“Judgey” Eyes: What Are Embryologists Really Looking At?

How do I look in this dress? What do you think of these shoes? Is red a good color for me? Let’s face it: even the most down-to-earth among us has an inner diva. Who doesn’t want to look good and turn some heads? Furthermore, how we look on the outside can impact the way we feel on the inside. While we’re certainly not saying that looks matter, we are saying that how you think you look often impacts the way you feel. The same can be said for your embryos. How they look to the embryologist in the lab can tell us a lot about their health, their genetics, and their ability to make a baby.

While different labs use different grading systems, most that perform day 5 or 6 embryo transfers use the Gardner and Schoolcraft embryo scoring system. This dynamic duo introduced their scoring system in 1999 to determine blastocyst (day 5 or 6 embryo) quality.

And while it’s certainly not the Miss USA competition, embryologists are grading the embryos in three ways: development and morphology (don’t worry; we can count). Morphology is assessed for both inner cell mass and the trophectoderm, bringing the total to three!

Embryologists are looking for things like embryo expansion, cell compaction/tightness, and cohesiveness. Years of experience and tons of training have trained their eyes to be really judge-y and label these areas with letters and numbers. We don’t give an overall number; it’s more of a general impression! The cumulative score determines which embryos have the potential to wear the crown. The scoring system not only helps embryologists and fertility doctors decide which embryos to transfer but also how many embryos to transfer. Those with straight As should have a limited number of embryos transferred to avoid an octo-mom situation.

Remember, just like undergrad universities, some grade inflation may go on. An A at Harvard may be a B at Yale—grading is subjective. (Just sayin’. And no, neither of us went to Harvard or Yale). Therefore, while a patient may make all A+ embryos in lab #1, when they come to lab #2, the report card can be totally different. Usually, this is not because your eggs or your partner’s sperm went over the cliff, but because the scoring was skewed. Skewed scoring doesn’t decrease one’s chances; it just messes with one’s expectations. If you have an A+ embryo, you’ll think this is a slam dunk. If it’s really a C, you won’t expect to win the science prize.

Unfortunately, even those with the “judgiest” of eyes can’t discern a trisomy 21 from a 46XY. Visually, they look pretty much the same. Aneuploid (genetically abnormal embryos) clean up well; they can look just as handsome when it’s time for their big date. Cue modern day PGS (pre-genetic screening). PGS has allowed us to distinguish between those who have natural beauty and those who are caking on the makeup. By subjecting the embryo to genetic screening, we can take embryo selection and success rates to the next level. We know a lot more about their abilities to make a healthy baby and the reasons why IVF cycles work or don’t work.

For the type As among us (we’re both raising our hands, so you’re not alone!) we lived and died by our grades. We burned the midnight oil to get the coveted A in Chemistry and logged many sleepless nights for the Honors on our English paper. However, grades don’t mean everything. In the same regard, there are several modest-quality embryos that make the most beautiful, smartest, and kick-butt kids.

So, while we totally get your hangup with the grade, don’t obsess. It won’t change the outcome and will only increase your anxiety. You’ve studied as hard as you can; the rest is in our hands!

One Plus One Plus One Plus One = Five: How to Analyze a Semen Analysis

When you think about it, men sort of have it easy. As women, we have to get poked and prodded, stabbed and jabbed, and pushed and pulled (all before 8AM) to figure out if things are working on our end. It’s about as easy as jumping on one foot while patting your head, rubbing your belly, and reciting the ABCs (backwards!). Sometimes, it’s just not easy being a girl! But even with all that we endure, it’s not uncommon to hear complaints from our significant others of the opposite sex when they are asked to provide a sperm sample. What we most commonly hear is, “Why do I have to do this anyway? What is it really going to show?”

Here’s the quick lowdown on what we are looking at with the sperm sample.

  1. Volume: The first parameter that is evaluated is the volume of the ejaculate (a.k.a. how much is in the cup). Normal volume is greater than or equal to 1.5mL.
  2. Concentration: Simply stated, how many sperm are there? By counting sperm, we are able to calculate the concentration. Normal concentration is greater than or equal to 15 million.
  3. Motility: While you may have sperm, can they swim? Sperm that just chill out are not going to get the job done! By assessing motility, you can answer this question. Normal motility is greater than or equal to 40%.
  4. Morphology: The last piece of the semen analysis involves analyzing each piece of the sperm (the head, the tail, and the middle). The percentage of normal sperm is calculated. Normal morphology is greater than or equal to 4%.

After all of the basic calculations have been completed, we are ready to get fancy. We plug the above values into a formula and by multiplying the volume by the concentration by the motility, we come up with parameter #5 = Total Motile Count (TMC). The TMC is important when deciding on how best to get the sperm to meet the egg. Above and below certain levels may mandate IVF vs. IUI or ICSI vs. insemination (for IVF).

Additionally, a borderline or failing grade on any, some, or all of the parameters will usually cost your guy a trip to the urologist. Abnormal semen analyses can be more than just markers of reproductive health but of overall health as well. Therefore, an abnormal semen analysis should always be repeated (this is not a one and done-type of situation) and never be ignored.