What CGH results look like

(Edit: Added PGD results to the bottom of this post.)

I thought some people might be curious about what sort of information you get when you have your embryos tested with CGH, so I scanned in my reports.

Here's the report from the lab that did the CGH (click the image to zoom in).

The embryos are numbered down the left, 1-12, the second column notes how many cells were tested (1 each, in our case), and then there are 22 columns for the 22 chromosomes, and another column for the sex. Then a summary of the data - if everything is a 2, and the sex chromosome is normal, then the embryo is declared normal.

It's noteworthy that every embryo was declared either normal or abnormal. It is possible to get "no result", because the biopsied cell fails to grow and thus there's not enough DNA to get test results. That's one downside of CGH, although we were completely ok with it - worst case we would have thrown out the known abnormals, transferred the known normals one at a time, and then moved on to the unknowns if necessary.

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Here's the report from my clinic that tabulates the CGH data (diagnosis column) with the physical grade at Day 3 and Day 5.

You can see that egg #1 produced a genetically normal embryo, but it fragmented by Day 5 and wasn't looking great at Day 3 (grade III).

Embryos #4, #7, and #8 are our good ones. They're genetically normal, and they are Grade 1 expanded blastocysts. We transferred #8, which was as good as embryo as you can get (5AA). Those following along closely can figure out what gender we transferred... #4 and #7 are frozen for future transfers - they're both graded 5AB which is only slightly below a 5AA, still awesome embryos.

We really lucked out that we had 3 genetically normal and physically perfect embryos. They don't always line up so nicely. (see egg #1)

#5 was the laggard that we were hoping would keep growing. It was genetically normal, but was 9-cells at Day 5 and needed to reach blastocyst stage by Day 6 to be frozen. Alas it stopped growing (or didn't grow fast enough).

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For comparison, here's the FISH report that we got on IVF4 earlier this year. My clinic used to only offer FISH (tests 9 chromosomes), but recently started working with another lab to offer CGH for patients who want/need it.

You can see that the report is much less complete - only certain chromosomes are tested (including sex). It also turns out that the FISH report is less reliable - it's possible for a normal pair of chromosomes to be situated so that the lab analyst can't tell if there's one or two. So there's about a 5% chance that an embryo showing one monosomy is actually normal. However, with FISH, unless the sample is degraded for some weird reason, you'll always get a result, so you don't risk the 'no result' that is possible with CGH.

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And here's the egg report from that cycle.

Slightly more information than for our recent cycle - the embryos were graded at Day 2. You can see that the best looking embryo at Day 3 (#2 with a Grade 1) was not normal. And by Day 5, our "normal" embryo had only reached early blastocyst stage.

Dr. Sher has an interesting blog about CGH compared to FISH. (Note that SIRM does a different type of CGH that requires that the embryos be frozen since it takes a few weeks for the analysis to come back.) Since FISH only looks at a subset of chromosomes, a "normal" FISH embryo is actually abnormal 40-50% of the time.  I found that out only after our failed IVF4, and it's likely the reason that IVF didn't work - that the 'normal' embryo we transferred wasn't actually normal.

It's infuriating, actually, since the cost for the two types of genetic analysis are comparable, and one only identifies about half of the abnormal embryos. It's still better than nothing, so if it's all your clinic offers, you may still want to do it, but it's why I insisted that my local RE do CGH on our donor egg-derived embryos.

Hopefully this is helpful and of interest. I know I would have loved to have seen what a CGH report looks like before I actually had one run on my own embryos. If you have other questions, leave them in the comments and I'll continue to flesh out this post if I have the answers.