201d (PGS)<\/a>.&nbsp;<\/p>\n\n\n\n<p>Sod\u2019s law dictates that PGS is extremely expensive and has its own set of drawbacks. You can read about <a href=\"\/pgs-testing-ivf\/\">the pros and cons of PGS here<\/a>. <\/p>\n\n\n\n<p><strong>You might be wondering if there's <em>any<\/em> kind of link between embryo grades and chromosomal abnormalities.&nbsp;<\/strong>After all, PGS Is expensive and has its drawbacks, so it'd be good to know if an embryo's grade can give a clue to its chromosomal make-up. <\/p>\n\n\n\n<p>Unfortunately, the answer is \u201cnot really\u201d. Setting aside the fact that embryo grading is largely subjective and two embryologists can easily give different grades to the same embryo, there\u2019s very weak (and therefore not to be taken seriously) evidence for a link between poorly graded Day 5 embryos and chromosome issues.&nbsp;<\/p>\n\n\n\n<p><a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S001502821000600X\">This study<\/a>, for example, found that \u201cMorphology and aneuploidy are linked at the blastocyst stage. However, the association is weak, and consequently, morphologic analysis cannot be relied on to ensure transfer of chromosomally normal embryos. A significant proportion of aneuploid embryos are capable of achieving the highest morphologic scores, and some euploid [chromosomally normal] embryos are of poor morphology.\u201d&nbsp;<\/p>\n\n\n\n<p>So basically: if your embryo grades aren\u2019t top notch, it <em>mayyybe <\/em>increases the risk that those embryos have chromosomal abnormalities. But there are plenty of examples to the contrary.&nbsp;<\/p>\n\n\n\n<p><a href=\"https:\/\/academic.oup.com\/humrep\/article\/29\/6\/1173\/624854\">This study<\/a> reported the same findings: \u201c&#8230; this analysis was able to confirm the moderate association between aneuploidy and several distinct features of blastocyst morphology\u2026&nbsp;<\/p>\n\n\n\n<p>\u201cHowever, this association was weak with a significant proportion of aneuploid embryos capable of achieving the hidghest morphologic scores (52% of excellent and good quality blastocysts).\u201d&nbsp;<\/p>\n\n\n\n<p>The study concluded that embryo grading can\u2019t be used as a proxy for PGS when it comes to assessing whether an embryo has chromosomal abnormalities or not.&nbsp;<\/p>\n\n\n\n<p>Now that you know how embryo grading works, what its drawbacks are, and what it can tell you, it\u2019s time to look into the specifics of Day 3 embryo grading and Day 5 embryo grading.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Day 3 embryo grading<\/strong><\/h2>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>How does Day 3 embryo grading work? <\/strong><\/h2>\n\n\n\n<p>First, bear in mind the caveats of embryo grading:&nbsp;<\/p>\n\n\n\n<ul><li>It\u2019s largely subjective because it\u2019s based on what the embryologist sees. <\/li><li>It\u2019s perfectly possible that an embryo with a \u201cpoor\u201d grade results in a pregnancy (and birth), and it\u2019s just as possible that one with a \u201cperfect\u201d grade does not. <\/li><li>Embryo grading can\u2019t tell you what\u2019s going on inside the embryo genetically. (You need PGS for that, although \u2013 as noted above \u2013 <a href=\"\/pgs-testing-ivf\/\">PGS comes with its own set of criticisms<\/a>.)<\/li><\/ul>\n\n\n\n<p>That out the way, let\u2019s discuss embryo grading!&nbsp;<\/p>\n\n\n\n<p>When Day 3 embryos are ready to be transferred (or ready to be frozen), they\u2019re viewed under a microscope and graded accorded to three criteria: <\/p>\n\n\n\n<ol><li><strong>The number of cells in the embryo (objective)<\/strong>. A Day 3 embryo that\u2019s growing normally should contain between 6 and 10 cells. (These embryos are more likely to grow, develop and survive compared to embryos with fewer cells at this stage.) <\/li><li><strong>How much \u201cfragmentation\u201d can be seen in the cells (subjective assessment). <\/strong>As mentioned earlier, bits of cell can break off as they divide (\u201ccleave\u201d) \u2013 and more fragmentation is associated with a lower-quality embryo. <br> <br>Generally, clinics believe that &lt;10% fragmentation is good, 10\u201325% is OK, and &gt;25% is poor. <br> <br>Fragmentation is often scored from 1 to 4 \u2013 where \u201c4\u201d (the best score) implies little or no fragmentation and \u201c1\u201d implies a high percentage of fragmentation\u2026 although some clinics switch the scoring to be the other way around. <\/li><li><strong>Whether the cells are \u201csymmetrical\u201d \u2013 i.e. that they\u2019re all roughly the same size as each other (subjective assessment)<\/strong>. When cells lack symmetry, it\u2019s associated with a lower-quality embryo.&nbsp; <br> <br>When the cells have complete symmetry, clinics are very happy! Anything &gt;50% symmetry is generally considered OK, and &lt;50% is poor. <br> <br>Symmetry is also often scored from 1 to 4 \u2013 where \u201c4\u201d implies near-perfect symmetry and \u201c1\u201d implies poor symmetry\u2026 although some clinics switch the scoring to be the other way around.&nbsp;<\/li><\/ol>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Deciphering your Day 3 embryo grades<\/strong><\/h2>\n\n\n\n<p>Different clinics have different ways of reporting embryo grading. A common method is to provide a grade like this for each embryo:&nbsp;<\/p>\n\n\n\n<p><strong>8c 3\/2<\/strong><\/p>\n\n\n\n<p>This means \u201c8 cells\u201d, \u201cgrade 3 fragmentation\u201d and \u201cgrade 2 symmetry\u201d.&nbsp;<\/p>\n\n\n\n<p>(Or for some clinics it might mean \u201c8 cells\u201d, \u201cgrade 3 symmetry\u201d and \u201cgrade 2 fragmentation\u201d.)<\/p>\n\n\n\n<p>Some clinics will combine\/average out the grades for fragmentation and symmetry, providing just one number. And remember: the numbers might be the other way around for your particular clinic. That is, \u201c1\u201d could be good instead of bad.&nbsp;<\/p>\n\n\n\n<p>Oh and by the way,&nbsp;<em>some <\/em>clinics just prefer to tell you \u201cgood\u201d, \u201cOK\u201d and \u201ca bit iffy\u201d instead. Ask your clinic how they choose to&nbsp;do things.&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image alignnone size-large size-full wp-image-2288\"><img fetchpriority=\"high\" decoding=\"async\" width=\"450\" height=\"338\" src=\"https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/02\/embryo-grading-9.jpg\" alt=\"Deciphering your Day 3 embryo grade\" class=\"wp-image-1116\" srcset=\"https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/02\/embryo-grading-9.jpg 450w, https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/02\/embryo-grading-9-300x225.jpg 300w\" sizes=\"(max-width: 450px) 100vw, 450px\" \/><figcaption>This image (with thanks to http:\/\/www.asiu.us\/embryo-grading-report\/4-8cell-grouped\/) seems to have a combined grade for fragmentation and symmetry<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>What\u2019s the \u201cperfect\u201d Day 3 embryo grade?&nbsp;<\/strong><\/h2>\n\n\n\n<p>Assuming \u201c4\u201d is best and \u201c1\u201d is worst, the perfect embryo grade would be:&nbsp;<\/p>\n\n\n\n<p><strong>6c 4\/4<\/strong><\/p>\n\n\n\n<p>Or&nbsp;<\/p>\n\n\n\n<p><strong>8c 4\/4<\/strong><\/p>\n\n\n\n<p>Or&nbsp;<\/p>\n\n\n\n<p><strong>10c 4\/4<\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>What\u2019s the lowest \u201cgrade\u201d an embryologist would consider transferring (for Day 3 embryos)?<\/strong><\/h2>\n\n\n\n<p>It seems most embryologists agree that anything less than a six-cell embryo is considered \u201cpoor quality\u201d \u2013 as is an embryo that scores \u201c2\u201d or lower on fragmentation and\/or symmetry. But clinics have different rules for which they\u2019ll consider freezing\/transferring. For example, some might be up for transferring a 4c 3\/2 while others wouldn\u2019t;&nbsp;some might be happy to freeze a 6c 2\/2 while others wouldn\u2019t.&nbsp;<\/p>\n\n\n\n<p>It also depends on the overall \u201cbatch\u201d of embryos from the patient: if you have six high-quality embryos and one relatively poor-quality embryo, that poor-quality embryo is more likely to be discarded than if you have a batch of <em>only<\/em> poor-quality embryos.&nbsp;<\/p>\n\n\n\n<p>The issue is complicated further by the fact that not all embryologists believe that all three factors (cell number, fragmentation and symmetry) are useful predictors of success. See the next question for more on this.&nbsp;<\/p>\n\n\n\n<p>Are doctors right to be generally dismissive of \u201cpoorer quality\u201d embryos? I haven\u2019t done too much reading around this, but from what I can tell\u2026&nbsp;<\/p>\n\n\n\n<ul><li>Poor-quality Day 3 embryos are unlikely to do a 180 and become high-quality blastocysts.&nbsp;<\/li><li>But if they <em>do&nbsp;<\/em>become \u201cgood enough\u201d blastocysts, they have a good chance for implantation and successful pregnancy.<\/li><\/ul>\n\n\n\n<p>(See <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5434534\/\">this cohort study<\/a>, for example.)<\/p>\n\n\n\n<p>That suggests there\u2019s a good argument for Day 5 embryo transfers rather than Day 3, because it gives a chance for the Day 3-ers to catch up rather than be discarded. It also means PGS can be done for chromosomal abnormalities (as embryologists tend to&nbsp;prefer doing PGS on Day 5 embryos). But THEN you have the issue that a relatively poor-quality Day 3 <em>might <\/em>survive if transferred immediately but will perish if left to grow further in the petri dish.&nbsp;<\/p>\n\n\n\n<p>Ultimately, the answer to \u201cWhat\u2019s the lowest \u2018grade\u2019 an embryologist would consider transferring (for Day 3 embryos)?\u201d should be individualised, and it should depend on how many eggs, embryos and funds you have.&nbsp;<\/p>\n\n\n\n<p>One more thing to mention: success rates. Poorly graded embryos, as we know, have a lower success rate when it comes to implantation and live births, We also know that poorly graded embryos still have a chance of successful implantation\/birth. But if a clinic decides to start transferring more \u201c1s\u201d or \u201c2s\u201d (perhaps for couples with poor-quality batches where those 1s and 2s are their only hope), their success rate is going to decrease compared to other clinics.&nbsp;<\/p>\n\n\n\n<p>Being an embryologist sure ain\u2019t easy.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>What\u2019s more important: number of cells, fragmentation, or symmetry?&nbsp;<\/strong><\/h2>\n\n\n\n<p>Arrrghh I think we\u2019re in one of those \u201clots of studies show lots of different things\u201d scenarios.&nbsp;<\/p>\n\n\n\n<p>From all my reading, it seems cell number and fragmentation are both more important than symmetry. What\u2019s more, cell number and fragmentation levels may be linked to each other \u2013 that is, a Day 3 embryo with a suboptimal number of cells is also more likely to have a higher degree of&nbsp;fragmentation.&nbsp;<\/p>\n\n\n\n<p>(Here are a few of the studies and articles I read: <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4831697\/\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4831697\/<\/a> and <a href=\"https:\/\/www.fertstert.org\/article\/S0015-0282(03)01308-6\/fulltext\">https:\/\/www.fertstert.org\/article\/S0015-0282(03)01308-6\/fulltext<\/a> and <a href=\"https:\/\/www.arcfertility.com\/understanding-embryo-grading\/\">https:\/\/www.arcfertility.com\/understanding-embryo-grading\/<\/a>.)<\/p>\n\n\n\n<p>But I\u2019ve yet to get to the bottom of this one, and I\u2019ll update the page if\/when I ever do so!&nbsp;<\/p>\n\n\n\n<p>It\u2019s a bloomin\u2019 minefield.&nbsp;<\/p>\n\n\n\n<p>Let\u2019s move on to a topic that\u2019s just as contentious: Day 5 embryos.&nbsp;<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large is-resized\"><img decoding=\"async\" src=\"https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/02\/Group-1285@2x.png\" alt=\"\" class=\"wp-image-492\" width=\"229\" height=\"105\" srcset=\"https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/02\/Group-1285@2x.png 443w, https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/02\/Group-1285@2x-300x137.png 300w\" sizes=\"(max-width: 229px) 100vw, 229px\" \/><\/figure><\/div>\n\n\n\n<p><\/p>\n\n\n<style>.elementor-291 .elementor-element.elementor-element-4c84a175{margin-top:2%;margin-bottom:12%;padding:1% 4% 1% 4%;z-index:2;}.elementor-291 .elementor-element.elementor-element-554afbfb > .elementor-element-populated{margin:0% 5% 0% 5%;--e-column-margin-right:5%;--e-column-margin-left:5%;}.elementor-291 .elementor-element.elementor-element-21014cc2:not(.elementor-motion-effects-element-type-background), .elementor-291 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data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-144e6175 elementor-align-center elementor-widget elementor-widget-button\" data-id=\"144e6175\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t<a class=\"elementor-button elementor-size-sm\" role=\"button\" id=\"fdg\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-text\">FREE DOWNLOAD<\/span>\n\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1ed2b9df elementor-widget elementor-widget-heading\" data-id=\"1ed2b9df\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Questions to ask your doctor at every stage of IVF treatment: free downloadable guide<\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-39ffc0a2 elementor-widget elementor-widget-text-editor\" data-id=\"39ffc0a2\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><strong>IVF isn\u2019t just overwhelming<\/strong>; it can also be a mind-boggling and sometimes terrifying experience because there\u2019s so much to learn and so many rules to follow.<\/p><p>Problem is, doctors are busy \u2013 and they often don\u2019t have the time to anticipate your concerns and provide all the information you might need.<\/p><p>This downloadable guide contains questions that will help you understand the process better, get the answers you deserve, and feel more in control of the situation (and your rights as a 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elementor-sm-100\">\n\t\t\t\t\t<button type=\"submit\" class=\"elementor-button elementor-size-lg\">\n\t\t\t\t\t\t<span >\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\" elementor-button-icon\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Get the PDF<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4e68b04a elementor-widget elementor-widget-text-editor\" data-id=\"4e68b04a\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><strong>I won't send you spam. Unsubscribe at any time.<\/strong><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t<\/div>\n\t\t\n\n\n<h2 class=\"wp-block-heading\"><strong>Day 5 embryo grading<\/strong><\/h2>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>How are Day 5 (or Day 6) \u201cblastocyst stage\u201d embryos graded?&nbsp;<\/strong><\/h2>\n\n\n\n<p>Before we get started, it\u2019s caveat time again! As with Day 3 embryos\u2026&nbsp;<\/p>\n\n\n\n<ul><li>It\u2019s largely subjective because it\u2019s based on what the embryologist sees. <\/li><li>It\u2019s perfectly possible that an embryo with a \u201cpoor\u201d grade results in a pregnancy (and birth), and it\u2019s just as possible that one with a \u201cperfect\u201d grade does not. <\/li><li>Embryo grading can\u2019t tell you what\u2019s going on inside the embryo genetically. (You need PGS for that, although \u2013 as noted above \u2013 <a href=\"\/pgs-testing-ivf\/\">PGS comes with its own set of criticisms<\/a>.)<\/li><\/ul>\n\n\n\n<p>Back to embryo grading!&nbsp;<\/p>\n\n\n\n<p>When Day 5 or 6 embryos are ready for transfer (or ready to be frozen), they\u2019re viewed under a microscope and graded.&nbsp;<\/p>\n\n\n\n<p>Many clinics use the \u201cGardner blastocyst grading system\u201d (or a variation of it), which involves assigning three separate scores to each embryo:&nbsp;<\/p>\n\n\n\n<p><strong>Score 1: the level of expansion of the embryo (scored 1\u20136) at Day 5 or Day 6<\/strong>. An embryo that can\u2019t fully expand and grow in the petri dish won\u2019t be able to develop into a baby.&nbsp;<br> <br>Here are what the different \u201cexpansion grades\u201d mean (you might need to remind yourself of \u201cThe stages of embryo development\u201d process at the start):&nbsp;<br> <br>  <\/p>\n\n\n\n<figure class=\"wp-block-image alignnone size-large size-full wp-image-2296\"><img decoding=\"async\" width=\"780\" height=\"608\" src=\"https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/02\/embryo-grading-10.png\" alt=\"Day 5 embryo grading: expansion grades\" class=\"wp-image-1115\" srcset=\"https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/02\/embryo-grading-10.png 780w, https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/02\/embryo-grading-10-300x234.png 300w, https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/02\/embryo-grading-10-768x599.png 768w\" sizes=\"(max-width: 780px) 100vw, 780px\" \/><figcaption>(With thanks to https:\/\/www.remembryo.com)<\/figcaption><\/figure>\n\n\n\n<p>Note: the \u201czona\u201d mentioned above refers to \u201czona pellucida\u201d \u2013 the blastocyst\u2019s protective outer membrane, which thins as the blastocyst expands. The blastocyst eventually breaks free from this membrane (\u201chatches\u201d), to enable it to implant properly once it\u2019s in the uterus.&nbsp;<strong><br> <br><\/strong>Also note: \u201cStage\/Expansion 6\u201d isn\u2019t necessarily the best. Many clinics believe that the best blastocysts are the \u201cStage 5s\u201d that haven\u2019t completely&nbsp;hatched yet.&nbsp; <\/p>\n\n\n\n<p><strong>Score 2: the quality of the inner cell mass (scored A\u2013C)<\/strong>. The inner cell mass (ICM) is the part of the embryo that develops into a foetus. ICM quality relates to the number of cells and how compacted they are: you want a lot of cells, and you want them to be tightly packed. <br><\/p>\n\n\n\n<figure class=\"wp-block-image alignnone size-large size-full wp-image-2298\"><img loading=\"lazy\" decoding=\"async\" width=\"547\" height=\"594\" src=\"https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/02\/embryo-grading-11.png\" alt=\"Day 5 embryo grading: inner cell mass grade \" class=\"wp-image-1114\" srcset=\"https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/02\/embryo-grading-11.png 547w, https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/02\/embryo-grading-11-276x300.png 276w\" sizes=\"(max-width: 547px) 100vw, 547px\" \/><figcaption>(With thanks to https:\/\/www.remembryo.com)<\/figcaption><\/figure>\n\n\n\n<p><strong>Score 3: the quality of the trophectoderm (scored A\u2013C)<\/strong>. The trophectoderm is the part of the embryo that develops into the placenta. As with the ICM, you ideally want a lot of cells that are tightly compacted.<\/p>\n\n\n\n<figure class=\"wp-block-image alignnone size-large size-full wp-image-2299\"><img loading=\"lazy\" decoding=\"async\" width=\"723\" height=\"594\" src=\"https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/02\/embryo-grading-12.png\" alt=\"Day 5 embryo grading: trophectoderm grade\" class=\"wp-image-1113\" srcset=\"https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/02\/embryo-grading-12.png 723w, https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/02\/embryo-grading-12-300x246.png 300w\" sizes=\"(max-width: 723px) 100vw, 723px\" \/><figcaption>(With thanks to https:\/\/www.remembryo.com)<\/figcaption><\/figure>\n\n\n\n<p>Note: some clinics will also have Grade D, for a very poor-quality ICM\/trophectoderm. And some clinics will give the ICM\/trophectoderm grades \u201c+\u201d or \u201c-\u201d ratings too (e.g. \u201cB+\u201d). And <em>some <\/em>clinics will convert their letter gradings into numbers \u2013 just to be different.&nbsp;&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>What\u2019s the \u201cperfect\u201d Day 5 embryo grade?&nbsp;<\/strong><\/h2>\n\n\n\n<p>Most clinics would agree that \u201c5AA\u201d (or \u201c5A+A+\u201d for some clinics) is a pretty impressive embryo. Clinics are also more likely to value Day 5 embryos over Day 6 embryos, so if you have a 5AA for Day 6 and a 5AB for Day 5, they may well select the 5AB from Day 5.&nbsp;<\/p>\n\n\n\n<p>(Having said that, recent research has shown that there\u2019s very little difference in outcomes between transferring a Day 5 embryo and a Day 6 embryo. If you\u2019re interested in learning more about this, <a href=\"https:\/\/www.remembryo.com\/embryo-grading\/#How_Blastocyst_Embryo_Grades_are_Reported\">here\u2019s a massive, fascinating post<\/a>. (Read the section called: \u201cTiming of blast development: Day 5, 6 or 7?\u201d)<\/p>\n\n\n\n<p>Here\u2019s what a hatching 5AA blastocyst looks like:&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image alignnone size-large size-full wp-image-2297\"><img loading=\"lazy\" decoding=\"async\" width=\"290\" height=\"267\" src=\"https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/02\/embryo-grading-13.jpg\" alt=\"Hatching 5AA blastocyst\" class=\"wp-image-1112\"\/><figcaption>(With thanks to https:\/\/www.advancedfertility.com)<\/figcaption><\/figure>\n\n\n\n<p>But please remember&nbsp;the following:&nbsp;<\/p>\n\n\n\n<ul><li>Even a 5AA embryo can result in no pregnancy. There are no certainties.&nbsp;<\/li><li>And, of course, something like a 3AB embryo can lead to a baby.&nbsp;<\/li><li>Any embryo can still have chromosomal abnormalities (which can only get picked up with <a href=\"\/pgs-testing-ivf\/\">PGS<\/a> rather than embryo grading).&nbsp;<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>What\u2019s most important when it comes to the blastocyst grade: embryo expansion, inner cell mass, or trophectoderm?&nbsp;<\/strong><\/h2>\n\n\n\n<p>Let\u2019s say you\u2019ve ended up with the following embryos:&nbsp;<\/p>\n\n\n\n<p>5BB, 2AA, 4AB, 4BA<\/p>\n\n\n\n<p>Assuming there are no chromosomal abnormalities with any of them, which embryo would an embryologist choose to&nbsp;transfer first?&nbsp;<\/p>\n\n\n\n<p>As you\u2019d imagine, there\u2019s no clear consensus.&nbsp;<\/p>\n\n\n\n<p><a href=\"https:\/\/academic.oup.com\/hropen\/article\/2017\/3\/hox017\/4616124\">This fantastic report<\/a> compared multiple studies into embryo grading, and learnt&nbsp;the following:&nbsp; <\/p>\n\n\n\n<ul><li>One study found that embryo expansion was the most important factor<\/li><li>Two studies found that the ICM grade was the most important factor&nbsp;<\/li><li>Four studies found that the trophectoderm grade was the most important factor<\/li><li>One study found that NONE of the blastocyst features related to implantation potential!&nbsp;<\/li><\/ul>\n\n\n\n<p>Embryologists do&nbsp;stress that they use the grading system as a tool to help determine which blastocyst(s) to transfer or freeze, but they don\u2019t rely solely on the grading system. They\u2019ll also consider your age, fertility history and other information to determine which embryo(s) to transfer or freeze.<\/p>\n\n\n\n<p>It\u2019s also important to remember that if an embryo has a good grade in one category, it\u2019s more likely to have good grades in the other two. That is, an embryo that\u2019s at Stage 4 of expansion on Day 5 is more likely to have A or B grades for both the ICM and trophectoderm in a healthy embryo. You\u2019re less likely to see something like \u201c4CC\u201d or \u201c1AA\u201d. Although, of course, there are always plenty of exceptions.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>What\u2019s the lowest \u201cgrade\u201d an embryologist would consider transferring (for Day 5 or Day 6 embryos)?&nbsp;<\/strong><\/h2>\n\n\n\n<p>As with Day 3 embryos, it depends on the clinic. And always bear in mind that embryo grading is subjective, so a \u201cC\u201d grade for ICM at one clinic might be a \u201cB\u201d at another. Something else to be aware of is that not all clinics use the same grading system (or, at the very least, many of them modify the Gardner system), so \u2013 again \u2013 it\u2019s difficult to make any clinic-wide claims here.&nbsp;<\/p>\n\n\n\n<p>All I really <em>can <\/em>say is that most clinics look for blastocyst expansion of at least \u201c3\u201d, and trophectoderm\/ICM grades of at least C (but usually A or B). Some clinics will attempt to transfer fresh embryos if they\u2019re Stage 1 or 2 \/ Grade C, but they\u2019re less likely to freeze them (as it\u2019s believed they wouldn\u2019t survive the freeze-thaw process).&nbsp;<\/p>\n\n\n\n<p>Here\u2019s what a 2BC embryo looks like:&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image alignnone size-large size-full wp-image-2287\"><img loading=\"lazy\" decoding=\"async\" width=\"230\" height=\"200\" src=\"https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/02\/embryo-grading-14.jpg\" alt=\"2BC embryo\" class=\"wp-image-1111\"\/><figcaption>(With thanks to https:\/\/www.advancedfertility.com)<\/figcaption><\/figure>\n\n\n\n<p>Are they right to be dismissive of \u201cpoorer quality\u201d embryos? No, according to a report called \u201c<a href=\"https:\/\/academic.oup.com\/hropen\/article\/2017\/3\/hox017\/4616124\">Is a \u2018C\u2019 a failing grade?<\/a>\u201d Not only does this report highlight just how subjective\/biased embryo grading is, but it also shows how Stage 1 or 2 \/ Grade C embryos can and do&nbsp;result in live births. The live birth rate is lower \u2013 as you\u2019d expect \u2013 but it\u2019s not insignificant.&nbsp;<\/p>\n\n\n\n<p>We also shouldn\u2019t forget (as if I\u2019d let you!) that embryo grading is only part of the equation. If it has abnormal chromosomes, the world\u2019s most beautiful embryo is far less likely to make it.&nbsp;<\/p>\n\n\n\n<p>So\u2026 as with Day 3 embryos, the answer to \u201cWhat\u2019s the lowest \u2018grade\u2019 an embryologist would consider transferring (for Day 5 or Day 6 embryos)?\u201d should be individualised, and it should depend on how many eggs, embryos and funds you have. If you have tons of good-quality embryos and a few not-so-great ones, transfer a good one. If you have a few poor-quality embryos, you and your clinic will need to decide if it\u2019s worth doing PGS (especially considering the cost to you), or if it\u2019s worth transferring them or starting from scratch with a new cycle.<\/p>\n\n\n\n<p>And again, there\u2019s the issue of&nbsp;success rates. Whether you\u2019re on the NHS or going down the private route, poorly graded embryos <em>are <\/em>less likely to implant and lead to a live birth, so if a clinic makes the decision to transfer more \u201cCs\u201d, their success rate is going to decrease.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>If a clinic is planning to transfer (or freeze) a Day 5 blastocyst, will the embryo also be graded on Day 3?&nbsp;<\/strong><\/h2>\n\n\n\n<p>For clinics that prefer Day 5 transfers, they\u2019ll often leave young embryos alone to do their growing thing (as long as there\u2019s no reason to believe those embryos will be struggling). But it really depends on the clinic.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>We\u2019re done!&nbsp;<\/strong><\/h2>\n\n\n\n<p>If you have any&nbsp;questions about this article, email me and let me know!&nbsp;<\/p>\n\n\n<style>.elementor-536 .elementor-element.elementor-element-3a6436ac{padding:4% 22% 8% 22%;z-index:2;}.elementor-536 .elementor-element.elementor-element-17d4eb46:not(.elementor-motion-effects-element-type-background) > .elementor-widget-wrap, .elementor-536 .elementor-element.elementor-element-17d4eb46 > .elementor-widget-wrap > .elementor-motion-effects-container > .elementor-motion-effects-layer{background-color:#C0E4E5;}.elementor-536 .elementor-element.elementor-element-17d4eb46 > .elementor-element-populated{transition:background 0.3s, border 0.3s, border-radius 0.3s, box-shadow 0.3s;margin:0% 14% 0% 14%;--e-column-margin-right:14%;--e-column-margin-left:14%;padding:2% 1% 4% 1%;}.elementor-536 .elementor-element.elementor-element-17d4eb46 > 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.elementor-element.elementor-element-17d4eb46 > .elementor-element-populated{margin:0% 0% 0% 0%;--e-column-margin-right:0%;--e-column-margin-left:0%;padding:8% 6% 12% 6%;}.elementor-536 .elementor-element.elementor-element-576153c1{text-align:center;}.elementor-536 .elementor-element.elementor-element-576153c1 img{width:20%;}.elementor-536 .elementor-element.elementor-element-574ef11f{text-align:left;}.elementor-536 .elementor-element.elementor-element-574ef11f .elementor-heading-title{font-size:1.1em;}.elementor-536 .elementor-element.elementor-element-574ef11f > .elementor-widget-container{margin:4% 0% 6% 0%;}.elementor-536 .elementor-element.elementor-element-3d61ba35 .elementor-post__title, .elementor-536 .elementor-element.elementor-element-3d61ba35 .elementor-post__title a{font-size:1em;}}@media(min-width:768px){.elementor-536 .elementor-element.elementor-element-ef00547{width:13%;}.elementor-536 .elementor-element.elementor-element-19a555d6{width:87.031%;}}@media(max-width:1024px) and (min-width:768px){.elementor-536 .elementor-element.elementor-element-ef00547{width:100%;}.elementor-536 .elementor-element.elementor-element-19a555d6{width:100%;}}<\/style>\t\t<div data-elementor-type=\"section\" data-elementor-id=\"536\" class=\"elementor elementor-536\" data-elementor-post-type=\"elementor_library\">\n\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-3a6436ac elementor-section-stretched elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"3a6436ac\" data-element_type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-17d4eb46\" data-id=\"17d4eb46\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-40f8e482 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"40f8e482\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-ef00547\" data-id=\"ef00547\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-576153c1 elementor-widget elementor-widget-image\" data-id=\"576153c1\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"94\" height=\"142\" src=\"https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/02\/Group-1294@2x.png\" class=\"attachment-large size-large wp-image-493\" alt=\"Lighbulb illustration\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-19a555d6\" data-id=\"19a555d6\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-574ef11f elementor-widget elementor-widget-heading\" data-id=\"574ef11f\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\">You might also like to read&#8230;<\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3d61ba35 elementor-grid-1 elementor-posts--thumbnail-none elementor-grid-tablet-1 elementor-grid-mobile-1 elementor-widget elementor-widget-posts\" data-id=\"3d61ba35\" data-element_type=\"widget\" data-settings=\"{&quot;classic_columns&quot;:&quot;1&quot;,&quot;classic_row_gap&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:12,&quot;sizes&quot;:[]},&quot;classic_columns_tablet&quot;:&quot;1&quot;,&quot;classic_columns_mobile&quot;:&quot;1&quot;,&quot;classic_row_gap_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;classic_row_gap_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]}}\" data-widget_type=\"posts.classic\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-posts-container 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IVF\t\t\t<\/a>\n\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<\/article>\n\t\t\t\t<\/div>\n\t\t\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>VISIT ANY FACEBOOK IVF GROUP (DON&#8217;T. PLEASE DON&#8217;T) and you&#8217;ll see countless posts about embryo grading. Usually, people are after anecdotes and reassurance that a<\/p>\n","protected":false},"author":1,"featured_media":1234,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5,4,9],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v21.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Embryo grading for Day 3 &amp; Day 5 embryos: your questions answered<\/title>\n<meta name=\"description\" content=\"How does embryo grading work? 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