Note: To view or change embryo grading settings, you'll need the Embryology Admin permission. If you do not have this role set, first speak to your Admin user.
1. What is customisable embryo grading?
By default, every wawa account grades embryos using a system derived from most common practice, the scale most labs already know: pronuclei counts at Day 1, cell counts and fragmentation at Day 2 to 3, and then the Gardner system expansion, inner cell mass and trophectoderm grades for blastocysts.
Not every clinic grades exactly this way. You can now define your own criteria, your own grade values, and your own labels, so the grading form matches how your embryologists actually work.
2. Where to find it
Go to Settings › Operations › Embryology › Embryo grading, or search for "embryo grading" in the command bar.
3. A few things to know before you start
The following are five stages are available for editing: Zygote, Cleavage, Morula, Blastocyst, and Other. You choose which criteria are assessed at each one, but you cannot add a new stage or rename an existing one.
One scheme per account. Whatever you configure applies across every clinic, site and brand on your account. You cannot set different grading systems for different locations.
A handful of criteria always use wawa's own values. You can change how they're displayed with a prefix or suffix, but not which values are on offer:
Criterion | Values wawa provides |
Pronuclei count | 0, 1, 2, 3, >3 |
Polar body count | 0, 1, 2 |
Cell count (Cleavage) | 2 to 15 |
Cell count (Morula) | 16 or 32 |
Not fertilized | NF |
4. Turning off wawa's default grading system
At the top of the Embryo grading tab is a switch labelled Use default grading system (Gardner system). This is the default settings and you cannot edit the custom grading while this switch is on.
On (the default): the criteria shown are wawa's standard Gardner setup
Off: the editor becomes active, pre-filled with the Gardner setup as a starting point, so you're not building from a blank page.
Before you turn this back on later: switching back to the default removes your custom criteria setup, so if you turn customisation off and then on again, you'll need to rebuild it. This does not delete or change any embryo grades you've already recorded. Those keep the grade they were given, but they'll be flagged as graded under a different scheme so they aren't compared like for like against grades entered afterwards.
5. Adding and arranging criteria
Once the default system is switched off, use Add criterion at the bottom of each stage's section to add a new one. Each criterion appears as its own card, which you can:
drag by the handle on the left to reorder it
remove with the bin icon
The order you set here matters twice over: it's the order fields appear in on the grading form, and it's the order values appear in the finished grade string. If you leave a stage empty, it simply won't appear when your embryologists are grading, which is the way to switch off a stage you don't record.
Not every criterion is available at every stage:
Stage | Available criteria |
Zygote | Not fertilized, Polar body count, Pronuclei count, Custom criteria |
Cleavage | Cell count, Fragmentation grade, Multinucleation, Symmetry grade, Direct unequal cleavage, Custom criteria |
Morula | Cell count, Compaction, Custom criteria |
Blastocyst | Blastocyst expansion, Inner cell mass, Trophectoderm, Early Developmental Stage, Custom criteria |
Other | Other criteria, Custom criteria |
A couple of exceptions worth knowing: each criterion can only be used once per stage, except Custom criteria, which you can add as many times as you like. Not fertilized and Early Developmental Stage are also recorded on their own; they can't sit alongside other criteria in the same stage.
You can change the value from Absolute to Ranged to customise further:
6. Setting up each criterion
Once you've added a criterion card, you'll see the following fields:
Criterion (required): what's being assessed, chosen from the list available for that stage.
Criteria name (required only for Custom criteria): the name your embryologists will see. Leave this blank for anything that isn't a custom criterion.
Value type (required): choose Absolute to record a single value from wawa's fixed sets, or Ranged to define your own grade values. Selecting Ranged reveals the grades section described below.
Prefix and Suffix (optional): text placed either side of the value in the finished grade. For example, a suffix of "PN" is what turns a pronuclei count of 2 into
2PN.
7. Defining grades for a ranged criterion
If you've set a criterion's value type to Ranged, you'll need to add the grade values yourself using Add grading option. For each one you can set:
Grade (required): the value itself, and what appears in the finished grade string. You need at least two grades for the criterion to save.
Description (optional): shown as supporting text on the grading form. Any row left completely blank is simply ignored.
If your grades stand for measured ranges rather than a label, such as a percentage of fragmentation, switch on Numeric range mappings. This adds Min, Max and a unit to each row, and shows the underlying range alongside the grade when your embryologists are grading, for example 25-50% where both bounds are set, >50% where only a minimum is set, or <10% where only a maximum is set. This is exactly how wawa's own Gardner fragmentation grades are built.
A few rules apply once numeric range mappings are switched on: every grade needs at least one bound, both bounds must be numbers where set, the maximum must be greater than or equal to the minimum, and only one grade at each end of the scale can be left open ended.
8. Saving your changes
The Save button stays greyed out until you've actually changed something, and every save asks you to confirm, since changes can affect how existing grades are read afterwards.
If something isn't valid, every issue is listed together rather than flagged next to the individual field, so if your save doesn't go through, check the full list of messages rather than scanning the form. A successful save shows the confirmation "Embryo grading system saved".
9. How your configured grade is displayed
Each criterion contributes its prefix, its value, and its suffix, and the criteria for a stage are joined together with hyphens in the order you've set them up in.
Stage and criteria graded | Resulting grade |
Zygote, pronuclei count alone |
|
Cleavage, cell count, fragmentation, symmetry |
|
Blastocyst, expansion, inner cell mass, trophectoderm |
|
The hyphens between criteria can't be removed. This means that if your lab is used to writing a Gardner blastocyst grade as 4AA, wawa will display it as 4-A-A instead.
A worked example: to reproduce Gardner blastocyst grading with the expansion figure prefixed, under Blastocyst you'd add, in this order: Blastocyst expansion (Ranged, grades 1 to 6, prefix "B"), Inner cell mass (Ranged, grades A to D), and Trophectoderm (Ranged, grades A to D). A fully expanded blastocyst with a good inner cell mass and trophectoderm would then record as B4-A-A.
A note on CHLOE: for cycles linked to CHLOE, CHLOE is treated as the source of truth, and each sync will overwrite gradings with its own values. Your configured criteria only govern grades entered manually.
10. If you change your scheme later
Grades you've already recorded never change. Nothing is rewritten or deleted when you update your setup.
How a grade is displayed is recalculated from your current configuration every time it's shown, so changing a prefix, a suffix or the order of your criteria will change how existing grades read in the culture grid, treatment reports, cycles overview and any CSV export.
If you remove a criterion, grades already recorded against it are kept, but they're flagged as "graded with an inconsistent grading scheme" so they aren't compared like for like with newer grades.
Where possible, make changes between cycles rather than partway through a patient's cohort, and let your embryology team know before you save.
If you make an edit to the grading system, you will be prompted to confirm that there may be inconsistencies:
10. Using your custom grading
When you grade embryos, your custom grading options will display on the right of the screen.
As an addition when adding this information, you will see it is not possible to change the date of observation:
