Embryo stages, progression and pregnancy outcomes

November 10, 2010Carole 410 Comments »

Did I mention I love getting blog topic suggestions from my readers? I get in a rut too. So I was happy to find this request in my inbox. “Carole, please could you discuss the various stages and the required number of cells the fertilized egg goes through up until it is vitrified on day 6? Also please could you explain the terms “cleaved”, “compacted”, “non-expanded” blastocysts and possibly give some percentages as to the chance of pregnancy when, e.g. a compacted 6 day blast is transferred.”

This post also gives me the opportunity to thank Dr. Liz Sanders from the Mississippi Fertility Institute and Dr. Robert Shabanowitz from Geisinger Medical Center for their generous permission to use their embryo images in this blog.

First things first. The first embryonic stage is the fertilized egg or zygote stage. Eggs usually show signs of fertilization between 16-18 hours after insemination. What embryologists look for are two well-defined transient structures called pronuclei in the center of the fertilized egg.  In the picture below, the PN look like two chocolate chip cookies inside the egg. These “cookies” contain the male and female DNA and for normal fertilization, there should be exactly two pronuclei or as embryologists like to shorthand, “2PN”.

Normally fertilized egg with a paternal and maternal pronucleus (2PN) visible. Photo courtesy of Dr. Liz Sanders, Mississippi Fertility Center, Jackson, MS.

What is significant about the 2PN stage? This stage is brief, lasting only a few hours and occurring approximately 16-18 hours after insemination. Seeing more than 2PN (say 3, 4, 6PN or more) are all abnormal numbers of pronuclei which can not be corrected and result in an abnormal embryo which may fail to develop further. 3PN zygotes can cleave and continue to develop but will not produce a healthy pregnancy. Embryologists need to identify these abnormally fertilized eggs and remove them from the viable embryo pool.

Some clinics use a zygote scoring system or Z-score based on the appearance of the PNs to try to identify the fertilized eggs that will cleave and progress from this early stage. If the 2PN stage zygote looks like the egg swallowed two chocolate chip cookies, then the tiny spots within each cookie that look like chocolate chips are the nucleoli. Nucleoli are small, typically round granular bodies composed of protein and RNA that are usually associated with a specific chromosomal site, These nucleoli are involved in ribosomal RNA synthesis and the formation of ribosomes.  Characteristics including the number of nucleoli within each pronucleus, the similarity in size of these nucleoli and whether they are lined up along the edges where the “cookies” touch are all factored into the Z-score.  The usefulness of the Z-score is in dispute and is not used by many clinical labs.

Cleavage stages. When the fertilized egg divides for the first time and forms two cells, it has entered the cleavage stage of development. The term “cleaved” simply means that the cell has divided from one cell to two. Divided =cleaved. The cells in the the two-cell embryo continue to divide, creating a four-cell embryo. Each cell in the four cell embryo divides or cleaves again, forming an eight cell embryo. You can watch a great video of development from the fertilized egg to the blastocyst stage on the NIH stem cell website. A note about “days of culture” related to embryo stages: When I refer to day 3 of culture, day zero of culture is egg retrieval day. Signs of fertilization are visible on day 1 of culture. Cleavage to two-cell stage is typically expected on day 2 of culture and cleavage of the embryo to an eight-cell is expected on day 3 of culture. 

What is significant at cleavage stage? Embryologists have long looked for characteristics at this stage which will identify which embryos will go the distance. Characteristics that are favored by embryologists include same sized cells with little or no fragmentation. The four cleavage stage embryos in the picture at the right are a good example of nice cleavage stage embryos on day 3, when the embryo is expected to have cleaved into at least 8 cells. There is some variability in the cell number that we see on day 3. We expect the best prognosis from embryos that have reached 7-12 cells. If the embryo is only two cells on day 3, this is not a good sign and likely indicates the embryo has ceased to grow. Normal embryos have a fairly strict rate of progression which starts at the time of fertilization. If the time of fertilization is delayed (for example, if rescue ICSI is used), the start time of the embryo’s progression program is delayed and the embryo may reach the eight cell on day 4, not day 3 of culture since fertilization occurred a day later than expected.  But except for delays in fertilization, progression should follow an expected predictable rate. Embryos don’t usually speed up to catch up if they are lagging.

Morula stages of development. The morula stage is characterized by a transformation from a loosely associated group of cells to tightly connected cells that are acting more like a tissue. The process by which cells change from loose association to tight association is called compaction. A compacted morula is a group of cells (usually around 30) which have squeezed together inside the zona. This stage is usually seen on day 4 of culture. The photo to the right shows two typical morula stage embryos that have compacted. The name morula comes from mulberry (Latin: morum), perhaps because the morula looks somewhat like a mulberry.

What is significant at this stage? Sometimes embryos get stuck at cleavage stage and never compact. This is a bad sign and the embryo is no longer viable unless it makes this transition. Embryologists like to see that most of the cells are incorporated into the morula. Cells or large fragments that are left outside of the compacted morula are non-viable. In the picture on the right, you can see a little fragmentation between the morula and zona pellucida (the shell) but not too much. These morula look pretty good. Notice that in each picture from fertilized egg to zona, the zona is still about the same size, but the dividing cells within it are getting smaller and smaller with each division.

The blastocyst stage. Reaching the blastocyst stage of development is considered a very favorable sign for implantation and pregnancy. In a typical IVF cycle, some embryos fail to go on at each stage. It is unusual for 100% of a patient’s fertilized eggs to get to blastocyst stage but it can happen. Embryologists talk about expanded blastocysts, non-expanded blastocysts and hatching blastocysts- all stages in the continuum of blastocyst development. By the blastocyst stage, the embryo has reached 50-150 cells and is starting to strain at the confines of the zona pellucida. This straining is not simply due to cell division but also active pumping of fluid by embryo cells into the inner space of the blastocyst, forming a cavity or blastocoel. The filling of this space with fluid expands the blastocyst and we call this embryo an expanded blastocyst. Before creation of this fluid space, the embryo is called non-expanded. You can see a group of blastocysts that have expanded in the photo to the right. The expansion of the blastocyst helps thin the zona and eventually helps to rupture the zona and let the blastocysts escape or hatch from the zona pellucida. In the expanded blastocyst, the embryologist can see the inner cell mass (ICM) within the blastocyst. I have labeled the ball of cells that make up the ICM in the photo. The ICM contains the cells that will give rise to the actual cells of the fetus. The other cells that surround and protect the ICM and line the inner side of the zona pellucida are the trophectoderm cells. The cells of the trophectoderm give rise to the fetal part of the placenta. The mother also provides cells to the placenta. 

What is significant at this stage? The embryo must have a inner cell mass. The absence of an ICM means game over for the embryo since these cells have died off within the blastocyst. These blastocysts are not transferred. The other troublesome sign is when the blastocysts seems to have a low number of cells, suggesting that the transformation program began before cell division was completed, leaving the embryo with an inadequate cell base for development. The blastocyst stage typically occurs on day 5 of culture and we would see hatching early on day five, especially if the zona was hatched earlier for embryo biopsy. Sometimes the blastocyst will not become expanded until day 6. Differences in culture medium or other features between programs may explain why some programs see full expansion and hatching on day 5 and others see this more on day 6. In our program, we expected to see most if not all the embryos in a patients group of embryos reach this stage on day 5.

There’s another interesting feature of blastocysts and that is their ability to expand- and contract. Expanded blastocysts may “collapse” in culture and look unexpanded. With time, the blastocyst will re-pump the fluid and “re-expand”.  A “compacted” blastocyst is likely a transient condition in which the fully pumped up blastocyst has “deflated’. As long as the blastocyst is capable of expansion, this temporary deflation is not a problem. In fact, prior to vitrification, many programs routinely deflate their blastocysts to optimize the vitrification procedure. After freezing and thawing, a sign of recovery is re-inflation or re-expansion of the blastocyst, showing that the embryo is alive and pumping- literally.

In vitro artifact or source of identical twins? Interestingly, one study using time lapse photography of collapsing and re-expanding blastocysts found a connection between the frequency of collapse and the size of collapsing blastocysts and an increasing frequency of monozygotic or identical twins from IVF. Researcher Dianna Payne described her theory that the frequent collapse was a sign of local areas of cell death. The frequent collapses allowed embryonic cells to move and relocate to a second site within the blastocyst, setting up two ICMs that could lead to identical twins. Excessive cycles of  collapse and reexpansion could kill the blastocyst if it becomes unable to expand. In another study, the ability of a blastocyst to reexpand after thawing was used as a predictor of better pregnancy outcomes.

Hatching Blastocysts. The photo to the right shows an empty zona and four fully expanded blastocysts in various stages of hatching. You can see a bubble of cells sticking out (hatching) out of the left side of the top left embryo. Directly below this embryo, you can see an embryo that is completely free of its shell and its empty shell or zona pellucida has floated to the top of the photo. If you look closely, you will notice that the edges of this hatched embryo is irregular and not shiny like those of the blastocysts that are still enclosed by the zona. The two smaller blastocysts to the right of the hatched blastocysts are still expanding, note their relatively smaller size.

In the picture below, you can see another photograph of a blastocyst in the middle of hatching, half in and half out of its shell. You can see an area in the middle of the embryo that appears more open. This is the blastocoel. Notice how thin and small the zona looks relative to the first photo of the fertilized egg. Some of the newer culture mediums are better designed to allow the natural thinning of the zona in preparation for hatching, making assisted hatching procedures to artificially open a hole in the zona largely unnecessary except for cases in which embryo biopsy is required. Embryo biopsy (removal of one or more cells) from the embryo for genetic analysis requires that a hole is made in the zona at either the eight cell or blastocyst stage embryo.

What does all this embryo progression, embryo scoring and achieving blastocyst stage mean for a person’s chance of pregnancy? Determining which embryo will implant and make a baby is the holy grail of embryology. Evaluation or scoring based on appearance of  the fertilized egg, cleavage stage or blastocyst stage embryos have all been proposed by embryologists to determine which embryos have pregnancy potential and which don’t.  Some clinics have done retrospective studies of embryo progression- a functional test. The embryo progression of sibling embryos was compared from patients who got pregnant to patients who did not get pregnant after day 3 transfer.  Did these sibling embryos stall out or progress to blastocyst stage? Generally speaking, patients whose excess embryos went to blastocyst stage were more likely to get pregnant than those patients whose remaining embryos did not progress to blastocyst stage. So progression is a good functional test of viability and selection of embryos at day 5 of culture is a good tool to identify the embryos that can make it at least that far. Genetic testing for embryonic abnormalities that prevent pregnancy may be the key to identifying the embryos that make babies but those tests are still under development. Testing of embryo metabolism or metabolomics is another promising arena for developing new predictive tools to determine embryo viability.

The bottom line is that even with all embryo characteristics that have been proposed as predictors of implantation and pregnancy, there is not yet one test which accurately predicts which embryos will develop into babies. I am hopeful that a combination of existing evaluation methods and future analytical tests will one day identify those embryos that will produce a healthy pregnancy and child.

© 2010, Carole. All rights reserved.

410 Responses to this entry

  • C Says:

    Many thanks to the in-depth reply above.

    I was wondering if there is any truth to the following thinking regarding the two different types of CGH, namely 3 day and 5 day.

    Up to day 3, the embryo is reliant on the energy in the maternal DNA, (which in my case is 42 years old) to reach the 8 cell stage. Assuming 3 day CGH is performed, 1 cell is removed and once again it’s the old, maternal energy that has to be used to bring the embryo back to the 8 cell stage.

    However, with day 5 CGH, a few blastomeres are removed at the 5/6 day stage when the blastocyst is growing using the energy of the blastocyst, which is young and fresh and thus in my eyes can easily regenerate and is the less invasive procedure.

    Please tell me if my thinking is fallacial. I have had day 3 CGH of 9 embryos where none made it being good enough to freeze. I have done a day 6 (my embryos are old and slow!) CGH after which 5 were and still are frozen. I have one more retrieval coming up before a FET and would like your opinion on my thoughts.

  • Carole Says:

    Hi C,
    Let me try to sort this out for you. You are talking about the switch-genomic activation- that happens in the early embryo on day 3. Before day 3 the embryo is relying on stored materials in the egg like RNA and protein (not DNA) that the developing egg transcribed from the maternal DNA prior to fertilization. The DNA of the the embryo is already a mixture of male and female DNA which commingle at fertilization. Unfortunately, there is not a rejuvenation of DNA with embryo development after genome activation. At genome activation, the embryo relies on its genome (a mixture of male and female DNA) which may have abnormal chromosomes in it. Aneuploidy or an abnormal number of whole chromosomes (can also be the presence of abnormal regions within chromosomes) are present in the egg (or the sperm) and probably persist indefinitely through all stages. It is possible, if the aneuploidy arose after fertilization in only one cell- a condition called genetic mosaicism- this cell might be weeded out as the embryo continues to develop. This concept is controversial and not universally accepted so I wouldn’t expect the embryo to “cure” itself of aneuploidy-especially if it arose from the egg. If the aneuploidy is present in the egg, it will likely persist and be equally detectable on either day 3 or day 5(or 6)- so CGH should work reliably well on either day. To diminish the risk of false results from sampling a non-representative cell (due to genetic mosaicism), trophectoderm biopsy on day 5 is useful because a greater number of cells can be sampled from the embryo. Unfortunately, your age is working very much against you. If you are like most women in your age group, aneuploidy is likely to be a problem in the majority of your embryos. The good news is that CGH should be able to detect this problem at either day of culture. I wish you the very best in a difficult situation. Please keep in mind all the other options you have for motherhood if this cycle and FETs do not work. Good Luck!!!

  • Anonymous Says:

    If an embryo was grade 3 (grade 4 being the best) on day 3 but a morula on day 5 when it was transferred, and there are no other embryos to compare progression with, what chances of implantation can be expected for <35 age group?

  • Carole Says:

    It is really impossible to say. A late morula is just a few hours away from an early blastocyst, so I wouldn’t rule out implantation. We use cell stages and progression as a rough indicator of viability but embryos can and do surprise us.

  • Melrose Says:

    Hi Carole

    Thanks very much for hosting such an informative blog!

    My question is regarding PGD. Due to my husband and I being a cariers of a thalassemia we have to undergo PGD. We are also looking for an HLA match with our baby who has thalassemia and want to start the process asap. We met 2 IVF experts (both highly regarded in our area) for consultation and both recommend very different approaches

    Option 1 – PGD for Thalassemia + HLA match + Aneuploidy (I am 36 yr old) on day 3 embyo with a fresh tansfer on day 5

    Option 2 – PGD for Thalassemia + HLA match + 24 chromosome testing on day 5 blastocyst with a FET in the subsequent cycle/month. The FET is needed becasue the PGD and chromosome tesitng will not be done in time to enable fresh transfer.

    My husband and I are very confused –

    While upside of option 2 is that the cells for genetic testing will come out of the blastocyst rather than embyo so it will be removing cell(s) from a larger vs. smaller embyo and thereby lesser potential damage. Is this correct?

    The potential downside of this option is that it will need freezing and thawing of the blastocyst so there will be extra stress to the blastocyst.

    So we dont know if the upside of option 2 outweighs the downside. Can you help us with some more insights regarding benefits/drawback of each option? Please help!

    Thanks

    Melrose

  • Carole Says:

    The short answer to your question is that either option CAN work very well. The key is determining which program has the best track record with their favored approach. Ask for statistics on their outcomes- not just the number of successful pregnancies but also the number of PGD cycles they have done using their methods and how long they have been using their preferred technical approach. You are correct in that option 2 has both advantages (more cells sampled), but also more potential for problems, since the team must be excellent at not only PGD but also cryopreservation. I would avoid a program that does NOT use vitrification for the freezing step. Older methods are more stressful to the embryo. If vitrification is the freezing method used and if it is performed competently, stress to the embryo is minimal. You’ll need to get some more data from the lab and physician about the number of cycles they have done (for PGD with or without freezing) and their pregnancy outcomes for patients in your age group. If the program can’t or won’t give you this information, that suggests to me that either 1) they are not tracking this data and so are doing no real quality control or 2) their results are preliminary because the procedure is new for the team or done infrequently or 3) they are not seeing very good results. Good Luck. Best wishes for a healthy baby (and sibling) in the new year!!

  • Melrose Says:

    Hi Carole

    A very happy new year to you!

    Thanks so much for your clear response. It is really helping us think clearly. A few other things –

    1. How many PGD cycles of an institute can be considered as a good sample size to estimate success rate? As PGDs are still quite limited what should we consider good enough.

    2. Can you suggest a few labs in the NY-NJ area which are the cutting edge labs for vitrification cryopreservation or the ones you have heard good reviews about?

    Thanks so much once again!

    Melrose

  • Carole Says:

    These are both tough questions because the national pregnancy success rates reported to the CDC don’t break out cycles that use PGD or vitrification, so there is no PGD- specific or vitrification-specific reports to allow you to evaluate programs. You can get a general idea about how good a program is at everything they do if you look at their overall CDC or SART reported pregnancy rates for your age group. I have two earlier posts that explain how to find a good clinic using these sites:
    http://fertilitylabinsider.com/2010/05/finding-a-good-fertility-doctor-part-one/
    http://fertilitylabinsider.com/2010/05/using-cdc-reports-to-find-a-good-fertility-doctor-part-two/

    The CDC and SART sites are state-specific databases so you can investigate NY-NJ clinics specifically). I’m sorry but I can’t recommend specific clinics–even though physicians have asked me to!–in my blog. My blog is more useful and credible if it remains independent.

    Generally speaking, If you are using a clinic that has a 50% pregnancy rate in its under 35 year age group and does at least 200-300 cycles a year including 10% PGD, that’s probably a decent program, Their PGD pregnancy rate should not be much lower than their overall pregnancy rate for each age group. f you want to know specifically about a program’s success rates only with PGD cycles and vitrification, you will have to ask the program to provide you with accurate up-to-date statistics on their success rates with both vitrification and PGD.

    Regarding your first question– It is hard to define a minimum number of PGD cycles necessary for proficiency. The clinic should be doing more than anecdotal PGD cases. It should be a routine offering. Our program was relatively small (only 200 cycles a year) but we had on average 1-2 PGD cases a month. If we didn’t have a scheduled case, we did biopsy practice just to stay “in shape” for our biopsy cases.

    The PGD lab may also be a good referral source to find a good IVF program. You can call the PGD lab which probably serves multiple IVF programs and ask them which IVF program they prefer to work with. If they know you are already aligned with program A, you may not get an unbiased opinion but if you are still looking for an IVF program- the PGD lab may give a useful recommendation. An IVF lab that is not very good at preparing slides or otherwise causes problems for the PGD lab may not be the one you want to handle your precious samples.

    Regarding vitrification, I would use a clinic that ONLY uses vitrification for cryopreservation of their current cases. They might have used slow freeze in the past and still utilize slow thaw on those stored embryos, but I would want them to use vitrification on all fresh embryos and would like to see that they been using this method for several years. You might find my earlier post about finding a good egg freezing clinic helpful. The same principles apply. http://fertilitylabinsider.com/2010/08/finding-a-good-egg-freezing-clinic/

    I hope this helps. Best Wishes.

  • Sara Says:

    Hi there,

    Am pretty new to the ivf world and haven’t been given good explanation nor didn’t know what to look for and ask about regarding my embryos grade.

    I got 2 embryos on day 5, one with 10 cells and the other had 9 cells.

    Doc told me they were rather slow and not to put my hopes up.
    What are the chances of implantation with these findings.?

    Thnak you and kind regards,
    Sara

  • Carole Says:

    Hi Sara,
    Usually, we would expect to see 50-100 embryo cells on day 5. Also on day 5, the embryo would have reached blastocyst stage with recognizable structures such as an inner cell mass (future baby) and trophectoderm cells (future fetal part of placenta) and a space between (the blastocoel). Although I never say never, the expectation for implantation of 10 and 9 cell embryos on day 5 would be very low, as your doc indicated. I am sorry I can’t be more optimistic. Best wishes, Carole

  • Rita Says:

    Hi I am 40 years and recently had an IVF done in India. The doc said that embryo was 4 cell and they implanted it on the 2 day only. I had only 2 matured oocyte (female eggs),but the quality of embryo was A. and the linning of the uterus was 8mm which is below normal. The outcome was that I didnot conceive. What would you suggest shall i go for the second trial and if yes on which day is it best to implant an embryo( how many celll division should it have)for the best result. And if i had only 2 oocyte and an 8mm inner linning of the Uterus what are the chances of the IVF sucess. Thanks
    Rita

  • Real time embryo development | Fertility Lab Insider Says:

    [...] is implantation-ready).One of my most popular posts is about the progression of embryo development, “Embryo stages, progression and pregnancy outcomes”, with lots of embryo photos- courtesy of some very generous colleagues and friends in IVF-, so I [...]

  • Adela Says:

    Hi Carol,

    Very useful blog.
    I am 38. I got a transfer of 3, 8 embryos cells on day 3. What stage is ideal for transfer? Or what is the criteria to go ahead with an embryo transfer either at cleavage, morula or blastocysts stage?

    Thank you,

    Adela

  • Carole Says:

    Generally speaking, at any stage, we look for the “best” embryo or embryos to put back fresh. What constitutes the criteria for determining what is best? Until we develop methods to look at what is happening inside the embryo, we are limited to evaluation of what the embryo looks like and whether it hit certain embryonic milestones on time- just like a baby is expected to reach specific developmental milestones on time, For instance, for cleavage stage embryos that are being evaluated for transfer, we like to see about 8cells plus or minus 2 cells, nice even cells with minimal fragmentation. If they have fewer than 6 cells, they are clearly lagging and may have stopped dividing so these would be a poor choice to return to the uterus. At the blastocyst stage on day 5, we like to be able to see all three distinctive structures- a well developed trophectoderm layer, well developed inner cell mass and a fluid-filled cavity between them. If the embryo lacks an inner cell mass – the cells devoted to producing the future baby, it should not be returned to the uterus. If the trophectoderm has very few cells, it might be a poor candidate embryo to make a healthy placenta and would be a lower-ranked embryo to choose for transfer. Hope this helps.
    Carole.

  • Sydney Says:

    What a great informative blog. I just had two expanded blastocysts transferred on day 5. Both were graded CC. With my last IVF we did a SET with expanded blastocyst, grade BB that resulted in a chemical pregnancy. In your mind is it more important that they are expanding blastocyst or the grade? (would an early blastocyst grade AA be better)….should we consider implanting on Day 3 (when we had 8 embryos still around)? Lots of research but no definitive answers.

  • Carole Says:

    Hi Sydney,
    An “AA” graded blastocyst just means that at the time of assessment, the embryo has a lot of cells in both it’s inner cell mass and the trophectoderm. It is an easy choice to transfer because it has reached an advanced stage. A “CC” graded blastocyst means fewer cells in both cellular compartments at the time of assessment but it does not mean that the embryo can’t implant. Transfer of cleavage stage embryos on day 3 and transfer of blast stage embryos on day 5 both result in pregnancies. Growing to day 5 is useful if we want to identify the most advanced embryos in a group of embryos. But even slower progressing embryos implant so grade is less important if they reach the blastocyst stage on day 5 (or even day 6). Your question is a good one so I wrote a new post http://fertilitylabinsider.com/2011/12/understanding-the-gardner-blastocyst-grading-scale/ based on your question that has much more details in it and a link to graded embryos which may be useful to you. So please don’t despair, it’s way too early to give up on this embryo and this chance at pregnancy. :) Best wishes,
    Carole

  • Sydney Says:

    Thank you! You have made my morning and the rest of the week. It is so helpful to have some one like you on the web!

  • KRISTIE Says:

    jUST WONDERING IM ABOUT TO GO IN FOR A DAY 5 TRANSFER TOMORROW AND THE CLINIC RANG ME THIS MORNING TO TELL ME THAT OUT OF MY 6 EGGS ONLY 4 ARE PROGRESSING AND ONLY 2 ARE DOING OK.
    I HAVE ONE THIS MORNING AT 10 CELLS AND THEN THEY RANG TO MAKE MY TRANFER APPOINTMENT 3 HOURS LATER AND IT HAD MOVED FROM 10 CELLS TO 12 CELLS. THE OTHER ONE WAS 6 CELLS AND HAD MOVED TO 8 CELLS. SHOULD I BE WORRIED THAT THESE ARE JUST TOO SLOW AND I WONT GET A PREGNANCY OUT OF THESE?????

  • Carole Says:

    The best thing to do is ask your doctor what is the pregnancy rate you can expect from embryos that look like yours for patients who are as old as you in THEIR program. That’s what you really want to know. In our lab, we would be concerned that they are somewhat slow UNLESS they are compacted and are actually forming a morula- the pre-blastocyst stage on day 4. I can’t really answer your question specifically because every lab is a little different. Best Wishes for a BFP. Carole

  • kristie Says:

    Thanks for that i went in for my transfer today and i had a compacting blasto and a morula that was compacting and growing to the early blasto stage. Im hoping that they are right on track for day 5 now the dr seemed happy with their progress should they be at this stage?

  • Carole Says:

    I would feel optimistic at this point. They haven’t stopped dividing! Best wishes!! :)

  • Kristie Says:

    If implantation was to occur when does that happen now I have had a transfer. Yesterday was a day 5 transfer.. Thanks for all your help

  • Kristie Says:

    If implantation was to occur when does that happen now I have had a transfer. Yesterday was a day 5 transfer.. Thanks for all your help I wish this was around for my other cycles.

  • Carole Says:

    Hi Kristie,

    About 2 days after the day 5 transfer, the blastocyst should be hatched and starting to burrow into the uterine lining. The implantation process continues for several days and the embryo start to secrete hCG which is the pregnancy hormone detected in the blood or urine. Here a link with a nice chart of what happens after either day 3 or day 5 of pregnancy. Best wishes and Good Luck!! Carole

  • Val Says:

    Hi! I would love to hear your independent thoughts on the quality of my blasts based on your experience. I am 43 and I’ve had 7 natural IVF cycles resulting in 6 blastocysts. The 7th embryo arrested on Day 4. They have been frozen via vitrification. Here are the blast ratings my dr.’s office shared with me and they said they never rate a blast as an “A”:

    1st number: stage of blast
    1 – early blast
    2 – regular blast
    3 – expanded blast

    2nd number: ICM
    The lower the number, the better

    3rd number: Placenta
    The lower the number, the better

    Here are my blasts:

    1. 5-day, “4-2-3″, “B”
    2. 5-day, “2-2-3″, “B”
    3. 6-day, “2-3-3″, “B-C”
    4. 5-day, “2-2-3″, “B”
    5. 7-day, “3-2-2″, “B”
    6. 5-day, “3-2-3″, “B-C”

    Your initial thoughts?
    Is it common for a 43-year old to obtain 6 blasts out of 7 natural cycles?
    Might I have better than normal pregnancy odds than an average woman might my age?
    Would the 7-day, expanded blast be considered to be higher quality than the 5-day regular blast? Or would a 5-day always be considered stronger than a 7-day?
    Are there specific questions I should ask my embryologist?

    We may pursue 2 more blasts before starting SET’s.

  • Carole Says:

    Val,
    Unfortunately, even with the very precise description you provided of the embryo scoring of your embryos, I can’t answer the question likely most important to you- the implantation potential of your embryos. The reason is that what any embryo looks like is less important than what is going on inside the embryo.
    The embryo’s viability depends in part on its chromosomal normality. The biggest hurdle women over 35 years of age have in getting pregnant is that as they age, they start producing eggs with either too few or too many chromosomes (aneuploidy). Most forms of aneuploidy are not compatible with a viable pregnancy. The condition of Down’s syndrome is one exception to this rule because a third chromosome 21 does allow implantation. pregnancy and life- although a shortened life span with significant health and developmental challenges. As you probably know, the risk of having a child with Down’s syndrome increases with the age of the mother- this correlation is due to increased aneuploidy in embryos with age. Generally speaking, an embryo that reaches the blastocyst stage on day 5 is progressing at the expected pace whereas an embryo that requires two additional days to reach the same stage is abnormally slow and would be less likely to implant, in my opinion. Embryo development has milestones similar to childhood developmental ilestones. Babies may reach them at different times but there is a range of normal. In both embryos and babies reaching these milestones later can suggest underlying issues delaying development.
    Good Luck!! Carole

  • Carole Says:

    Hi Adele,
    Either stage (cleavage or blast) can result in implantation or pregnancy. If a patient has many fertilized eggs in excess of the number desired for transfer, giving the embryos a chance to progress in culture can reveal the best growing embryos and so the best two can be transferred. If the patient only has two cleavage stage embryos on day 3, there is not any advantage (in so far as selecting the best two) by allowing the two to keep growing in culture for two days. At cleavage stage, embryos that have around 8 cells (6-10) with little fragmentation and evenly shaped cells would be preferred for transfer. At blastocyst stage, we would select embryos with a well-defined inner cell mass and trophectoderm. The inner cell mass has the cells that give rise to the future child and the trophectoderm cells give rise to the fetal placental structures. Both structures are equally important to the future success of the pregnancy so we like to see that these structures consist of well-organized groups of cells. The morula stage is a sort of in between stage when the embryo is reorganizing itself from a uniform collection of loose cells to a more tissue like organism. Morulas are the ugly duckling transitional stage between cleavage and blast. Morulas can be transferred and they do result in pregnancies (assuming they continue to develop after transfer). Transferring 3 8 cell embryos in your age group sounds promising. Best wishes for a positive pregnancy test! Hope this info helps, Carole

  • Tanja Says:

    Hi Carole, the information on your site is fascinating. I had PGD done so knew the gender of my day 5 embryos transferred. 1 good looking blastocyst (about 100 cells) = boy. 1 morula somewhat fragmented, only about 10 cells = girl. Both implanted and at 7 wks there were 2 heartbeats, but one of them – baby B – was much smaller and lagging behind, slower heartrate and doc didn’t expect it to catch up. By 10 wks it was clear that baby B had stopped growing and was disappearing. We assumed I’d be having a boy since that was the healthier looking embryo at transfer. I’m now 16 wks and at today’s ultrasound, my doc is 95% sure that I’m having a girl! I am so surprised that the little girl morula that the doc didn’t think would be good enough to freeze would beat out the boy blastocyst that was developing right on track. Have you any comment or insight into how this comes about?

  • Melissa Says:

    Can you please give me some help? I just did a 3 day transfer. We transferred 3 embryos (11 cell, 6 cell, 4 cell). At first I was excited about the 11 cell but with more reading it seems on day 3 there should be 6-10 cell and the 11 cell may have grown too fast indicating it is abnormal. Is that correct? Thanks SO much for your time! Melissa

  • Carole Says:

    I would not be overly concerned about the 11 cell, that’s not far removed from the 8-10 cell “ideal”. I would be more concerned if it had even more cells- say, 13 or more cells and no sign of compaction. No need to worry at this point. Be hopeful. Good Luck! Carole

  • Em Says:

    Carole,

    I have gone through 3 failed IVFs (2 fresh, 1 frozen). I have transferred 5 blasts to date (all which were rated as “perfect”.) Unfortunately, I have also suffered from thin linings during FETs and recurring fluid in my uterus. My doctor feels that I have a uterine issue and is treating me accordingly.

    However, a second opinion with another RE stated that it may not be my uterus, and than even with “perfect” blasts, they could all be abnormal.

    I currenlty have 6 frozen 2PNs, 1 frozen 5 day blast and 4 frozen 6 day blasts. I am 32 years old and my only diagnoses have been blocked tubes which I had removed and hypothyroid which I am treating.

    What are the odds that All of my blasts are abnormal????????? I always assumed a surrogate was my last resort but now I am afraid I might not have that option.

    Also, my Dr. suggested biopsying my blasts after thawing them and then performing the FET. He said we could perform CGH restrospectively if things failed. Is this highly risky to do to the embryos?????

  • Carole Says:

    Dear Em,
    I am sorry that you are having such a hard time. I don’t know what the odds are that all your blasts are abnormal. You are only 32 years old so having 100% abnormal blasts is more UN-likely in a young woman (under 35) such as yourself compared to a woman over 40. I think what your doctor is talking about is thawing the 2PNS, growing them out to either cleavage stage and biopsy (test results back in 2 days for a day 5 fresh ET) or biopsy at blast stage. Biopsy at blast stage usually means refreezing the blasts and storing them pending results and a future FET. However, some testing labs are offering overnight testing so results are back in time for a day 6 fresh transfer, so the embryos don’t have to be frozen (or refrozen in your case). You could thaw the blasts, biopsy them and depending on when the test results get back, either refreeze or transfer fresh a day late, if overnight results are available in time. In theory, if you get aneuploidy results on each embryo, you can choose to just transfer the embryos that have a normal chromosome number. Doing that could remove one reason that you are having trouble getting pregnant but as you mention, there might be other factors as well. CGH testing costs several thousand dollars and probably is not covered by most insurance plans (but you should always check in advance just to be sure). Biopsy and CGH testing is still considered research, not routine clinical care because the biopsy can go wrong, providing an inadequate sample for testing, resulting in NO RESULTS or even damaging the embryo. Shipping to the testing lab can go wrong and again you might have no results you can use. Refreezing also has risks. “Perfect” embryo scores are not terribly meaningful as usually it is only based on appearance of the embryo – how even the cells are and how much fragmentation is present. I’d bet on an “ugly” embryo from a young woman before I’d bet on a “beautiful” embryo from an older women, because what’s inside (what we can’t see) is more crucial to whether the embryo will implant or not, and we know pregnancy rates decline with age due to maternal factors. Another option is to go ahead and transfer some of your stored embryos in more FET cycles. Just because it didn’t work before does not mean it’s guaranteed to fail in the future. I wish I had an easy answer for you. Good Luck, Carole

  • Em Says:

    Carole,

    Thank you for your response. I am really enjoying reading your blog.

    To clarify, my RE is suggesting that we thaw my embryos do a biopsy, and then transfer them before acutally performing CGH. He then suggested that I only spend the $ on CGH if my FET fails (since he will already have done the biopsy.) I plan to transfer 3, so this would only allow him to biopsy 3 of my 5 blasts.

    The thought is that if I fail another cycle, this might give a more definitive answer as to whether my uterus or my embryos are the problem. (Maybe neither and next time is my time). But, I am not sure if only testing 3 would give the whole story?

    Also, I can’t find anything on-line about biopsying blasts after a thaw. Usually it is done before. I’m not sure how high the risk is that the embryos will become damaged in their fragile state.

    Thoughts?

    Thank you!

  • Carole Says:

    Em, I don’t know of anyone who does the biopsy, then transfers the embryos without the benefit of the test result. The whole point of testing is to start the pregnancy with a healthy embryo to prevent you the heartache of a miscarriage. Also, testing detects chromosomal abnormalities like Trisomy 21 which are completely compatible with pregnancy but you’ll have a child affected by Downs Syndrome. You can’t assume that abnormal embryos won’t implant, they do, but cause issues down the road. This does not seem like a great option for you as I understand it. You are also correct that testing 3 only gives you information about those 3 and tells you nothing about the other embryos you have. You might be best served with a second (or third) medical opinion from a physician. Good Luck, Carole

  • melissa Says:

    Hi Carole

    Just wanted to tell you thanks SO much for answering my question. You made me feel much better!

    Melissa

  • January Cycle Buddy Group, Week ending Feb 6th - IVF & High Tech Forums Says:

    [...] 15 Just a little info for anyone interested. I found a good website where an embryologist blogs about IVF stuff. Very informative but the best part is at the very bottom of the page you can submit questions and she will actually answer them for you. I asked about my 11 cell embryo and she responded 20 min later to answer my question! Hope this helps. Embryo stages, progression and pregnancy outcomes | Fertility Lab Insider [...]

  • Carole Says:

    You are very welcome! Good Luck!! Carole

  • kim Says:

    Hi Carole,
    I just had an FET from a blast frozen from my second IVF–the cycle that gave us twins! We had two frozen blasts left and one made it through the thaw–it was grade 2 out of 3 at the time of freezing (it was from 2004 before the clinic changed it grading). They said it looked good and the embriologist gave me a picture after the thaw picture to show me it was “expanding”….I feel like this is good, but what else should I have asked? What else should I look for? Does it help that it was from a previous successful cycle or does the freezing change that?

  • Carole Says:

    Hi Kim,
    It is good that these embryos came from a previously successful cycle and expansion suggests that your embryo survived the thaw and is going about it’s business of continuing to grow. All good signs. There’s nothing else to do or ask but to get through the time until your pregnancy test. “Don’t worry, be happy” may be trite but it is actually a good plan-if you can manage it- until you know how things have turned out. Good Luck!! Carole

  • rosy Says:

    on day 3 i did embryo transfer with 18cells it is good or not scared can anybody help me with this please
    thanks

  • Carole Says:

    Rosy,
    Don’t be scared. Embryo scoring is subjective. Large fragments can be scored as cells, inflating the cell number. Your IVF team would have selected embryos to transfer based on what they have seen create pregnancies in the past. If you had nothing they felt was viable, you wouldn’t have had a transfer. Try not to worry. Good Luck!! Carole

  • Kim Says:

    thank you so much Carole! Its so nice to have this forum!

  • Anonymous Says:

    Hi i m 27 yr old i m undrgng ivf tretment his is my 8 day after ET.this os my first ivf cycle got 25 follicle,11 are fertilised nd 3 are transfer in that one is compacted,one is compacting,nd one is 8 cell on 4 day transfer how much is the chance of geting pregnant?

  • Carole Says:

    Generally speaking, your age (under 35) is definitely in your favor. I really can’t predict whether you will get pregnant or not. Your doctor, however, should be able to look at his (or her) previous clinical cases and tell you what percentage of patients at your age with your history and embryology stats became pregnant. This is the best predictor of your success. Good Luck!! Carole

  • Anonymous Says:

    thankss a lot..bt i am askng from my embryo ststaus is that good? nd my ingertlty r due to tubal factor prebsly i had ectopic.from last 2 year m unable to concive,just repy abt my embryo is that gd in 4 day transfer to becme pregnant plz reply…

  • Meagn Says:

    Jan 2002 I transfered 2 gradeC 8cell and was successful…both implanted but lost one at four weeks. I froze the remaining two which are 8 cell graded B…. Weird that they took the one that were graded C first..
    My age was 29 at retrieval time….
    What are the chances of my embryos making it through the thaw (slow freeze)
    What about implanting.now that I am 38? my lining on cd14 was 10mm triple line…

  • Carole Says:

    Hi Meagan,
    Although most programs typically transfer the best scoring embryos and freeze any others meeting freezing criteria, some programs freeze the best. Wny? In the past, it was not unusual to lose 50% of the cells after thawing from a slow -freeze protocol. Vitrification, done correctly, preserves the cells better so you don’t have to factor in a loss of cells when deciding which embryos to freeze. Some programs may want to be sure that most of their patients have something to freeze and freezing the best and transferring the rest helps to accomplish that goal. You’ll need to ask your clinic what their results are-for instance, ask “typically, what is your pregnancy rate using embryos frozen and thawed using the same protocols used for my embryos? Protocols change at clinics over time, so their success rate during the time period your embryos were frozen is most pertinent to your success. The ovaries suffer most from aging. Wtih hormonal priming, your uterus can carry a pregnancy even after menopause. You may have read the news accounts of a grandmother serving as a gestational carrier for her own daughter, in effect giving birth to her own grandchildren. This is possible because the uterus retains function longer than the ovaries, so if your lining develops appropriately in response to the hormones you’ll receive, your age should not be an issue.
    Good Luck,
    Carole

  • varsha Says:

    Hii.
    my ET was done at 02/02/2012 this is my first ivf.
    with 3 embryo(8cell)fr last night since12/02/2012 i had small amnt bleeding …morng also bleedng…(blood colour r pinkish brownish) is that i lost everythng .i m cring pkz plese help.why this bleedng oon 12 day post tramsger?

  • Carole Says:

    Dear Varsha,
    Please call your doctor to answer this question. There are many causes for bleeding and it doesn’t always mean that you have lost the pregnancy. There is implantation bleeding which can occur at the time of implantation. Some women have bleeding episodes at various times in pregnancy and have the pregnancy survive. Please see your doctor for help. Good Luck!!
    Best Wishes, Carole

  • Jessie Says:

    Hi,
    I’m 45 years old and have gone through several ivf trials with no success. The last was a donor who was 33 at the time of retrieval and I had a transfer with day 3 embryos which were a 4 cell and an 8 cell. I got pregnant there was a yolk sack but no fetus. It has now been 8 months since this transfer and I haven’t gotten a period. I went to my doctor and they told me I have gone into menopause. I have to frozen embryos left both at the 3 day stage. One is 5 cells and the other is 10 cells. My husband and I are very ambivilant about whether to attempt another transfer with these embryos. Do we have any chance at pregnancy with this history.

  • Carole Says:

    Jessie,
    I don’t know is the honest answer. There is always a chance but whether there is a good chance–what you really want to know– is more difficult to answer. On day 3, embryos should be at least 6 cells, 8 cells is the ideal and some embryologists feel that much past 8 cell (10 or more without signs of compaction) could also be problematic. You should ask your doctor what his/her experience has been transferring embryos like yours. This is probably the time to sit down with your husband and really decide what you want at the end of the day. Certainty that you have exhausted all options? Or is it time to move on and try some other avenues to parenthood? I can’t answer that for you but I truly wish you the very best going forward. Good Luck!! Carole

  • cp Says:

    Hi, I was just wondering what would cause my embryos to arrest at the day 1 – 2 stage?

    I have done 3 cycles. First one at age 30 resulted in 6 mature eggs, 4 fertilized with ICSI (we went to ivf because of severe male factor). By day 2 – one was 4 cells, one was 2 cells and one was dying and the fourth was not dividing properly. We transferred the 4 and 2 cell, I got pregnant with a singleton, but m/c just before 9 weeks.

    2nd cycle at 31 years old I again got 6 eggs and 4 fertilized. By day 2 only 2 were still alive. We did a day 3 transfer of a 6 & 7 cell embryo and I got pregnant with twins, but twin B died at 21 weeks. I gave birth at 31 weeks because of pre-eclampsia.

    Now 2 years later we decided to cycle again for another child. Everything was going good when I triggered on day 13 (had 11 mature follicles), but at ER they were only able to retrieve 4 eggs. Yesterday which was day 2 past ER they called with the fertilization report to say out of the 4 eggs collected, only 2 fertilized and they both arrested (like my 2nd cycle they must have arrested at the zygote stage before even cleaving once).

    Just wondering why so many of my embryos are not even getting past the one cell stage. Is it just bad eggs or is it the lab? 2nd and 3rd cycle were done at the same place (first one was done at a different clinic). Also how can this be possible. I am not even 34 yet and before we started ivf all my tests were fine (I ovulate every month etc), it was just my husbands low sperm count that lead us to ivf. Both me and my husband have also had our karyotyping done and we are both normal.

  • Carole Says:

    Dear cp,
    The short answer is I don’t know. There are many reasons that an egg might become fertilized but then not divide at all or only divide once. We don’t even understand all the molecular pathways in the embryo that make it “go” and do the stuff it does. Genetic problems like having an abnormal number of chromosomes in the gametes is one possibility for failed cleavage- even if your karotype is okay, there are problems with aging (increased incidence of aneuploidy) that affect us all. Then there are cytoplasmic factors- proteins, enzymes, growth factors etc –again many largely unknown- that have to function correctly for cell division. It is probably less likely that the lab screwed this up since you had success with this lab before- especially if their success rates are greater than 50% overall. And you shouldn’t even consider going to a program with less than a 50% success rate in the youngest age group. Whatever the reason, IVF is not working very efficiently for you. The question becomes- how much more emotional and financial reserves will you want to use here? You have gotten pregnant with IVF but if IVF works only once per every 3-4 tries, it may not be the best option for you for enlarging your family. Your physician should be able to give you more specific advice going forward. I am sorry I don’t have a better answer but I wish you all the best going forward. Good Luck!! Carole

  • Michelle Says:

    Hi,

    I was wondering if you could help me? I’ve had a day 5 embryo transferred 2 days ago. When the clinic phones me they said my blastocyst was collapsed but this is normal and I had it transferred later that day. I had 3 day 3 frozen embryos, 2 survived the thaw, the clinic decided to grow to day 5, only 1 was viable ( the collapsed blasto) I’m in a but of a panic as what are the chances of this embryo implanting? I had an fet 3 years ago, that was a day 3 and resulted in a successful pregnancy. Please can you put some clarification on this collapsed blastocyst?
    Thanks x

  • Carole Says:

    Hi Michelle,
    I would feel pretty good about an embryo that was thawed and continued to grow for two more days until blastocyst stage. Blastocysts expand by two means- producing more cells and pumping themselves full of fluid-literally. The space between the inner cell mass and the trophectoderm fills with fluid and the embryo grows bigger. Sometimes, the embryo collapses, meaning it releases this fluid and has to pump itself up again. Sometimes we do this on purpose.To get better results with vitrification, embryologists will deliberately deflate or collapse the blastocyst by lasering a gap between two of the trophectoderm cells, causing it to collapse. The embryo recovers from this rather well and reinflates itself post-thaw. So don’t worry about the fact that it collapsed before transfer- that’s likely just a temporary stage in it’s development. So please don’t worry. i know it’s a long two week wait but this is not something to worry about. Also, you got pregnant before so be hopeful.
    Good Luck!! Carole

  • Anonymous Says:

    Thank you so much for putting my mind at rest! So good to be able to talk to someone like you on the net! Excellent blog by the way :-) x

  • jflower Says:

    Your blog and responses to comments are such a tremendous resource! I am home after a FET this afternoon. I transfered a single 4AA blast in July, which resulted in a pregnancy that we sadly had to terminate in the second trimester due to a severe heart defect. We had three other 5day blasts frozen: 4AA, 3AB, 4AC.

    Today we trasferred the pre-freeze 4AA 5 day blast. What has me concerned is that the photo of the blast they gave me today looked so sketchy post thaw. I’ve read here about the concept that blasts are supposed to rexpand after thaw. I don’t know how many hours after thaw my blast was transferred. My RE said there weren’t black areas indicating cell death. He said post thaw they rate them as good/fair/poor, and that mine is still a 4AA blast but has a fair rating post-thaw.

    How bad of a sign is this post-thaw rating? I’ll be really grateful for any information you can provide – I haven’t found much information about blast ratings post-thaw. Thanks!

  • Carole Says:

    Hi Jflower,
    I think the post-thaw rating system your doctor describes is an in-house thing. Most embryologists have an idea what they want to see post-thaw but there is not a standard rating “system” that most labs use for post-thaw assessment. He is correct that we look for dark areas as a sign of cell death and if your embryos didn’t have any post–thaw that is a good thing. I wouldn’t worry about the fact that the embryo did not look expanded in your photo. That can take some hours so if they thawed and transferred pretty quickly, the embryo might not have had a chance to re-expand before being transferred. We often collapse the embryo before we freeze it for vitrification because it freezes better so don’t worry about it still being collapsed at thaw. That would be expected. If it is healthy post-thaw, it can re-expand inside you just fine so don’t worry about that. Good Luck!!! Carole

  • jflower Says:

    Thank you for your quick and helpful reply. I talked to the embryologist today, and she said that at our clinic there is a 57% success rate with “good” post-thaw blasts and a 52% success rate with “fair” post-thaw blasts. That also set my mind at ease a bit – yesterday I was imagining a more significant difference between the two in-house ratings. Thank you for being willing to share information with so many people – it’s such a comfort and a tremendous service.

  • mayu Says:

    Hiii..i m 29 yr old recently i had ivf in feb 2012but after 2month miscarriage.total my 11eggs fertilize nw 8 embryo in hosp. frreze.nw i m planing to go for my frozen embryo is that good nd how much is chance nnd sucess rate with frozen cycle.8 cell embryo frozen

  • Carole Says:

    Hi Mayu,
    You’re best answer to that question would come from your doctor at your IVF lab because they are keeping data on pregnancy outcomes for their patients. Post-thaw success rates can vary a lot between clinics so I don’t want to even attempt to guess, but nothing you said should rule out a good outcome in the future. Best Wishes, Carole

  • Anonymous Says:

    Hi! I was supposed to have a 5-day transfer today but was told my embryos are not where they should be yet. They are having me come back tomorrow for a 6-day transfer. Is that common? Is implantation less likely with 6-day embryos? Thank you!

  • Carole Says:

    Hi Anonymous,
    Pregnancies happen with blastocysts that reached blast stage on either day 5 or day 6. There is some evidence that the pregnancy rate is higher when the embryos reach blast stage on day 5 http://www.ncbi.nlm.nih.gov/pubmed/11384637. In my experience in several labs, our day 6 pregnancy rate is less than day 5. But remember that reaching blastocyst stage is a milestone, whether it happens on day 5 or day 6 and pregnancies occur from embryos that reach this milestone on either day, so don’t give up. Wishing you much Good Luck!!! Carole

  • Anonymous Says:

    Thank you so much for taking the time to write!

  • hb Says:

    Hi! i must congratulate you for this very informative blog. my wife and I are TTC for the last 3 years now with no luck. she is youg (29 yrs) but has had high FSH (21) in the last 2 yrs and recently high LH (15) too. we have had one IUI without success and moved to an IVF cycle recently. since my wife’s LH was high, our doctor told us that he could not give stim meds as he would not be able to control the balance between fsh and lh and moved us on with a natural cycle. we were betting on the single egg that was to come and the doctor followed up with many u/s and finally a mature egg was retrieved which was then injected thru ICSI. the egg got fertilized and got us all excited – but on the the day of the transfer (day 3) we were called and told that the fertilized egg did not divide further. that really left us heartbroken and with emotions which are impossible to describe. could you please throw some light on why this happened? if the egg was mature and the sperm sample was OK – we thougth ICSI would give the doctors maximum control over the situation but that was not the case.

    would really appreciate your inputs.

    thanks,

    hb

  • Carole Says:

    Hi hb,
    I am so sorry to hear of the difficult time you are having. First, I would seek a second opinion from another RE. I am not an expert in stimulation protocols but i have worked with many REs who have gotten good results with various protocols for patients with various hormonal issues so I don’t think that a natural cycle is your only option. if there are any REs reading this, please weigh in with your expertise. A natural cycle for IVF is a long shot proposition because at every stage in IVF, there is a loss on viable eggs or embryos. My previous post discusses this in detail http://fertilitylabinsider.com/2011/02/egg-count-mathematics-why-the-numbers-change-between-retrieval-and-transfer/ The next thing you should know is that even with ICSI, you can have failed fertilization or failed embryo development because the only thing that ICSI ensures (when done properly) is that one sperm entered the egg. But getting into the egg is only the first step of many to call the egg fertilized. See this post for more information on fertilization http://fertilitylabinsider.com/2010/06/ivf-disasters-no-fertilization/ Fertilized eggs sometimes fail to divide for any number of reasons, both known and unknown. Another reason to start IVF with 10-12 eggs, not 1. I think the first step is getting a second medical opinion if you are planning on doing another IVF cycle. Good Luck!!! Carole

  • Rachel Says:

    Hi Carol,

    I am a bit confused! We had transfer of two embryos on day five on Monday. Our 5 embryos were very slow developing apparently and on day four we had an arrested 2 cell, two 5 cells, a 6 cell and a 7 cell. We were told that we may not get to transfer any. On Monday we were told that the 6 cell was showing signs of compaction as was one of the 5 cells! We were also told that there was still a chance of pregnancy in this situation but it was reduced as the embryos should have reached blastocysts by day five. I was just wondering how realistic a pregnancy from these embryos is. From what i can make out they are particularly slow and i cant seem to find anything about 5 or 6 cells starting to compact or what this might mean. Many thanks in advance

  • Leanne Says:

    Hi Carol,

    I had a 5 day tranfer of 2 embro’s yesterday and was told I had 1 early blastocysts stage and 1 Morula stage. I am 42 years of age and the is my 5th IVF cycle. What are the chance of these progessing or are they 2 slow.

    Regards
    Leanne

  • Carole Says:

    Hi Leanne,
    The embryo progression is fine, blast on day 5 is as expected. A morula on day 5 can still become a blastocyst on day 6 and blasts on day 6 do create pregnancies but at a somewhat lower rate than day 5 blasts. Your embryo progression is fine. Your main obstacle to becoming pregnant is most likely the increased risk of producing embryos with aneuploidy (an abnormal number of chromosomes). This increased risk is unfortunately a normal feature of aging that is unaffected by good health practices. Aneuploid embryos will go along fine for some time and look normal but then most will fail. Exceptions include trisomy 18 embryos (an extra chromosome 18 causing Downs Syndrome). At 42, the CDC reported pregnancy rate for women age 42 using their own eggs is “Pregnancy rate = 18.1%, Live birth rate=10.0%, Singleton live birth= 8.6%” http://www.cdc.gov/art/ART2009/sect2_fig6-15.htm#15 You didn’t mention using donor egg, but if you used donor egg from a younger women, your chance of pregnancy can more than double- essentially your predicted pregnancy rate is now the same as the age of the donor. Anyway, I sincerely hope this works for you but if it doesn’t, it may be time to reconsider other options for parenthood after 6 failed IVF cycles. Good Luck!!! Carole

  • Miela Says:

    Hi Caroline

    I am 36 years old. We have done 8 IVF’s. 5 Fresh ICSI/IMSI cycles and 3 FET’s. We have had beautiful blastocysts in the past, in one cycle even 6 extra to freeze.

    BUT, the last 3 cycles we have seen that on day 3 our embryos look great. They are 8-10 cells with little fragmentation. But then on day 5 they are still just morulas and only on day 6 some of them move to the blastocyst stage. So after day 3 something goes wrong.

    We have sperm morphology problems and with IMSI we had almost no fertilization while regular ICSI give us anything between 65-99% fertilization.

    We are using a really good lab. Do you have any ideas? Can it really just be bad sperm or might it be an egg problem. Or maybe a combination? What is the most likely reason for this pattern?

    Any ideas why we have such bad fertilization with IMSI? (We always have at least 15+ eggs)

    Thank you so much for your time.

  • Miela Says:

    Sorry, me again…I forgot to mention that we have had 3 pregnancies, but all ended in miscarriages. With the first 2 pregnancies we transferred 3AA blastocysts and with the last pregnancy we transferred a Morula on day 5.

  • Carole Says:

    Hi Miela,
    First, I wouldn’t do IMSI again if fertilization rate is so poor and regular ICSI gives you between 65-99% fertilization which is what we would expect. IMSI is a newer method based on the idea that by selecting sperm whose nucleus look normally shaped at high power (using a special microscpe at higher power than normal) results in better pregnancy rate. Because you had good fertilization with regular ICSI and no or very little fertilization with IMSI, it might be a technical issue with IMSI. If this is a brand new offering at the program, the techs might not all be proficient. Pregnancies also occur from embryos that get to blastocyst stage on day 6 instead of day 5, although usually the pregnancy rate is somewhat less for d6 blasts. Failure to progress is difficult to diagnose, could be sperm, could be egg, could be both. Could be the lab can’t grow embryos to day 5 consistently but that’s not the case if it’s a good lab. Heading over to you next question now. TBC, Carole

  • Carole Says:

    Dear Miela,
    Miscarriages suggest something is wrong with the embryos, perhaps aneupoloidy. Aneuploidy means that the embryo has the wrong number of chromosomes and this can arise in either the egg or the sperm before fertilization or arise spontaneously in the daughter cells of the developing embryo. It is expensive but it is possible to biopsy and test sample cells from the embryo at either day 3 or day5 to see if the cell is normal, which suggests the embryo is normal-at least in terms of total chromosome number. I don’t know if this option was discussed with you but you might ask your RE about this. If you are producing mostly aneuploid embryos, that could be one explanation for the miscarriages. You are a little young to be at the highest risk of aneuploidy, but risk increases with increased age after age 35.It’s a normal process of aging. You should discuss these concerns with your doctor. They are better able to provide you advice based on their understanding of your special circumstances. good Luck!! Carole

  • CM Says:

    Hi Carole,

    Thank you for such an informative blog. I’d be interested to hear your thoughts on my situation. I am 30 yrs. old and my husband is 31. My husband has a separated vas deferens and had TESE to remove sperm. Other than that, we did not realize we had fertility issues until starting IVF.

    Our first cycle, we had 11 of 14 eggs fertilize. Things looked great until day 3. By day 5, only 1 embryo made it to the blast stage. We transferred the blast and 1 morula, but it didn’t result in pregnancy.

    Our doctor explained that sperm quality can vary between vials and suggested we try the same protocol, but do a 3 day transfer for IVF 2.

    For our second IVF, we had 11 of 12 eggs fertilize. Had 3 8-cell embryos on day 3, 2 10-cell, a 7-cell, a 6-cell, and a few lesser quality. We were optimistic. Again, none of these made it to blast.

    I’m not sure if we should continue trying. It seems like our embryos just will not develop past day 3.

  • Carole Says:

    Hi CM,
    I am sorry you are having such a hard time. I guess the first thing to rule out is lab issues with day 5 culture so I would find out whether your clinic routinely cultures embryos out to day 5 and that this is successful for the vast majority of their patients. Having said that, there is a correlation with having very low sperm count due to congenital absence of the vas deference or obstructed vas deferens (more similar to your husband;s situation) with increased chromosomal abnormalities in sperm. Sperm chromosomal abnormalities in the embryo is one possible explanation for arrested embryos before they get to day 5. The good news is that some of your embryos made it to blast or nearly (morula) in IVF 1 so it’s not a case of 100% arrest. In IVF 2, the normally progressing were likely transferred so if only lesser quality embryos were left in culture, failure to reach blast is not too surprising. The bottom line is I really don’t know what to tell you. If you went to a program that offered microarray aneuploidy screening to look for chromosomal abnormalities (avoid FISH screening- it is not very accurate) you could do another cycle but test the embryos on day 5, then transfer back in a frozen embryo transfer cycle. However this plan does not guarantee that you will get pregnant (or even a transfer) and adds several thousands of dollars to the cost of IVF so this is not without considerable risk. It may be time to look at all your options and see if you have the stomach to continue down this IVF path which has not been very kind to you or try something else- donor sperm, embryo adoption, child adoption??? It’s a hard place to be but you are asking good questions. Good Luck!!!

  • CM Says:

    Thanks so much for your response! I really appreciate it. I should have mentioned that my husband’s separated vas deferens is actually due to Cystic Fibrosis. We’ve been told that the disease should not affect the sperm quality.

    The IVF facility we’ve gone to typically does 5 day transfers with blasts so I don’t think the lab is to blame (unfortunately).

    I was thinking it might be worthwhile to have the sperm tested so we know what we’re dealing with.

  • baby chick Says:

    I had a five day transfer with hatching blastocyst grade 1. I had pain on left side of ovary for two days then woke up and found very small amount of blood one wipe and pink tmi! Now have no symptoms at all on day four after transfer. I had icsi and four of my eight eggs fertilised all four made to blast three expanded (grade 2 and one grade 1) and one hatching. I am 37 with pcos and endimetriosis. Should I be having more symptoms than this? Thanx

  • Carole Says:

    HI CM,
    You could always have more tests done. Aneuploidy testing http://www.tdlpathology.com/services-divisions/tdl-andrology/sperm-aneuploidy
    http://www.andrologyjournal.org/cgi/content/full/29/2/124 Professional Guidelines for The clinical utility of sperm DNA integrity testing can be downloaded from ASRM here http://www.asrm.org/Guidelines/ The problem with all these sperm tests is that if your husband has a poor test result, it will suggest that you might do better with ICSI, which you are already doing, so I am not sure it is worth it to you to get a confirmation of that. Furthermore, these tests tell you that a percentage of all the sperm in a sample are bad but don’t give the tech a method to pick out “good” sperm for ICSI. They will still be mixed in with all the sperm. There are some pre-ICSI sperm selection methods (PICSI dishes, hyaluronate coated dishes commercial site info here http://art.biocoat.com/products.htm) that some labs are using. We used it in one of my labs and it seemed to be beneficial for some of our patients. If you are looking for more information in making a decision about using donor sperm, a really bad test result might lean you more in that direction. Anyway, more tests may not help you get pregnant unless you can use the info to adjust your treatment path or method.
    Best of Luck! Carole

  • Carole Says:

    Hi Baby Chick,
    I really can’t answer those questions because they are outside of my area. Your doctor and/or nursing staff should be able to talk to you about what symptoms their patients experience after transfer. Best of Luck!! Carole

  • Marie Says:

    Hi,

    Love your blog. It’s great!

    For the last 2 years, we’ve had a total of 5 transfers (2 fresh and 3 frozen), only one was successfully implanted but resulted in miscarriage. We currently have 15 day 3 embryos frozen. About to do another FET. Our question is, should we thaw the day 3 embryos and wait to day 5 (blast stage) before transferring or just transfer the day 3 embryos? From all we’ve read on the Internet, day 5 embryos seem to have better chance to implant. Btw, I’m 35 years old and we used donor eggs from a 23 years old. Thank you.

  • Carole Says:

    Dear Marie,
    Because your eggs came from a 23 year old, and assuming the clinic is good at freezing and thawing, you may very well have 3 embryos survive thaw and be availalbe for transfer which would probably be excessive. ASRM has issued guidelines for how many embryos to transfer. In patients under 35 (your category now that you are using eggs from a 23 yr old donor) with a good prognosis for pregnancy (if there are no other major issues affecting implantation), they recommend transferring one blastocyst or 1-2 cleavage stage embryos. You case is complicated by the fact that you have had a miscarriage before which tends to make physicians want to transfer more, assuming 1-2 might have issues. The main reason to grow embryos out in culture is to test them to see if they can continue to grow, assuming that the stronger embryos that are more likely to implant will make it to blastocyst stage. Extended culture is a method to transfer less better embryos rather than more of unknown progression ability. Because you have 15 embryos, you could do more transfers if you transfer 2 at a time, instead of three and also reduce your risk of triplets. If the previous miscarriage was due to egg factors, that is not the case anymore. If the previous miscarriage was due to a problem with the uterus, you probably don’t want to overload the uterus with three fetuses. Having said all this, your doctor has your entire history in hand and should be able to advise you best. Personally, I am happy never to see more than 2 transferred because twins can be managed in most people- triplets are much more problematic. Good Luck!! Carole

  • Anne Says:

    Hi,

    We retrieved 19 eggs. 16 have fertilized. On Day 2 the embryologist determined we would do a Day 5 transfer. They called me Day 3 with an embryo report. I thought I would get details regarding how many are still surviving, their grade, etc. However the nurse told me the embryologist does not provide grading for the embryos until the day of transfer (Day 5). The nurse mentioned something about it being detrimental to the embryos to have them out any longer than necessary; therefore they take them out long enough to determine whether or not things still look good for a Day 5 transfer, but not long enough to grade each embryo. MY QUESTION: is this a fairly typical practice? I guess I thought I’d be getting daily somewhat detailed reports as opposed to just a vague, “Everything still looks good for a Day 5 transfer.” I suspect I’m just being impatient and I tend to be thirsty for knowledge. It makes me feel like I have a modicum of control over a situation I know I really have no control over at this point. :)

  • Lola Says:

    Thank you for your feedback. I am worried about my recent second ICSI cycle. I produced 16 eggs but only 2 became embryos on day 3, 6 and 7 celled. In the first ICSI I produced 8 with 4 getting to 7 and 8 celled embryos by day 3, but did not have a positive result.
    My husband has very low sperm count but morphology seems to be ok. I am 33 and he is 45. I am wondering, how likely is it that the reason for the poor response is sperm? The RE just said they cant tell whether its sperm or egg quality issues. But I want to know in your experience is it more likely sperm or egg at that stage? I am worried about about the next cycle, we don’t want to use donor sperm. Was the fertilization rate acceptable in the first cycle?

  • Carole Says:

    Hi Anne,
    I would have to say that scoring embryos on day 3 is typically done very quickly. We have a 2 minute rule such that the embryos can only be out of the incubator for 2 minutes at most (1 minute is better) so the scoring that is done is never leisurely. If we are doing a longer procedure- such as ICSI or stripping cumulus cells, we use a HEPES buffered medium and warming surfaces to control pH and temperature. But HEPES buffer is not good for regular culture. We used to check embryos everyday but over the years, and as we gained confidence with the culture medium, we stopped checking so much. I think your clinic’s approach is very reasonable. You can look at an embryo in a second and see that it has about 8 cells and so good to go for day 5, but it might take a bit longer to count every cell exactly and consider the amount of fragmentation and uneveness that is reviewed to create a score. If that day 3 scoring info has no clinical use- why do it? It just exposes the embryos to less than ideal conditions. If it is not going to be used to make a clinical judgement, the only purpose of the day 3 score is for patient satisfaction- customer service- patients like to hear about their embryos. But in this case, you and the embryos are probably better off to just wait until day 5. With so many fertilized embryos and a “good to go” for day 5 assessment, I think you will likely be pleased with your day 5 report. Good Luck!!!Carole

  • Carole Says:

    Hi Lola,
    Maternal age is the biggest factor normally in determining IVF success so at 33 (under 35ya) this should be working in your favor. I would have expected better fertilization. You husband’s sperm quality may be part of the problem.

    Some links to papers/articles on maternal and paternal age and IVF success
    http://www.ncbi.nlm.nih.gov/pubmed/22082792
    http://www.ivf1.com/male-age-infertility/
    http://doctor.ndtv.com/storypage/ndtv/id/4794/type/news/Fathers_age_and_IVF_success.html

    The most pertinent paper is this one (http://www.ncbi.nlm.nih.gov/pubmed/22040161 “Poor sperm quality and advancing age are associated with increased sperm DNA damage in infertile men.Varshini J, Srinag BS, Kalthur G, Krishnamurthy H, Kumar P, Rao SB, Adiga SK.Andrologia. 2011 Nov 1. doi: 10.1111/j.1439-0272.2011.01243.x. [Epub ahead of print])
    which specifically talks about the effect of paternal age on poor embryo progression and failed or poor fertilization. The study showed that older men (over age 40) with poor sperm quality were more likely to have sperm DNA damage which could easily explain the poor fert and poor embryo progression you are seeing. Ask your doctor about doing a sperm DNA fragmentation test. Anyway- here is the abstract copied from PubMed. If his fragmentation is high, donor sperm should be considered. Good Luck! Carole

    “With increasing evidence for faulty paternal contribution to reproduction, there has been a steady increase in studies highlighting an association between sperm DNA damage, failed/delayed fertilisation and aberrant embryo development. Owing to prevailing ambiguity, the aims of the study were to analyse the genetic integrity of the male gamete and then to understand its association with age, standard semen parameters, lifestyle and occupational factors. The study included 504 subjects, attending university infertility clinic for fertility evaluation and treatment. Semen characteristics were analysed by standard criteria; terminal deoxynucelotidyl transferase-mediated nick end-labelling assay was employed for DNA damage assessment. The average incidence of sperm DNA damage in patients with normozoospermic semen parameters was <10%. Patients with oligozoospermia, severe oligozoospermia, oligoasthenoteratospermia, asthenoteratozoospermia and necrozoospermia had significantly higher level of sperm DNA damage (P < 0.001). Patients above 40 years of age had significantly high levels of DNA damage (P < 0.001) compared with their counterparts. Patients with varicocele and a history of alcohol consumption had higher incidence of spermatozoa with DNA damage (P < 0.01). Poor sperm characteristics in the ejaculate are associated with increased sperm DNA damage. Age-related increase in sperm DNA damage and association of the same with varicocele and alcohol consumption are also demonstrated."

  • Anne Says:

    Hi Carole,

    I just wanted to say a quick thank you for your incredibly prompt and informative response. I have great faith in my RE, and I believe his lab to be world class. That being said, your insight is very reassuring and makes me feel better. Again, thank you for your incredible site and dedication to answering our questions.

    Appreciatively Yours,
    Anne

  • CG Says:

    Hi Carole,
    Thank you for such a wonderful and informative post. I found your website today while trying to find out information to help understand what it means that my 2PNs (frozen) haven’t cleaved at ~27 hours post-thawing. I was told that they haven’t died but haven’t progressed and will be checked again tomorrow morning. Not sure if it’s reasonable to harbor at least a little bit of hope or if this is very bad news.

  • Carole Says:

    Hi CG,
    I tried to find some precise data on the expected range for hours post thaw before cleavage typically resumes. I was able to find data for fresh, not frozen zygotes. Generally speaking, it is about 24 hours from time of sperm entry but some researchers have reported a rather wide time range in non-frozen fresh zygotes from the time of sperm entry to first cell division which can be between 22 and over 30 hours. http://humrep.oxfordjournals.org/content/17/2/407.full
    http://humrep.oxfordjournals.org/content/13/6/1606.abstract?ijkey=b464981d6da75f4fedb0e0816ec78edb1f1992d0&keytype2=tf_ipsecsha and this paper Payne, D., Flaherty, S.P., Barry, M. and Matthews, C. (1997) Preliminary observations on polar body extrusion and pronuclear formation in human oocytes using time-lapse video cinematography. Hum. Reprod., 12, 532–541. So there is a larger range around 24 that is possible. Recovering from the thaw process may slow things down also. So although they are not on the early side of cleavage, they may still cleave. I think your lab gave you good advice. Wait until 48 hours have passed and then you can be sure. Hang in there. Good Luck! Carole

  • We’re Getting Pregnant On Sunday | daysofserenity Says:

    [...] can also read more about zygote/embryo/blastocyst development at http://fertilitylabinsider.com/2010/11/embryo-stages-progression/  I’ve just given you some of the basics.  There is soo much more.  I find it so very [...]

  • Cori Says:

    Hello Carole,
    I am 43 and just did a day 3 six cell ET on May 1. We only have one. Fertalized of three, and the Dr said it was of medium grade with some fragmantaion. I know it is an age factor, all other areas a fine. I am 6 days PT and wanted to know if you have seen any success with just one embryo and that being only a 6 cell on day three?
    Thanks for any insight.

  • Carole Says:

    Hi Cori,
    Yes, I have seen pregnancies with embryos with less than optimal grades. It’s too early to give up. Good Luck!!

  • Belated 2 year “Blogaversery” | Fertility Lab Insider Says:

    [...] Embryo stages, progression and pregnancy outcomes | Fertility Lab Insider [...]

  • Janie Says:

    Hi Carol
    I can’t tell you how interesting I have found your blog – I have been devouring the information over the last 24 hours. I think the medical profession really underestimate how much women are able to understand when it comes to IVF. At consultations I am often asked what I do for a living and when my reply states that it has nothing to do with the medical profession then I feel I am given a frustratingly brief answer to my questions. Your blog provides invaluable support to so many women going through this isolating journey and helps us by providing a clear, knowledgeable, sympathetic yet honest response.

    I am 38 years old and on my second cycle of IVF.At egg collection I had 6 eggs, 4 of these fertilised. By day 3 I was told that these were ‘textbook’ embryos of excellent quality and so the decision was made to push them to blastocyst. Yesterday (day 5) , 2 were early blastocysts (2cc) and 2 were still at morula stage. The 2 morulas have been left to grow to see whether they are good enough to freeze – hopefully I will hear more tomorrow. I am currently feeling extremely deflated because what it seems that the embryos haven’t gone on to do as well as expected. The embryologist said that it is extremely difficult to grade the embryos at this stage and was reluctant to tell me the grading as she said that the embryos change extremely quickly at this stage.

    I have read both the ‘embryo stages…’ and ‘Understanding the Gardner…’ blogs and found these really useful. What I can’t quite understand is whether a 2cc blastocyst can then become say a 4aa etc? Or is this early low grade indiciative of how the blastocyst will develop? Or is it really just impossible to tell? At the moment I feel as though I’m bracing myself for another failure.

    Many thanks
    Janie

  • Carole Says:

    Hi Janie,
    Don’t give up hope yet. Although you didn’t say it explicitly, it sounds from your comment, that your clinic probably transferred the two blasts (grade 2CC) to you on day 5. The designation 2 means that there was a fluid filled cavity but the cc means the cells were sparse in both the inner cell mass and the trophectoderm, so these are some hours behind what we have come to expect as ideal for day 5. However, that doesn’t mean that they won’t continue to develop inside your uterus. They have several days to catch up and still implant in a receptive uterus so don’t give up on them yet. Prediction of pregnancy success from appearance of the embryos is at best a very inexact science and we are often surprised by embryos who apparently haven’t read our text books!! :) Good Luck!! Carole

  • Janie Says:

    Hi Carole – many thanks for your reply. Yes, you’re correct it was the two grade 2cc blasts that were transferred. I just heard that the morulas didn’t make it so I guess that makes me all the more nervous that the blasts that were transferred were also on their ‘way out’. Guess we just have to tough it out now for two weeks.
    Thanks again for your reply.

  • Dannielle Says:

    Hi Carole,
    I am currently undergoing my second IVF attempt…first was one year ago when I was 36. 29 eggs were retrieved with 21 being fertilized. The day of our transfer we received a call from the RE advising us not to come in as only two of the embryos were looking viable for transfer but they wanted to wait one more day. We had a transfer of one on day 6 which resulted in a BFN. The eggs had arrested development and fragmentation which I believe started around day 3. This cycle he did not do lupron, lowered my gonal f dose and added ganirellex and omnitrope to hopefully boost the quality of the egss. 17 were retreived with 15 mature and 11 fertilzed. My RE called today with an update…said things are looking “good”. Some are showing signs of fragmentation and some are not. Once I heard fragmentation I started freaking out and am worried I did not ask the proper questions. First of all should I be concerned? I assume that even under the most normal cirmcumstances embryos will fragment and not make it to the transfer stage. Should I be calling back and asking for more specific information? Any insight would be greatly appreciated!
    Dannielle

  • Carole Says:

    Hi Dannielle,
    Some fragmentation is not that unusual and does not mean that you will not get pregnant this cycle. When fragmentation gets to be 25% or greater, it starts to be more worrisome. Even then, it is not necessarily the kiss of death. I have told this story elsewhere on the blog but one of my first IVF pregnancies was with embryos that were so badly fragmented, I couldn’t with confidence say they were even alive- yet they resulted in the birth of a beautiful baby girl. That same week, we transferred 3 beautiful textbook perfect looking 8 cell embryos —and no pregnancy. The second patient was in her forties. The first patient was younger. So, the bottom line is, don’t freak out. Some fragmentation does not rule out implantation and pregnancy. Hang in there. Sending you some positive thoughts!! Carole

  • Sheena Says:

    Hi Carol,
    I am 39 and we have had 2 fresh icsi cycles and 2 fet. One gorgeous boy and one miscarriage from those cycles. On wednesday we transferred one blastocyst grade 5bc, which had started hatching and a compacting morula. The icm and te were only grade b and c, so I wonder how good the blastocyst actually was. How much do you think that will impact the viability of the blastocyst?
    Thanks
    Sheen

  • Carole Says:

    Hi Sheena,
    Grading systems describe a snapshot of development at a specific time. They are somewhat useful but are far from 100% predictive. The fact that the embryos were a compacting morula and a hatching blastocyst means they have already passed several developmental milestones. At this point, with your history of one successful pregnancy, be optimistic. Good Luck!! Carole

  • Anonymous Says:

    Hello carole
    I have just completed an egg sharing cycle where 10 eggs were retrieved so 5 for me.

    After the most stressful week of my life I amazingly have one precious little two day embryo on board… we had only two eggs mature so we were very lucky the 2 day embryo is a three cell slightly asymmetrical, two cells are slightly bigger than the third, no fragmentation but embryologist said it was good quality I am worrying if my little embie has continued dividing as I know blasts are generally more successful dont get me wrong I am so lucky to have this little miracle and a chance but do I have a good chance? I love this little embie already so much I am trying to stay positive and relaxed. Im worried about the slight assymetry? and the fact its 3 cell? thanks so much, I keep googling sending myself crazy ha ha

  • Carole Says:

    Dear Anonymous,
    Please don’t drive yourself crazy. There is little difference between a 3 and a 4 cell embryo on day 2- both are okay; the developmental change between 3-4 cells can happen in a few hours. Just take it one day at a time. Your embryo has already met several milestones. Be hopeful and happy for that. Wishing you much good luck!! Carole

  • Anonymous Says:

    Hello again Carole,
    You were kind enough to answer my question regarding my day 3 update from my RE last week and that some of the embryos were showing signs of fragmentation. Sadly we receieved a call the day of the transfer that only two had continued to grow. We live 45 minutes from the clinic and were literally pulling into the parking lot when we got the call. We went in to meet with our doctor and it was his recommendation that we wait one more day to determine if there would be a transfer. This answer did not sit well with my husband and I as something in our gut told us to go for the transfer right away. They stressed over and over that these had not made it to the blast stage yet and we were taking a chance that these would end up to not be viable. We were okay with this and decided with the transfer. My last IVF cycle we had a transfer of one that had continued to show signs of growth from day 5 to 6. When I compared the photos they gave us from last cycle vs. this cycle of what was transferred the images were drastically different. The photo from last cycle showed what appeared to be the likeness of a day 3 embryo where the photos of this transfer the embryos (in my very NON medical opinion) showed much more compaction and appear to be more at the morula stage. So…I guess the long and short of my question is are the photos shown explaining the gardner grading system really a good comparison or can things vary so much that I should not be using this as a guide to what my little guys looked like? Also in your opinion do you think we did the right thing by transferring on day 5 rather than waiting until day 6 or rather have you seen cases similar to this?

  • Carole Says:

    Hi Anonymous,
    I appreciated your question about fragmentation so much that I used it as a basis for my most recent blog post. http://fertilitylabinsider.com/2012/05/q-from-u-embryo-fragmentation/

    Regarding the transfer: yes, I think you did the right thing because you said the IVF staff conveyed their concerns and you understood that there was a chance that they could not be viable and you still wanted to proceed. That is the basis of informed consent and while there is always a chance that the embryos may prove not to be viable, if they look like morula’s on day 5, I would still give them the benefit of the doubt. As I have said many times before, using morphology or exact developmental time tables will give you good predictive value much of the time but embryos consistently manage to surprise us. So be happy about the transfer. I am wishing you much good luck!!! Carole

  • julie Says:

    First off, thank you so much for doing thus blog! This is such a new venture, we are minimally informed and rely a lot on Google elp us understand. Ivf is all about hope, so its hard not to remain positive, more information helps make being positive easier.

    My question is about day 3 versus day 5 transfer. I am 37 and I had fibroids ( myomectomy , open , to preserve chances of fertility at 35). Started ivf at 36, 1 round fresh (2 transferred day 5), 2 Fet – nothing. Second round, different doctor. Noted some fluid in my uterus from first round scans, so he sucked fluid out before day 5 transfer. Chemical pregnancy. I did another hsp which showed blocked tubes, so I had both tubes removed. Transferred 2 Fet, no dice. This clinic is rated the ‘best’ in the dc metro area, and they boast high success rates.

    Third round, no fluid, no tubes, I am all in for ivf. 9 eggs retrieved, 7 mature, 5 fertilized. Day 3, doctor recommended day 5 transfer b/ c j had 2 8 cell, 1 7 cell, 1 5 cell. I tried a day 5 transfer of 4 blastocysts in
    2 Seperate occasions, so this time, I decided to ask for day 3 transfer. I was transfered 4 days ago, my 2 number 8s. The number 7 cell made it to blasts but was slow growing so did not make frezing quality. Number 5 cell just died off.

    You have stated what most of us understand – day 5 is better selection b?c survival of the fittest, and the best are chosen. You also stated that day 5 has better birth rates than day 6.

    My questions are:
    1) any idea on births between day 3 and day 5 transfer? You mentioned that the ‘extra’ embies grown in culture serve as good comparisons to what your transferred embies are doing, but the transferred usually are the best of the bunch. Any studies on comparing same stage embies, culture to late blastocysts versus birth rates? Ie. Who REALLY grows it better, a great lab, or my uterus? I tried a great lab twice, I decided to try my uterus this time!
    2) we are familiar with the blast stage, we all want that stage to be reached, but what is the furthest stage (and or # of cells) that embryologists have grown embies to that can still be viable for birth? Can someone, somewhere grow to, say for example day 10, and have an even higher success rate?

    Your feedback is invaluable to a desperate hopeful Mom to be . Thank you so much for your time.

    Julie

  • Janie Says:

    Hi Carole
    I emailed a week ago because I had concerns about 2x2cc 5 day blasts that were transferred. I just thought I would update you that I had a BFP but sadly I have since had heavy bleeding so I believe this is what is called a chemical pregnancy. I have lots of worries about why this may have happened but I know you can’t answer these questions. I guess from an embryo point of view it’s probably not that surprising and they just ran out of steam. Does this seem a fair comment?
    Many thanks – your website is invaluable for women going through a time of very high stress.
    Janie

  • Carole Says:

    Hi Julie,
    I am glad you’ve found the blog useful. Your questions and my answers (in italics) below:
    1) any idea on births between day 3 and day 5 transfer? Implantation rate and therefore pregnancy rates tend to be greater when day 5 embryos are transferred. THis is probably due to the “weeding out” of non-progressing embryos You mentioned that the ‘extra’ embies grown in culture serve as good comparisons to what your transferred embies are doing, but the transferred usually are the best of the bunch. Any studies on comparing same stage embies, culture to late blastocysts versus birth rates? Ie. Who REALLY grows it better, a great lab, or my uterus? I tried a great lab twice, I decided to try my uterus this time! There are selection pressures to sort out embryos which may count as a benefit from culture in the lab (see previous) , but there is no evidence that lab culture is superior to growth in your uterus and obviously, without your uterus, there is no pregnancy.
    2) we are familiar with the blast stage, we all want that stage to be reached, but what is the furthest stage (and or # of cells) that embryologists have grown embies to that can still be viable for birth? Can someone, somewhere grow to, say for example day 10, and have an even higher success rate? Currently, embryos are not cultured past day 5 or 6 if they are to be transferred to the uterus. I don’t know of any one who will transfer a day 7 embryo. The embryo in culture past day 6 is looking for a place to implant and a tissue culture dish doesn’t offer that kind of environment (not 3D, not proper growth hormones; no interaction with uterine cells etc.) Now if you want to grow embryonic stem cells, then you can grow the cells longer in a tissue culture dish, but it is no longer a implantable embryo and is disaggregated at some point. Hope that answers your question. Wishing you much good luck with this latest round! Carole

  • Carole Says:

    Hi Janie,
    Unless your clinic has confirmed that the beta has reduced to background levels, I wouldn’t use bleeding alone as a guarantee that the pregnancy is gone. Heavy bleeding is not good but some bleeding can be compatible with pregnancy. Please follow-up with your clinic. Even if the result is negative, most docs like to follow the beta back down to make sure that there is no ectopic pregnancy. It is usually not possible to diagnose why a pregnancy fails. There are unfortunately, many possibilities. If that is indeed what has happened, I am so sorry for your loss. Best Wishes, Carole.

  • Cathy Says:

    Hi Carole

    I know this is a question I should ask my clinic but I saw your blog and it prompted me. I have never tried to get pregnant before but appear to have no issues other than age. I am just 43 and on my 2nd ICSI cycle. The first provided 8 eggs, 7 or which fertilised and divided. I had a 5 day ET of 1 Blasto & 1 Morula which resulted in a BFP but ‘miscarriage’ 1 week after the Positive. Nothing was frozen of the remaining embryos. The 2nd cycle progressed exactly the same but with 10 eggs collected resulting in 9 fertilising and dividing and again 5d trfr of 1 Blasto & 1 Morula but again nothing to freeze. Should I be worried that I haven’t been able to freeze any embryo’s or is it just a reality of my age or possibly something else ? Thanks.

  • Julie Says:

    Hi Carole,

    Thank you so much for providing this information and answering so many questions!

    My question is about the timing of a day 5 transfer. You mention above that “Normal embryos have a fairly strict rate of progression which starts at the time of fertilization.” You also mentioned that late morulas are just a few hours away from early blastocysts. If my eggs were retrieved in the morning, but then weren’t ICSI’d until mid afternoon, should we ideally be looking for the embryos to be expanded blasts by that same time of day in the afternoon on day 5, or should they have gotten there by early in the morning on day 5?

    I ask because my transfer just got moved from later in the day to 10:00am due to scheduling, and I’m wondering how that would affect what we should ideally hope to see. During my last IVF cycle which unfortunately resulted in a m/c, we were able to transfer a 5AA, a 2BA, and a 1BB, but our transfer wasn’t until 4pm in the afternoon on day 5. When I look at the embryology report, when the embryos were checked in the morning at 9am, the one that became the 5AA had been a 2BA in the morning, and the other two were noted as c/2, which I think is compacting 2 (there was another one on there marked as a c/1that we did not transfer, which I’m guessing is an earlier morula?). The time noted for ICSI on the sheet was 3:20pm on day 0.

    So I see how quickly things can change, but this time we’re not going to have the benefit of the extra hours to wait to the afternoon. Ideally should we still hope to see full blasts in the morning or would morulas be considered still reasonably on schedule in the morning?

    I am 40 and only have 3 fertilized embryos this cycle, so we are planning on transferring as many of them as possible if any of them are still even growing on day 5, so I don’t think my RE will push us to day 6, since we won’t be trying to choose the best out of many.

    Thank you again so much for answering our questions!

    Julie

  • Carole Says:

    Hi Cathy,
    Even in younger women, it is common to see an attrition of embryos in culture. See my earlier post http://fertilitylabinsider.com/2011/02/egg-count-mathematics-why-the-numbers-change-between-retrieval-and-transfer/ And yes, unfortunately, as you age past 35, the probability that more of your eggs are aneuploid (chromosomally abnormal in number) increases, so observing that some of these embryos are not be able to progress is not unexpected. I am not surprised that you were unable to freeze any embryos, again due to natural attrition and increased aneuploidy rate with advanced maternal age. Having excess embryos to freeze would be highly unusual at age 43. This blog post on aneuploidy and microarray testing may be of interest http://fertilitylabinsider.com/2011/01/what-is-aneuploidy/ Good Luck! Carole

  • Carole Says:

    Hi Julie,
    If the ICSI occurs later in the day, then the Fertilization “start time” will be later, so any milestones will be later. We see this often when we do a “rescue” ICSI on unfertilized eggs the next AM after fert check. Any eggs that fertilize from the rescue ICSI will naturally be a half day or so behind their companions (if any) that fertilized from the original ICSI. But although the timing of your transfer may affect when your embryologist looks at your embryo report, it is just a snapshot in time and although your embryo report may not be as “advanced” as you like, as long as there are sufficient normally progressing embryos (1-2) to transfer on day 5, your score will not affect whether you get pregnant or not. As you noted, a 2BA in the morning can be a 5AA in the afternoon. If the 2BA had been transferred to you in the morning, you would still have had a 5AA in you in the afternoon, you just would have been blissfully unaware of the score. The score is a useful tool for embryologists to select the most advanced embryos from a cohort but it is not very useful as a pregnancy predictor because unless the embryo dies, it will push through those milestones whether anyone is watching or not. You will get no benefit from “the extra hours in the afternoon” unless your embryos are indistinquishable in stage (need more selective pressure from time in culture) or haven’t met the minimum milestones for that time in culture (suggesting they are non-viable). Otherwise, nature will take care of itself. Please try not to fixate on scores. See my answer to Cathy and links to previous posts regarding aneuploidy. Good Luck!! Carole

  • Sam Says:

    Hi I had day5 blasto done last Sunday today 28/5/12 is day 7 for me I did a test and it was a bfn! Is it to early to test or has it just. Not worked?? I am getting allot of cramping in my lower tommy and my period Is 6 days late. Can some one please help me…..

  • Carole Says:

    Hello,
    Here’s a link that should be reassuring. http://www.nyufertilitycenter.org/ivf/embryo_transfer Based on this calendar, day 9 is the earliest you could expect a blood test to be positive and home pregnancy tests tend to be less sensitive. It is too early to assume that you are not pregnant but you should make the clinic aware of your symptoms. Good Luck!!

  • Sam Says:

    Thank you so much I feel allot better xxx Sam

  • Sam Says:

    Hi carole,

    Today is day 10 after blastocyst I had a 5. Day blasto done again I tested today and it was a bfn tomorrow is my testing day but as it was bfn today what is the chance of that changing over night.

    I’ve had period like pains over the last 4days and been taki g paracetamols that’s not helping this is our first icsi and I feel it’s not worked. Can you help???

  • Carole Says:

    Dear Sam,
    Unfortunately, I don’t know what I can do to help except encourage you to keep in touch with your doctor regarding your symptoms and wish you good luck for your official test. I agree that the signs are not good but the official blood test is the one that will be definitive. Good Luck. Carole

  • Sammy Says:

    Hi carole,

    I had a day 5 blasto done and today is day 10 after egg transfer. I did a test this. Morning and it was a bfn. My test day is tomorrow so can this change I doubt it. I am disappointed and it ws bfn today.but can this change over night.

    I am also getting period like pains in my lower belly getting worse dy by day been told to take paracetamols so its helping a little

    But main concern is has it worked if its bfn today????

  • Val Says:

    Hi Cathy,

    I am 33, and my DH is 37. We just had an IVF cycle in which 14 mature follicles were retrieved, 10 fertilized, and 7 made it to blast stage (day5: three 5AB, two 5BB; day6: two 5BB). We were so happy to hear that, but then the news came in: only 1 day 6 5BB embyos was normal, as well as 2 were no-result (day 5 5AB and 5BB). We are at a clinic that has a high success rate for FET. How likely is it that no result embryo is normal? Should we do FET with our 1 normal blast and 1 unknown or retest our 2 unknown blasts? How typical is it to only have 1 normal out of these number of blasts? If we fail this cycle, can the next IVF produce more nomal embyos or should we look at other options (egg donor, adoption)?

    Thank you,

    Val

  • Carole Says:

    Dear Val,
    These are all good questions you should ask your RE and your genetic counselor. Sorry, but I am not qualified to answer these questions. Good Luck! Carole

  • Kim Says:

    Hi Carole,

    Is it ok to freeze by vitrification at the 2pn stage after performing ICSI? I am 40+ so worry a little that the removal of the zona cells to perfom ICSI will impact survival of the vitrified 2pn?

    Thanks, Kim

  • Carole Says:

    Hi Kim,
    In my experience, if the lab is proficient at vitrification, excellent results can be obtained at any embryonic stage, including 2PN. When ICSI is performed, the granulosa cells (the cloud of follicular cells surrounding the zona shell) are removed. The zona itself, which is a carbohydrate rich shell is NOT removed for ICSI. Removal of granulosa cells should not affect the vitrification procedure and may be helpful, in some cases. Best Wishes, Carole.

  • Linzie Says:

    Hi Carole –

    I am 32 years old and have high FSH (17 and 20 on the last two tests) / only about 7 visible andral follicles on both ovaries. My husband also has male fertility factor issues (2% morphology on last reading and has had motility issues on past samples too). We just underwent our first IVF cycle which resulted in the retrieval of 4 eggs (we only had 3 visible follicles over 14 cm on the sonogram – 20, 19 and 17 cm on last scan before retrieval). Only 2 eggs were mature, and both fertilized normally via ICSI and made it to day 3 – a 9 cell (no fragmentation) and a 6 cell (5% fragmentation). We were so excited given all the speeches the clinics had given about how bad it was expected my eggs to be… We were advised to wait until a day 5 transfer (not sure 100% why). The doctor said it would give them “more information”. He sounded optimistic and so we took this advise. This AM was supposed to be the 5 day transfer, but the clinic called to tell us that the embryos “aren’t ready” – one is in the morula stage and the other 6 cell only grew to 7 cells. They said they would wait another day to see if the morula forms a blast tomorrow and if it does they will freeze it(though I’m not particularly optimistic since the embryo was slightly “ahead” of schedule at 9 cells on day three). My question is this – when the clinic says this outcome will provide “information” – is arrested development at the Day 3-4 stage a clear indication of poor egg quality due to DOR? We’re so disappointed as we thought the point that both mature eggs proceeded to cleavage stage with minimal / no fragmentation was a good sign that my issue is a quantity, but not necessarily “quality” issue.

    Also, our only other attempt using fertility meds was a clomid cycle IUI using a different doctor. That doctor said there were 3 large follicles brought up on the sonogram (he didn’t say the size). So how is it possible that 5 measly clomid pills could have yielded the same result as 375 ml Gonal F / 150 ml Monopur IVF protocol? Would a mini-IVF cycle make more sense for us as perhaps the extra stims didn’t helping much beyond a point? What would you recommend? Thank You in Advance for your help!

  • Carole Says:

    Dear Linzie,
    I understand your frustration with your current cycle. I would not worry about a 9 cell on day 3 being too fast; that is normal variability for embryo progression. Sometimes a large fragment can be graded as a cell too so, again, don’t fret about the cell number. Regarding arrested development; the two large categories that explain arrested development are problems within the embryo (usually genetic) which don’t support normal cell division or problems in the culture system which don’t support continued growth. If one embryo proceeds and the other doesn’t, the first option is more likely. High FSH does affect egg quality. This link to more information about FSH and poor egg quality in both older and younger women like you may help you have a better conversation with your doctor regarding your questions http://www.drmalpani.com/highFSH.htm

    The rest of your questions are outside of my expertise as an embryologist and are better answered by a reproductive endocrinologist. Typically, when a cycle does not result in a pregnancy or in your case, at best a freeze without transfer, you can expect to have a follow-up appointment with your RE to discuss in detail the previous cycle and what can be done differently for further treatment. It is important that you feel that you have had your questions answered in a manner that lets you effectively understand your treatment and enables you to make good decisions going forward. If you aren’t getting that, you might consider another RE for a second opinion.
    Good Luck!!
    Carole

  • Linzie Says:

    Thank you, Carole. Our embryo made it to blast today, but it was only a Grade 1 CC so it could not be frozen and we were told that day 6 is too late to do transfers. The RE said the lining is usually too thin? I know Grade 1/CC isn’t as likely to implant as higher grade blasts, but we are still really kicking ourselves now for not doing a day 3 transfer…In your experience, does poor egg quality typically first present itself this way in the morula phase? This is all so confusing. Thank you!

  • Carole Says:

    Hi Linzie,
    I am sorry that this cycle didn’t work out. I think your RE should be better-positioned to answer these questions for you at your follow-up meeting. Yes, poor egg quality can reveal itself by poor progression, but poor culture conditions (or poor sperm quality) can also effect embryo viability and ability to progress. Be sure to ask your doctor all these questions, including what he/she would suggest be done differently in a next cycle. It is never a bad idea to get a second opinion as well. Good Luck!! Carole

  • Naomi Says:

    Hi Carole,

    Thank you for a highly informative blog.
    We are going through our first IVF cycle (ICSI) and have just had our day 5 blastocyst transfer. I am 31 and have no known fertlity issues. My husband’s sperm count was borderline normal hence ICSI.

    I have two questions if that is ok.

    Firstly, 17 eggs were retrieved of which 14 fertlised and 12 were still alive by day 5. However, of these, none were suitable for freezing by day 6 and only two were considered ok to transfer. The two that were transferred back into me were ‘below average’ in terms of grading. My first question is, is there a reason that despite the high number of retrieved and fertlised eggs and most of them reaching day 5 we didn’t get any higher grade blastocysts?
    If this isn’t successful is there anything we should ask the clinic or be asking in the future?

    My second query relates to the likelihood of pregancy from the two transferred blastocysts. Our blastocysts were 3CB and 4CC. I know that blastocysts can improve but are you able to able to give a ‘best guess’ liklihood percentage of pregnancy?

    Thank you very much in advance,
    Naomi

  • Carole Says:

    Hi Naomi,
    A previous post of mine, “Egg count mathematics:why the numbers change between retrieval and transfer”, should answer your question regarding the very common attrition rate that you observed. Our ability to determine sperm and egg quality is very crude. Both sperm and egg can have intrinsic genetic problems (eg. aneuploidy or an incorrect number of chromosomes) which can cause the embryo to fail to progress. Aneuploidy can also arise spontaneously as the cells divide. So unfortunately, even with no obvious female issues and a borderline normal count, there is still plenty of opportunity for things to go wrong. There are also lab conditions to consider. If the lab is not very good at growing embryos to blast stage, you can also get poor development in vitro. If this does not work, you should ask your doctor to discuss what he/she thinks contributed to the low efficiency and what suggestions they have for a different approach next time. If the answers you receive are not useful to you, you can always get a second opinion.

    But here is the important point. You may still become pregnant this cycle, so it is too soon to give up on your embryos. Grading is subjective and can only show you a snapshot of time so I wouldn’t be overly concerned about grade. I can not give you a meaningful guess at your chances of pregnancy. Your youth is on your side and grading as a pregnancy predictor has fooled many an embryologist. Good Luck! Carole

  • Naomi Says:

    Thank you so much for replying so quickly Carole, it is massively appreciated. We will take your advice! Thank you so much again

  • Janey2011 Says:

    Hiya Carole,

    Thank you so much for taking the time to answer all our questions.

    I’v had 2 cycles of ivf with ICSI, both times 7 eggs collected and 6 injected. The following day all had fertilised but each cycle 6 out of the 7 embryo’s had black spots in so were unusable. Embryologist said this is rare but can happen . So only one embryo transfered each time.. After first cycle it was negative, but second cycle resulted in a pregnancy. After a rough start my daughter is now 6months old.

    Have you come accross the black spots/areas in fertilised embryo’s ? Do u know what could be the cause, and what does it mean?

    Thanks so much

    Janey2011

  • Carole Says:

    Hi Janey,
    I am not sure exactly what you mean by black spots in embryos. Dark areas in embryos usually mean that the cells are dead. For instance, in the bad old days of slow freezing, we expected to see some cells in the embryo looking dark, having not survived the freeze/thaw process. Since you say “fertilized embryos” , maybe you meant fertilized eggs. Eggs can have dark areas as well. Here is a link to an older paper which found good pregnancy outcomes even in eggs with abnormalities including dark spots humrep.oxfordjournals.org/content/11/3/595.full.pdf . This previous post http://fertilitylabinsider.com/2012/01/egg-vacuoles-in-ivf/, may be helpful. Although primarily about vacuoles, it does mention other types of egg abnormalities that can reduce the fertilization rate or viability of eggs and there is a link to a paper which talks about these kinds of egg abnormalities. But I am just guessing about what they might have seen. Your clinic should be better positioned to answer these questions specific to your case. When have they seen these type of dark spots before? What do they mean? Can the stimulation be adjusted to help prevent their occurrence? Anyway, congratulations on having a six month old! Best Wishes, Carole

  • janey2011 Says:

    Thanks for your reply Carole,

    I did mean fertilised egg, sorry it was all very confusing at the time. They did say if I was to have another treatment cycle then I would be better off using doner eggs, so possibly the eggs showing abnormalities. Thank you so much for your reply

    Xxx

  • Janey2011 Says:

    Thank you so much for your reply,

    I did mean fertilised egg I think, it was all so confusing at the time. They did say if I was to have another treatment cycle then I would be better off using doner eggs, so maybe most of my eggs showing abnormalities.

    Thank you again

    Janey xxx

  • Julianagrace Says:

    Hello Carole,

    I found this website and it is the best one I have ever found :-)!!! you are so thorough in all your answers!!!!! Thank you in advance!!!!

    I am 40 and I have done 5 IVF cycles and all failed. I just recently did a donor cycle with a 24 years old donor. She produced 20 eggs and 17 were matured and 6 of them made to blastocyst. I transferred 3 and the fertilized normal just like the picture on your website (2 rings inside the egg). I transferred on Wednesday 06/06/2012 and I have minor crams here and there and I am really worry. Are these symptoms sign of impending period???? my lining was above 9 even a week before transferred ( I assumed the lining was greater than 10 on the day of transfer)….I did not have the 3 line in my uterus. PLEASE help ease my mind. My blood pregnancy test will on Monday 06/18 and the wait is killing me :-(….Thank you a bunch Carole!!!!!!!

  • Carole Says:

    Dear Juliana Grace,
    Don’t panic. Some women report experiencing cramping at the time of implantation so your symptoms are not necessarily cause for worry. But, as always, you should ask these questions of your clinic staff because they know your entire history and can best advise you regarding your medical concerns. Good Luck!! Carole

  • Juliana Grace Says:

    Thank you so very much Carole!!!! I couldn’t help myself..so I did a HPT last night 6.5 days after 5 days transfer and it was a big NEGATIVE :-( I have a friend and she did the same 6 days after 5 days transfer and got a positive. She has twins girl. Does this mean it’s over for me? I am so sorry to bug you!!!! Thank your bunch for your expertise!!! God bless you!!!! For all that you do!!!!

  • Carole Says:

    Hi Juliana Grace,
    You can have a false positive or a false negative result if you test too soon. I know it is hard to wait but the timing of the test is to get you past the window of false results. I don’t know how it will turn out for you but I am wishing you lots of good vibes and good luck. Hang in there. Carole

  • Cherry Says:

    Thank you so much for your blog. Very informative. I am 37 years old with no know fertility issues (other than age) using donor sperm. My first IVF a few months ago, I responded very well to low dose stim producing 13 mature eggs. However, 7 of the 13 fertilized as 3PN – we did iCIS on all of them. We transfered 3 day 3 embroyos. There was nothing to freeze and I miscarried at 8 weeks. The lab is very reputable. I just completed my second IVF (using a different donor). I was on the same protocol but lower doses. This time I produced 14 eggs (I fracture and one abnormal). Out of the 12, 6 fertlized (we tried to do IVF on 4 and only 1 fertlized and arrested very soon). We had 5 good quality embryos by day 3 and pushed to day 5. On day 5, I only had 3 morulas, a grade 1, 2 and 3. We transfered the 1 and 2 and am in my 2ww. The third morula turned into a high quality blast (5AB) by day 6 and was frozen (wish it was frozen!). My question is any reason for the abnormally high number of 3PN during my first cycle? The dr only explanation is that maybe my eggs were overmature or my E2 was too high. Also, give that none of my embroys made it to blast by day 5, my dr thinks I may have an egg quality issue (we used a very proven donor). Is this any egg quality issue? Thank you so much.

  • Gina Says:

    Thank you for this VERY informative website. We just finished our first cycle of IVF (now enduring the long wait to see if it was successful). I am 27 and our infertility was unexplained. We had seven eggs retrieved and all looked great up to day 3. When we arrived at the office for a day 5 transfer we only had one that had matured to a blastocyst. He mentioned that this was a much lower number than expected and was probably due to genetic abnormalities. From your experience, would this be more of an egg or sperm issue (all of our previous tests came back normal), or something else? What follow up questions would your recommend we ask our doctor? Thanks!

  • Carole Says:

    Dear Cherry,
    Regarding the abnormally high number of 3PNs after ICSI: The condition of having 3PN (3 pronuclei) at fertilization is abnormal. There should be 2, one from mom and one from dad. The extra nuclear body can arise from an extra sperm or the failure of the egg to extrude it’s extra nuclei via the second polar body. We can rule out an extra sperm because if ICSI is performed properly, only one sperm is inserted per egg. The other possibility (failure to extrude) does point to an egg problem. Which (my guess) is why for your second cycle, your doc adjusted your stim (to avoid overly high E2 levels) as well a suggested a different donor. A less than optimal stim does affect egg quality and failure to fertilize or failure to extrude a second polar body may be seen with poor egg quality. Unfortunately, the first IVF can often be suboptimal because it is impossible to predict how an individual patient will do with a stim protocol. One size does not fit all. Poor embryo progression can also be due to either (or both) egg or sperm quality. It is encouraging that your morula in culture did turn into a blast, although it was a little slower than optimal. D6 blasts are somewhat less likely to result in pregnancy than day 5 blasts, but both can produce a pregnancy. Good Luck!! Carole

  • Carole Says:

    Hi Gina,
    First, don’t give up on this cycle yet. You may still be pregnant.

    Failure to progress in culture can be due to many factors. Aneuploidy (an incorrect number of chromosomes) in the embryo is one common reason. Since both sperm and egg contribute to the embryo, either can be the source of abnormal chromosome numbers, and aneuploidy can also arise spontaneously in the embryonic cell lines after cell division. Semen analysis does not give you information on the “per sperm” level, just the overall population so diagnostic tests are not usually very useful to figure out if the sperm that “made it” into the egg was normal or not. Diagnostic tests about ovarian reserve also do not tell you anything about specific eggs. SO even though “all tests came back normal” that is more useful for suggesting a treatment plan than for diagnosing failure to progress in a specific embryo.

    Poor culture conditions are another reason for failure to progress. Hopefully, your physician will not be offended if you ask about this. If they are good, they will have thought about this too and will be able to tell you that other patients exposed to the same media, incubator etc did as expected. If day 5 culture is new for them, and they are using sequential culture systems which require a media change on day 3, it is possible to do this incorrectly (use wrong media or do not rinse off old media sufficiently) but this mistake is easily avoided with adequate training so that is probably not likely. But as always, if your doc gets overly defensive and doesn’t answer your questions to your satisfaction, you always have the option of getting a second opinion. Hopefully, none of this will be necessary. Good Luck!!

  • cherry Says:

    Wow Carole, thank you so much for your quick response. I have one further question if that is ok. Any idea how many day 5 morula turn into blasts?

  • Carole Says:

    Hi Cherry,
    It really varies. There is no meaningful probability I could give you. It depends on the embryo’s potential. In my experience, most patients had the majority of their blasts by day 5, and very few had embryos left at morula stage to go on at that point. Carole

  • Hopeful Says:

    Hi Carole,

    I am 28 & hubby is 33. We had one faile ivf cycle after transferring 2 grade AA blasts on day 5. I still got BFN even after those perfect embryos. We had FET done & transferred 3 day 6 embryos. 1 of them was hatching grade 1 (on a scale of 1-4: 1 being the best), 1 was fully expanded & the 3rd one had started expanding. I wonder if it’s going to work this time. I do not believe in my clinic anymore since nothing worked last time although they said everything was perfect. We do not have any infertility issues but my hubby is HIV positive so we are taking this as a precautionary action. My lining was 12.5 2 days before the transfer.

    Thank you in advance.

  • Carole Says:

    Dear Hopeful,
    Scoring and grades are not 100% predictive. I have seen high scoring embryos fail to implant and low-scoring embryos make beautiful babies. That is why you should take every cycle as a new chance. Don’t give up yet. It is too soon. Good Luck! Carole

  • Het Nederlandse hoekje; deel 3 "juni"! - Page 48 Says:

    [...] Blog Entries6 Just to make sure that everyone understands, there are 2 ways to evaluate an embryo- the chromosomes and metabolic health. The progression and transfer state is very important. The major difference between a morula and a blastocyst is the presence of an ICM- Inner Cell Mass- if the embryos stalls, no ICM develops and the embryo never makes it to blast stage, then it can never become a baby. Transferring a morula is taking the chance that the embryo will continue to develop and develop an ICM. You have no idea if it does so after transfer obviously. When you transfer a blast or a HB, you know there is an ICM, all the parts are there so it is much more likely that a blast or HB will implant and result in a live birth. Now, obviously morulas can become babies and there is a study that says that girls are slower growers but you just cannot know if it will progress if you transfer before it becomes a blast. A HB however is seeking something to grab onto to implant right away- it is hatching to do just that so much more likely to stick. Just wanted to clarify. This is a great post by Carole, the lab guru on here- Embryo stages, progression and pregnancy outcomes | Fertility Lab Insider [...]

  • Mm Says:

    Hi! My doctor and team are not responsive to questions and now my doc is out of the country anyway. They wouldn’t give me any rate info other than that at 44, I have a 4% success rate. It’s too late to change clinics and I didn’t learn until it was too late they have a poor general success rate compared to other clinics. Anyway I ended up with 4 eggs then 3 embryos. Because of my age and discomfort with waiting for genetic info we decided to do pgd. At day 5 I have 1 early blast and 2 morulas. I found out if the morulas have not progressed by tomorrow they would discard them. They can’t be tested with pgd. I don’t want to do another cycle after this so it’s my last chance and now I feel bad about tossing out the day 6 morulas. Since my clinic won’t give me any info (the nurse said she didn’t know what they did with morulas and would not even tell me what doctor was handling cases while my doctor is abroad) I have no idea what kind of success rate there could be for a day 6 morula that is frozen and then thawed. I also wonder if the chance of genetic issues is elevated since the development is slowed. Maybe my early blast will be strong and grow but I feel bad about the others. I wish I had done my research on the clinic in advance. I think this has been unnecessarily painful and confusing. When the nurse told me that maternal stress and depression has no known impact on miscarriage and also yelled at me for asking the same question more than once I really wished I could change docs mid cycle. Anyway any morula info would be appreciated. I did read some of the stuff you posted (thanks!) but I have read some successes with day 6 morulas and fets with morulas so am confused. Thanks! Mm

  • Carole Says:

    Hi Mm,
    I am sorry you are having such a difficult time. Don’t feel bad about the day 6 morulas. It is highly unlikely that they would have made a baby; they are lagging by two days. Freezing and thawing does not improve an embryos chances; at best, freezing and thawing does no harm. So I would not expect a better sucessrate with freezing/thawing day 6 morulas. Yes, the chances of genetic issues (meaning the risk of abnormal chromosome number called aneuploidy) is increased with severely lagging embryos and also is increased, unfortunately, due to your age. Generally speaking, you asked about morulas. Embryos that reach morula stage on day 4 of culture are proceeding at the right pace and have every chance of implanting if transferred, assuming there are no other problems. The problem is if the embryo reaches morula stage a day or more later than day 4; this signals a problem with the embryo and the expectation for implantation is much less. Good Luck with the early blast. I agree that you want to find another physician/clinic and if this does not work, you may want to consider the possibility of using donor eggs. Good Luck!!

  • Mm Says:

    Wow. I’m incredibly grateful for your time and energy in answering my question. I didn’t think freezing would help but I thought it might hurt quite a bit. my clinic won’t transfer without freezing at this point because it doesn’t fit their schedule so I’m kind of thinking about whether there is any chance for the morulas if we froze them and used them later (once ive built up a lining again) because the other option is just to discard But since we cant test the morulas and it sounds like their development is problematic, your answer that there is likely an issue puts me more at peace. I hate to let the little things go because I truly can’t stand to do this process again, even with egg donor, but I don’t want to transfer them if they have a strong chance of having issues. I don’t even know what kind of freezing process the lab uses but it’s a moot point now that they’ve told me I just have to go with their protocol. If the embryos had reached morula at day 4 but were still morulas at day 6, this still shows low potential right, even if they were ok at day 4? The lab person actually said they didn’t have good results with freezing morulas. I guess i also dont know what to do if the early blast is still too early a blast at day 6 for pgd tomorrow and if it would make sense if it is stalled at early blast on day 6 do i skip pgd but still freeze and transfer if it survives thaw? My problem if that im uncomfortable with termination post cvs for me personally and also uncomfortable about a child with aneuploidy so i feel very anxious. At any rate, bless your heart for helping me feel a little better in the midst of this traumatic process. I’m truly grateful. Mm

  • Carole Says:

    Hi Mm,
    You asked “If the embryos had reached morula at day 4 but were still morulas at day 6, this still shows low potential right, even if they were ok at day 4? “. That is correct. Morula on day 4 is the appropriate stage for the embryo. Morula on day 5 is slow. Morula on day 6 may no longer be alive and certainly has the poorest probability (if any) of continuing. Embryos continue to develop or die, they can’t take a “time out” or rest, so when they stop going forward, it’s not good. Most good programs can biopsy an early blast as well, although it is more difficult because the structures are less-defined. Unfortunately, some techs are trained to biopsy hatching blasts only because that is easier but blasts don’t always progress according to the clinic’s transfer schedule, leaving you with the choice of cancelling the PGD and doing the transfer. If you are uncomfortable with termination, then you should probably not skip the PGD, because the PGD is your only method to deselect abnormal embryos before pregnancy actually occurs. Good Luck! Carole

  • adele Says:

    Hi I’m 41 and had 2 day five blastocysts seven days ago. I have started to notice soms spots of blood and cramping as though I am going to start my period. Does this mean the ivf hasn’t worked

  • Carole Says:

    Dear Adele,
    Some women report experiencing cramping at the time of implantation so your symptoms are not necessarily cause for worry. But, as always, you should ask these questions of your clinic staff because they know your entire history and can best advise you regarding your medical concerns. Good Luck!! Carole

  • Dinkan Says:

    If an embryo was grade 3 on day 3 but a compact morula on day 5 when it was transferred, what chances of implantation can be expected for <30 age group?

  • Carole Says:

    Dear Dinken,
    Since grading varies somewhat between clinics and since outcomes vary between clinics even with the same “grade” embryos, the answer to your questions is highly clinic specific. You need to ask your clinic what their statistics are for patients in your age who have embryos like yours. Carole

  • Dinkan Says:

    Thanks Carole

  • Krissy Says:

    Hi Carole,
    I am presently doing a donor cycle (recipient) and I just got the day 3 results. At retrieval they got 12 eggs, and at day 3, the results are as follows: 2 compacting Morulas, 8x8cell, 1x6cell, and 1x4cell. My question therefore is: is it ok for morulas to be evolving as early as day 3? The lab seem happy, but I just wanted your opinion. Thank You for a fascinating insight into what goes on in the lab!

  • Carole Says:

    Hi Krissey,
    I think your donor’s cycle is going really well. I wouldn’t worry about a compacting morula on day 3. What they look like on day 5 will be the determining factor. A compacting morula may be 10 cells that are starting to show evidence of “compaction”. Morulas are disorganized and kind of ugly looking–sometimes this is the designation for more advanced embryos that aren’t easily categorized so don’t get overly hung up on what could be anything on day 3. The picture will be much clearer by day 5. Good Luck!

  • June 2010 IVFers - February 2010 Playgroup Forums Says:

    [...] That is a great thing! It means they are transforming into a compacted morula. The morula stage is the stage right before they turn into a blast. The morula stage is characterized by a transformation from a loosely associated group of cells to tightly connected cells that are acting more like a tissue. The process by which cells change from loose association to tight association is called compaction. A compacted morula is a group of cells (usually around 30) which have squeezed together inside the zona. This stage is usually seen on day 4 of culture. Embryo stages, progression and pregnancy outcomes | Fertility Lab Insider [...]

  • Sarah Says:

    Hi Carole

    I am 39 and just nearing the end of my first cycle in the 2ww. I am a bit concerned about the progress of our embryos between day 3 to 5. I had 7 eggs collected, 6 fertilised, 5 eight cell @ 3 days and 1 four cell. By day 5 transfer we had 1 blast and 1 compact moroula and 3 still at 8 cells. Is this normal for only 1 blast? By day six the moroula had progressed to early blast unsuitable for freezing. What percentage of embryos usually make it to blast is one from five particularly low?

  • Carole Says:

    Hi Sarah,
    It is typical to lose eggs and embryos at every step in IVF. In my experience, if we had 10 eggs, on average we could expect 70% to fertilize, meaning sometimes it was 100% but other times it might be 50%, depending on the patient. Of those that fertilize, maybe 70% would go all the way to blast but sometimes only 50%. So 70% of 10 eggs means 7 will fertilize. Of the 7 that fertilize, we would expect 3-5 to get to blast. If you start with 7 eggs, then you might only have 5 fertilized (you had 6), of 6 fertilized, 3-4 may get to blastocyst. You had 1 blast at day 5 and 1 compact morula which might be slightly low if you were under 35, but given that you are 39, it’s not unexpected. At this point, I would feel good about the blastocyst you had transferred and try not to worry too much. The 2WW is nerve wracking but it is too soon to give up. Good Luck! Carole

  • Leah H Says:

    I am going crazy, I have 3 embryo’s. Yesterday at day 2, I had 1 3 cell and 2 at 4 cells. Does it mean the 3 cell may catch up. they are trying to get me to 5 days for implant.

    The embryologist said the 4 cells ones won’t die off overnight, is that true?

    I am so confused.

    Any help would be great

  • Carole Says:

    Hi Leah,
    Having a 3 cell and two 4 cells on day 2 is fine. Assessments are typically made first thing in the morning. if this is the case at your lab, the 3 cell easily could have divided later in the day to a 4 cell. The 4 cells are fine on day 2. There is no reason to believe that the 4 cells will die overnight. Please don’t go crazy. It simply will not help. Take each day at a time. So far, so good. Good Luck! Carole

  • Baby_Dust Says:

    Hi Carole,
    I am 25 years old as is my partner. I had a day 2 transfer 4 days ago using ICSI. 15 eggs were retrieved, 10 eggs were mature and 4 eggs fertilised (I’m guessing this may be why I had a day 2 transfer as the clinic said that they are better off inside me than out). On the day of the transfer I had 3 that were all at 4 cells and 1 was at 7 cells. I had the 7 cell one transferred. I still feel a little bruised from collection, but I also have hot flushes, light headedness at times and an increased appetite. Are these symptoms normal (maybe due to medication), and when will I start to feel anything? Also were my embryos good quality.Thank you :)

  • Carole Says:

    Hi Baby-dust,
    On day 2, 4 cells and even a 7 cell are about where we would expect them to be. By day 3, we like to see 8 cells so they are well on their way to that goal. Usually clinics will give you a “grade” for each embryo which depends on their appearance. Round even cells “score” better than irregular uneven cells. No or little fragmentation “scores” better than significant fragmentation. Hopefully, you will freeze the non-transferred embryos at some point. Regarding your physical symptoms, please discuss these with your clinic doctor or nurse. They can best advise you about these symptoms. Good Luck! Carole

  • Baby_Dust Says:

    Hi Carole,
    Thank you so much for your reply. i was not given a grade for my embryos, but i have had my three 4 cell embryos frozen. i can see that you give fantastic advice to everyone on here!

  • Faith Says:

    Hi Carole. i had a 2day transfer and currently on day 6 post transfer. i have a sore chest and an upset tummy (could be due to progesterone). my question is when is the earliest i can take a hpt, and also my menstraul cycle is irregular (currently day 19) does this mean that even if i dont bleed during 2ww it may not be pos on my test day as it will be day 27 of my usual say 35-42 cycle? Thank you.

  • Carole Says:

    Hi Faith,
    First, you need to ask your doctor/clinic nurse about any symptoms you are concerned about (your sore chest and tummy). Here’s a link with a chart that tells you what typically happens each day after transfer for day 3 transfers. Add a day for your situation. One day after day 3 transfer is 2 days after day 2 transfer, for example. The chart gives guidelines on when hcg (the pregnancy hormone detected by your hpt) starts to be secreted if implantation occurs. I would not change (stop) any of your doctors instructions for medications until you get the official blood test. The reason I say this and the reason your clinic typically tries to discourage hpt tests is because sometimes the home pregnancy tests get it wrong. The test can pick up residual hCG from your trigger shot if you do it too early and give you a false positive result. The later you take it , the more likely it is to be correct but not always. It is better to wait if you can for the official test. Regarding your question about your regular cycle- disregard any expectations from any natural cycle. The hormones you have taken have overridden your usual pattern. Good Luck. Carole

  • Faith Says:

    Thank you Carole, much appreciated.

  • Leigh Says:

    Hi Carole. I to like Faith above am in the middle of my 2ww and have an irregular cycle. On Friday and Saturday i had abdominal discomfort as if my insides were being stretched. i responded well to stims and had retrieval on day 11. Iam currently on day 21 of my cycle. Is it true that if i have no bleeding up until and beyond my test day which is in 4days time that this means success? If not, will the cycle mimic the 28 day cycle? Thank you.

  • Carole Says:

    Hi Leigh,
    I think that you shouldn’t necessarily expect this stimulated cycle to act anything like your normal cycle because you have been exposed to a lot more gonadotropins. I think there is little if any correlation between incidental bleeding (spotting) during the 2WW and whether or not you are pregnant. Everyone wants a “sign” before their pregnancy test to let them know what’s going on but there aren’t any that are reliable predictors for everyone. As far as your symptoms, please discuss these concerns with your clinic. They really can give you much better advice (and treatment if necessary) than I can. Good Luck! Carole

  • Leigh Says:

    Thank you

  • Baby_Dust Says:

    Hi Carole
    i feel so sad and disheartened, i tested this morning (2days early) currendly 12dp day 2 transfer and got a bfn! It was an online hpt that is a month or two out of date. I had cramping foyr days ago as if af was here, but apart from that nothing. i had a m/c with a normal preg a while back and now starting to think is it my body.

  • Carole Says:

    Hi baby-Dust,
    I am so sorry that you are going through this now. If at all possible, please get your actual test done in two days and don’t stop your meds until your doctor/nurse advises you to. While I agree, the odds look bad now, you are two days early testing with an out of date home test. Just give it two more days and wait to get the blood test. Sometimes, we have found patients who assumed they were not pregnant based on a hpt and then got a positive result at the official test. That’s why clinics discourage early at home testing. Good Luck! Carole

  • The Embryologist’s Role as Patient Communicator | Fertility Lab Insider Says:

    [...] Embryo stages, progression and pregnancy outcomes 2. Egg Count Mathematics: Why the numbers change between retrieval and transfer. 3. Sperm [...]

  • Shell Says:

    So just did a FET today… They were frozen years ago as 8-cell. They were viable yesterday with >50%intact. One wasc4-cell, one was 5-cell. There was no growth overnight…however the RE still wanted to continue with transfer. These were our last 2. It wasn’t quite 24hrs, just about 20…. Is there sometimes a delay before replication with FET? Or am I reaching for pixie dust? ;)

  • Carole Says:

    Hi Shell,
    When there is significant fragmentation, it is discouraging but it is too soon to give up hope. One of the most beautiful IVF babies I ever saw came from an embryo that we had all but given up hope for. So, you see, it may not be over yet. Good Luck!!! Carole

  • Baby bound Says:

    Hello,
    I had a 3 day transfer on 7/21/2012. One 8 cell and one 12 cell.
    I think there was some framenting. I am 40 yrs old. This is my 2nd cycle of IVF.

    Can you give me your thoughts? If the 12 cell implants will it be abnormal?

    What questions can I ask my doctor to make me feel more at ease?

  • rochii de seara ieftine Says:

    rochii de seara ieftine…

    [...]Embryo stages, progression and pregnancy outcomes | Fertility Lab Insider[...]…

  • Fizah Says:

    Hi carole… i ‘m 33 years old. this is my first ivf. i had a day 3 transfer. the embriologist told me that out of 5 only 1 can be transfered which is with 5 cell. and she also told me that i only got 1% chance in getting pregnant.
    Can you give me your thoughts?

  • Carole Says:

    Hi Fizah,
    It’s too early to give up. A five cell embryo does have fewer cells than ideal –we like to see 8 cells after three days of culture–but I have seen pregnancies even with a less than ideal number of cells. Your youth is in your favor. If this doesn’t work, I would check the programs success rate at http://www.sart.org. If they are not reporting AT LEAST a 50% live birth rate in the under 35 years of age patient group (your group) I would consider finding another program. Good Luck!! Carole

  • Fizah Says:

    thanks carole….

  • CM Says:

    Hello,

    I have undergone 2IVFs. The 2nd cycle we did was at one of the best clinic in US (CCRM) hoping to get better results & some answers. I am 36yr old & we are unexplained. No sperm issues. 24 eggs were retrieved, 18 mature & only 7 fertilized using ICSI. Out of the 7 none made to it blasts. There were 4 good embryos on Day 3 – 10 cell, 9 cell & 2 8-cell .We were gonna get our embryos CCS tested, hence had decided to push them to Day 5. My doc thinks it is definitely an egg issue. What are your thoughts on my case? Do u really think it is an egg issue? And lastly, my 1st cycle also did not make any blasts & hence we did Day 3 transfer with nothing to freeze. Your thoughts will be much appreciated.

  • Carole Says:

    Hi CM,
    I am so sorry you are having such a hard time. It’s really impossible for me to know whether it is an egg or sperm (or embryo) problem. It sounds like your embryos stop growing after about the 8 cell stage. Aneuploidy (defined as an abnormal number of chromosomes) can occur in either the sperm or egg, causing problems with either fertilization or later embryo development. In addition, it is possible for aneuploidy to arise spontaneously in the embryo during the course of multiple divisions, which can also cause the embryo to stop dividing. Deficiencies in the egg cytoplasm (eg. a low number of mitochondria) also can cause the embryos to stop dividing since mitochondria “power” the work of the cell. You are on the young side –aneuploidy-related problems are more common as we age–but even younger women (or men) can have aneuploidy problems. The only (possibly) helpful thing I can say is that although we don’t know why you are having this problem, you are one of those patients who unfortunately are experiencing a very low efficiency with IVF (lower than expected fertilization) and then poor progression, no transfer and no frozen “surplus” embryos. Since there is no obvious sure cure and you have been using a good lab, it might be time to reconsider other routes to parenthood. You are spending a lot of emotional and financial reserves and it is not working well for you. The problem is that since it is hard to know why you are experiencing low fert rates and poor progression, the next often proposed step, (egg donation) may also not work and is even more expensive. Sperm donation, though less expensive, still usually involves IVF and may not fix the problem. I wish we had better diagnostic capabilities to understand the source of the problem to guide you but we aren’t there yet. Other options besides gamete donation (of either egg or sperm) are embryo donation or adoption. Perhaps a break from treatments to reassess would be most helpful to you now. Good Luck!!!

  • CM Says:

    Carole – Thanks for your reply.

    One important thing I forgot to mention is that the embryologist pushed the 3 embryos upto 7 days to study their growth. On his recommendation we biopsied those embryos to have some answers during that cycle. As it turned out all the 3 embryos were aneuploid. He & the RE both are of the same opinion that it is an egg issue, cause all the sperm tests have come back normal. They also informed me that in 95% of the cases it is always the egg issue, when they see this kind of cases.

    Any thoughts?

  • Savi Says:

    Hi carole,i am 31years old with one fersh ivf cycle day 3 transfer failed.3 clomid cycl failed not ovalating.on sep 20 started my fet cycle for day 5 transfer. On day three I got call that I lost two embryos and third one is 60% o.k.(they said that embryo lost four cell out of nine cell ) I did not had hope but monday on day five I got call my embryo reached bioplast stage with 1BB grade. I want know wheter have chance success with this embryo and want know about embryo stops expanding and rexpands. Please mail the reply thank u

  • Ricarda Says:

    Hi we just had a fresh transfer, they transferred two five day morulas, and I just found out that the other four didn’t make it so none to freeze. I have a picture of the two they put back but no other information. What questions should I be asking the embryologist about my morulas.

  • Ricarda Says:

    OH and will morulas result in pregnancy?

  • Carole Says:

    Hi Ricarda,
    Yes, morulas do result in pregnancy, even if they are morulas on day 5 instead of day 4. It is disappointing that none of the others made freezing criteria but I wouldn’t give up on the two you had transferred. One question you can ask your embryologist is what has been their experience (pregnancy rate, take home baby rate) with transfer of day 5 morula in women in your age group. Good Luck!!
    Carole

  • Ricarda Says:

    Wow thanks for the quick response. I guess I could have shared…
    This is my third ivf. however the eggs were from a 31 year old donor.
    I am 42, no issues other than mild endometreosis
    Ist ivf, three 3 day embies
    2nd ivf, four 2 day embits
    third ivf with donor cancelled
    and this one with same donor, 9 eggs, 8 injected 6 fertilized 2 morulas put back and like I mentioned none to freeze.
    i have been given a 60% chance. My final question.. will hatching the two morulas increase the implantation rate? they did hatch them.
    and is there anything i need to aviod or do to encourage implantation?

  • Carole Says:

    Hi Ricarda,
    Assuming that the lab is proficient at hatching–and if they have a laser, it’s very easy to do well–there should be no downside to hatching. I think you should ask your clinic about what they recommend for you in the 2WW. Typically, most programs suggest that you stick to your normal routine, unless your normal routine is running a marathon, sky jumping or otherwise overly stressing yourself. On the other hand, bed rest is not needed and is not recommended. Take your daily multivitamin but not excessive doses of anything. Be moderate in all things and find ways to keep your mind busy and spirits up so you don’t fret about the pending pregnancy test. It’s a cliche but “Don’t worry. Be happy” is a good goal if you can manage it. Good Luck!!

  • nik Says:

    Hi Carole,
    Thanks for blogging and taking the time to answer questions. I am 36 y.o. with 1 miscarriage (at 7 wks), 4 failed IUIs, 3 failed IVFs. We are currently on our 4th IVF cycle. Today on Day 5 after fertilization, we were told that we have 5 embryos, no blasts. When the nurse called on Day 3, we had “two good ones” and the lab wanted to delay us to Day 5 to give the others more time to develop. Today they did not say whether we had morulas, just no blasts and that none have arrested development yet. One embryo fertilized late on Day 1, since our fertilization report initially came back with 4. We are wondering if we should be hopeful that this late one and others still have a chance to become blasts on Day 6. Nurse didn’t think the probability was good, but at least the embryologist wanted to give the embryos more time. To have 5 embryos on Day 5 that are still developing, while slow is the best progress we’ve made so far. Cycle #1 we had 2 to transfer on Day 3, Cycle #2 none to transfer, Cycle #3 1 to transfer on Day 3. We are so anxious and nervous! Thank you in advance.

  • Carole Says:

    Hi Nik,
    Different programs have different policies on when to transfer (d3,5,6) and what stage to transfer (multicellular, morula, early blast, expanded blast, hatching) . The programs I have been with would transfer what was most advanced on day 5–even if those are early blasts or morulas. Some programs will transfer only blastocysts and will wait until day 6 to reach that milestone. Your program appears to take the later route. They place a very high value on what they see in culture and are comfortable with not transferring anything that didn’t hit the milestones exactly on time in vitro. Others might argue that embryos do better in the body and put them back sooner. I don’t know what’s best. The important thing is that you feel good about the plan and if you have concerns or unanswered questions, I would go back to your doctor and have him explain the thinking behind their policy. They may have data to show that they never get pregnancies from transferring morulas–though I would doubt that. The other thing is that although you are young, IVF is not working for you very well and it may be time to get a second opinion from another RE or move on to another family building strategy. As a rule of thumb, if you don’t get pregnant after 3 tries, it’s time to move on. Whatever happens, I wish you the very best and much Good Luck!! Carole

  • Jessica doyle Says:

    Hi …
    I am 23 years old with mild pcos &’low motility I have just had my embryo transfer it is my 2nd icsi cyle , 18 eggs retreived 15 mature 8 fertilized only 1 made blast on day 6 today what are my chances of a pregnancy my. 1st cyle I had 13 eggs 10 mature & only 4 fertilized had 2 4 cells grade 1 put back on d2 bfn no frosties my embrolasgest is very happy with my 1 blast please help I’m so worried of failure again :( x

  • Carole Says:

    Hi Jessica,
    I can’t tell you what your probability of being pregnant are this cycle but I can tell you that you have two very important things going for you: You are young and your embryo made it to blastocyst stage before transfer. Don’t worry. Worry will not help and will only make you miserable while you wait. Follow your doctors instructions and try to occupy yourself with other good things going on around you during this 2WW. Good Luck!!! :) Carole

  • Alexandra Says:

    Hi Carole,
    I have a question about interpreting the embryology development for my upcoming IVF day 5 transfer. Specifically, I’m wondering if any of the following results show cleavage that is too advanced for Day 3? My basic stats are that I am 40, 18 eggs were retrieved, 15 were mature, 12 fertilized. As I mentioned, I am scheduled for a day 5 transfer. On day 3, all 12 fertilized embryos were still developing: two were described as “expanding and compacting,” one 11-cell; two 10-cell; four 8-cell; one 7-cell; one 6-cell, one 4-cell. l realize that at least one is cleaving too slowly to indicate normal development, but what is the range of normalcy for day 3 and are any of these embryos so rapidly cleaving as to suggest poor quality? Unfortunately, I do not have additional information about fragmentation, etc. Thanks very much.

  • Carole Says:

    Hi Alexandra,
    In my program, we would favor the on-target embryos over their slower or faster siblings if we were transferring on day 3, we would be interested in transferring from the four 8-cells you have first. The “range of normalcy” is not clear cut but the textbook expectation is 8 cells on morning of day 3. That may be too rigid a criteria of normality. But since you are going on to day 5 with your embryos, you should have more info about their growth potential by then. Some culture systems support expanded blasts and even hatching blasts on day 5. Other programs report that in their system, they see the majority of blasts on day 6. Your lab can advise you as to what their experience is regarding the best day to transfer and what their best blast for implantation looks like on that day. They will probably want to transfer any expanded blasts you have or even hatching blasts. Good Luck!!

  • rachel Says:

    Hi Carole,

    What a great site you have for people with infertility questions.

    I had a FET transfer last week. 2 of the 3 made the thaw. They were graded 2BC’s day 6 embryos. I am not sure when they thawed the embryos. The paperwork said 0% re expanded done at 830AM. My transfer was at 915AM but the doctor said they were slowly re expanding. He said they like to see them expand more but they for sure survived the thaw. One had >20% cell loss and other >30%.

    My question is how crucial is the re expanding of the blasts? I am not sure when they were thawed. He did say that they showed improvement 10 minutes before transfer. Thank you to any insight. This is our last shot with our own DNA before pursuing adopted embryos (I am age 35, he’s 30 with MFI factors).

    Also, we had 1 failed IVF resulting in our frozen embies but I believe we had implantation issues as my lining was over 18mm at trigger date.

    Thank you for your time- Rachel

  • Carole Says:

    Hi Rachel,
    I think it is a good sign is the blasts showed signs of re-expansion just before transfer. That means they are alive because expansion is an active process. It can easily take a few hours for re-expansion so I wouldn’t be alarmed that they were not expanded at 8:30AM but by 9:15AM showed signs of expansion. That is fairly typical. If I understand your email, you are in the middle of the 2WW before your pregnancy test and no doubt getting anxious. That’s normal. Just try to distract yourself with some good things happening around you right now. In spite of the male factor issues, your relatively young age is working in your favor. Good Luck! Carole

  • rachel Says:

    Thank you Carole for the reply.

    I asked the lab today and they said 12 hours thawed before transfer. My test is the 15th. I think the doctor said that to try and make me feel better.

    Your help was greatly appreciated.

    Rachel

  • Rachel Says:

    Hi Carole,

    I trust my doctor, but I’d like to get your opinion too. I’m 33 with unexplained infertility, my husband is 35 with good sperm. We have been TTC for 3.5 yrs. We are just finishing up our first ivf. I had 11 follicles, 6 eggs, 5 mature, with 4 that fertilized. My doctor wants to do a 3 day transfer, that will happen tomorrow. The clinic here rates the embryos 1-4, with 1 being the best. This morning on Day 2 my 4 embryos were
    6 cells Grade 2
    4 cells Grade 2
    4 cells Grade 1
    3 cells Grade 1

    I’m not sure what they will look like tomorrow, but which ones would you transfer? Assuming they double tomorrow maybe? Also, why not wait until day 5, isn’t there a better chance of success if we do? Also, can I suggest one on day 3 and one on day 5?

    Thank you for your advice!

  • Carole Says:

    Hi Rachel,

    On day 3- I would transfer 8 cell embryos even if they have a slightly lower score. If you wait to day 5, you will know which ones were able to progress to blastocyst (implantation ready) stage. As you are young, most clinics would transfer only 1-2 embryos based on maternal age (if there are no other factors that otherwise would diminish your odds of pregnancy) so longer culture may help show which embryos are most progressive when there are more candidates on day 3 than the 1-2 for transfer. Since 3 of your embryos are at least 4 cells on day 2, some docs would want to see more development to pick 1 or 2 best on day 5. You should discuss this further with your doctor as you still have questions. I would NOT transfer some on day 3 and some on day 5. Every time you put the catheter into the uterus, there is some risk of scratching the endometrium (uterine lining) which would pretty well nix your chances of implantation. Good Luck!!! Carole

  • Rachel Says:

    Thank you very much for your answer! They ended up putting 2, 8 cell embryos in, and freezing two. Great resource you have. Thanks again!

  • Rachel Says:

    oh, and all four had progressed overnight to a 1 rating, (the best). I had 3, 8 cell and 1, 10 cell. Some had even starting developing into the next stage, I forgot what she had called it. I was very upset when they had only gotten 6 eggs, but now I’m super happy with the results. I wish we could have waited until day 5, but initially they said because it was a low number they recommend a 3 day transfer. I hope it was the right choice. They seemed optimistic about it. Thanks again for the answer, info, and the blog!

  • Carole Says:

    Good Luck Rachel!

  • Sara Says:

    Hello Carole,

    Ive had 2 failed ICSI cycles and am now waiting for the results of my third IVF. I was surprised when the embryologist siad they were doing IVF this time.

    Last two cycles I produced 11 eggs and which most fertilised but on day three Ive always had 4-5 cell embryos to transfer.
    This cycle I only produced 4 eggs of which 3 fertilised. I was on teh short protocol and was on150 menupur and 0.25 cetrotide. We were told on the morning of transfer that there were two 5cells to transfer. When we got there in the early afternoon one had split into a 6 cell and teh other was still a 5 cell.
    I am 30 years old and had my first ICSI when I was 28.
    What are my chances with slow growing embryos?

    Sara

  • Carole Says:

    Hi Sara,
    I am sorry you are having such a hard time. As far as trying to understand why you are having such slow growing embryos at such a young age, it’s impossible for me to know for sure. But there are a few things to consider.

    First, I assume you have checked the success rates of your program and that for women in your age group, the pregnancy rate is above 50%. SART has a website (www.sart.org) that has an easy-to-use tool for looking up pregnancy rates on most every center in the US. If you find poor rates in the youngest age group in a program, I would consider finding a program with higher rates.

    If you can rule out lab quality issues, the other common cause of embryo slowness or failure to progress is aneuploidy- meaning some chromosomal abnormality exists in the embryo (two few or too many chromosomes) which can arise from either the male or female side. These problems with chromosome number can occur during egg or sperm production or in the early cell divisions of the embryo after the egg is fertilized. it is possible to test the embryos by removing a cell and sending it to a genetic testing lab (embryo biopsy and PGS Screening) to see if that cell is normal. With that test result on each embryo, normal embryos can be chosen for transfer, upping your odds of pregnancy. But aneuploidy testing adds to the cost of IVF- so that is not always possible. And sometimes patients find out that all their embryos in that cycle are abnormal and they have no transfer–which is very disappointing.

    I can’t give you a probability of pregnancy with embryos that only have 5-6 cells on day 3 but I agree that if the embryos aren’t ever reaching 8 cells on day 3 of culture or blastocyst by day 5 or early day 6, the probability of pregnancy with IVF is suboptimal and it might be time to consider other paths you have available to you. I wish you the very best. Good Luck! Carole

  • sara Says:

    Thankyou very much Carole for the fast reply. I’m hoping that the embryos transfered will stick. Ive had all my cycles in England nearer to where I reside. So I’m looking at going abroad if this cycle does not work.
    I would just like to take the opportunity to thank you and reading the other posts and your replies has helped alot!
    It means so much you’ve taken your valuable time out to answer my question!

  • PA Says:

    Hi Carole, First all of thank you so much for this blog and helping several women with their questions like me. You are so kind.
    I am 31 year old and dealing with infretility. I am doing my 2nd IVF cycle and had 14 Eggs Retreived, 13 Mature performed ICS1 and 11 fertilized. Today was day 5 for the embryos and I heard that there are 9 left and are not blastocysts yet and may be slow and become Blasts tomorrow. So they will call me tomorrow and we will not have fresh trasnfer. I have some questions for you, if they make to blasts tomorrow(early Day6), is it bad that they become blasts late or what is the impact and then should we transfer more embroys since they are day 6 blasts than we were going to transfer if they were day 5 blasts. We are also doing PGD on them..in case they are PGD normal Day 6 blasts , is it good to transfer.. Even in my last cycle, none egg made to blasts on day 5 either. I am just worried if it is worth transfer day 6 blasts..i mean dont have a choice..i do not have any blasts that grow in 5 days only 6 day if I get good response tomorrow.

    Sorry for all the questions..your time and response is highly appreciated.

  • Carole Says:

    Hi PA,
    If they are PGD normal, I would transfer the blasts, even on day 6. Culture systems vary enough that at some labs, most of their embryos are blasts on day 5. In others, they might see a good number reach blast only by day 6. Your embryologists should have a better idea of what to expect when d6 embryos are transferred in their lab. Don’t be afraid to ask your embryologist or doctor for their specific experience with their system as it applies to your medical situation. With PGD, some programs routinely delay transfer until day 6 to accommodate 24 hr testing between day 5 and day 6 so day 6 transfer does result in pregnancies. Good Luck!! Carole

  • PA Says:

    Thanks Carol for the response. I got an answer today that we got 4 Blasts today Day 6 and have been sent for PGD. We will know results in a week as we cannot do fresh transfer. It is a good idea you said that I should ask my doctor or embroyologust their experience with my situation.

  • viv Says:

    Hi carole,am 35,on my first ivf,3eggs was retrieved n the 3 fertilized but very slow on day 5 they were still on stage 3,it was transferd on dat day 5 cos doc said they r still alive n I was given a shot to help d growth of the embryo,hope it works n I get pregnant,is it so bad dat on day 5 my embies were still in stage 3.

  • Carole Says:

    Hi Viv,
    I am not sure what you mean by stage 3. On day 3 in culture, we like to see that the embryo has around 8 cells, has fairly even cells with minimal fragments. By day 5, we like to see a well-defined embryo called a blastocyst that has two parts- one part that will make the baby and the rest is for making a healthy placenta. It is concerning when embryos don’t hit the milestones when they should because it often signals that the embryo might have stopped growing. You should discuss these concerns with your doctor/embryologist to get the specific details of your case. Good Luck!!

  • Anna Says:

    Hi Carole, geat post. I just completed a 5 day transfer with eSET (grade AA blastocyst) that was beginning to hatch. Of the 4 eggs fertilized in my cycle, ALL made it to blast stage and were either AA or AB. The clinic (the largest clinic in the mid atlantic, based out of MD) seemed rather optimistic about my cycle given the lack of decline my embryos experienced. Is this indicative of pregnancy outcomes? I was actually quite surprised that the embryos did so well given my husbands severe male factor problems, including 0% morphology, so I am hesitant to get my hopes up. I am 31 and my husband is 33. We have 4 iui failures with donor sperm for a bit of history. Thanks!

  • Carole Says:

    Hi Anna,
    There are no guarantees but it is always a great sign when embryos reach blastocyst stage with high morphology scores. Your and your husband’s youth are also working in your favor. Good Luck!!

  • VJH Says:

    Hi Carole I am 31 and boyfriend is 29. I have endometriosis and a low AMH of 6.25 for my age but boyfriend has no problems. At collection, last Wednesday, 10 eggs were retrieved, 9 fertilised but only 2 made it to transfer on day 3, both 6 cells and grade 3 with 4 being the top grade. The other 7 embryos stopped dividing at just 2 cells. Please can you shed some light on why so many embryos stopped developing and what are the realistic chances of the 6 cell embryos lasting the distance. I feel very disheartened that I don’t have the magic 8 despite the fact that literature quotes 6 -8 is normal for day 3. Any help is appreciated, thanks.

  • Carole Says:

    Hi VJH,
    I am sorry that you are feeling so low. There can be many reasons for why embryos don’t progress. This can reflect problems in either the embryo or the culture system. The only way you can assure yourself that the culture system is good at your clinic is to choose a clinic that does at least 150 cycles a year (practice does make perfect) and they report a pregnancy rate in the youngest age group of at least 50%. Sometimes embryos are slower if they have an abnormal number of chromosomes (aneuploidy). There is no way to eyeball the embryo and tell if this is the case. Representative cells from each embryo need to be sent to a testing lab and submitted to genetic testing but that adds to the expense of the IVF cycle so that is not always possible. If an embryo is struggling with lots of fragmentation, it may appear to be slower but actually is on target but cells are being lost to fragmentation along the way. The timing of the morphology check also affect the number of cells. So in spite of the fact that your embryo did not hit the “magic 8″, don’t give up yet. Embryos surprise us all the time and your youth is on your side. Good Luck!!

  • Liz Says:

    Hi Carole. I’m reading your blog and have a few questions. I recently had my third FET. We had 3 (3 day) embryos transferred. Two of them lost some cells during the thawing process but quickly recovered and went on to be 10 and 11 cells by the time we transferred. The 3rd one was a 9 cell. It did not lose any cells during thawing, but it also had not grown at all in 24 hours. The Dr. placed all 3 back saying “I’m sure that even if we cultured the 9 cell embryo that hasn’t grown in the lab for another 2 days it wouldn’t go anywhere-so I’m OK with putting 3 back”. This was on 10/10. I had my HCG checked at 8 days past transfer (or 11 dpo) and it came back at 100! Progesterone was 42.4. I was tested again 4 days later and HCG was 444 (doubling time 49 hours) and progesterone 38.6. I had another draw 2 days after that. HCG was 1021 (doubling time 36 hours) and progesterone 38.7. I had a blood draw on 10/30 measuring my progesterone at 55.8 and estrogen at 555. I did not get an HCG value. We also had an ultrasound done to measure early uterine activity. Obviously only hoping to see a sac. Instead we saw 3!

    The Dr. said the middle sac is “questionable” and we need to wait it out. Each sac is 3mm, but the middle is a “tish” smaller than the others. I have another U/S scheduled for next week.

    What are the clinical chances that all 3 sacs turn into viable babies…and if the 9 cell hadn’t grown for 24 hours…isn’t it odd that it implanted?

    I have 3 children from previous FET cycles. B/G twins (daughter passed away at 6 hours old) that was 4 embryos transferred. and a Son from 3 embryos transferred.

  • Gudz Says:

    Dear Carol,

    I had egg retrieval 2 days ago ad 10 eggs were collected. 4 were inseminated conventionally but 0 fertilized. 4 were icsed and 2 fertilized. We have poor sperm motility and morphology . So I only have 2 embryos in culture. The clinic wants to perform a 5 day transfer. I am worried that if we wait that long I may have nothing to transfer.

    What would you advise in such a situation?

  • Carole Says:

    Hi Liz,
    The short answer is that I can’t tell you the probability that all three sacs will turn into viable babies. There are many possible scenarios that affect the number of viable babies when embryos are put back. I have seen embryos split after transfer so that we transfer two and see three sacs. In your case, when the questionable third was put in, it is possible that it didn’t make it but one of the other two may have split- resulting in three sacs. Whether that happened is not possible to discern this early in the process. The other explanation is that the embryologists’ scoring of the nine cell may have been off. Sometimes, cells divide but than fragment so the number is unchanged but the embryo is still alive- less likely but possible. I also have seen cases where three sacs are present at the beginning but some of them-hopefully not all!- demise over time. As an embryologist, I tend to want to be conservative and only put one or at most two embryos back per cycle because especially if patients have been pregnant before, embryos have a way of defying our expectations when we assume some will fail. Based on your history , your doctor made an educated guess that the three won’t all make it but we really never know what an embryo is going to do after transfer. I wish our system supported multiple transfers of one embryo at lower cost rather than gambling with more but that probably won’t change any time soon. At this point, wait and see how it goes and consider carefully how you feel about triplets- and what obstetrical issues triplet pregnancies pose-if you have an obgyn, it might be good to discuss these issues with them. Sometimes embryos may demise –especially if you see a smaller sac–and you may well end up with a twin or singleton pregnancy but it is too soon to know. I wish you all the best!! Good Luck!!

  • Carole Says:

    Dear Gudz,
    I would ask your doctor to tell you–based on his/her statistics in their own lab–what is the probability of your embryos getting to the blastocyst stage? Also, ask them, how allowing the embryos to go to blastocyst stage will affect their choice of which ones to put back? If they are already planning to put two back in if you have them, there seems little advantage to waiting to see if both make it through their culture system–because failure to make it can be a sign of either a poor embryo or a poor culture system. If you are hoping to only transfer one, it would be useful to see if one is more advanced then the other by day 5-assuming the culture system is good. If you are having genetic testing done, it may be necessary to go to day 5 to 1) get the results back after day 3 biopsy or 2) do trophectoderm biopsy. If neither genetic testing or elective single embryo transfer applies to your situation, these reasons can can be ruled out as a reason to culture longer. I think you need to have another conversation with your doctor to understand what he/she hopes to accomplish with this approach. If there is no compelling reason to continue to day 5 or their past success with day 5 culture is low (and if you will be charged more for day 5 culture), it might make sense to ask for a day 3 transfer instead. Good Luck!!

  • Gudz Says:

    Thank you Carole for your prompt response. I am going to speak to my doctor today to get more information. It seems it is standard for them to culture to day 5 or 6 .

    We were planning to transfer 2 anyways and no genetic testing necessary so there really is no reason to wait but I will speak to my doctor today and get his opinion and find out if we can do a day 3 transfer .

  • Liz Says:

    Thanks Carole. My next appt is Monday…so we will see more then. I’m really holding out hope to only have 1 healthy baby in there! I can be OK with two…but 3! After losing our daughter….I’m just in shock that it’s possible that the 9 cell may have “taken off” and implanted. My Dr. told me I need to relax (little freaked out here lol) and just because I see 3 sacs…doesn’t mean 3 babies just yet. He said, in his professional opinion, that my numbers more represent a twin vs a triplet pregnancy. Especially given my progesterone numbers. Thoughts on that?

  • Carole Says:

    Hi Liz,
    I can’t weigh in on that- that’s a medical, not lab/embryo question. But if your three sacs resolved to two sacs, you wouldn’t be the first. Good Luck!!

  • Rob Says:

    Hello Dr and thank you so much for all your info.

    My wife had 2 blastocytes implanted last week and she sent for her blood test Sunday, and later that day they called to say she is pregnant. Im very excited to say the least, but also very nervous. This is not our first attempt although the 1st time with good news so far. My question is, from this first blood test and a positive pregnancy reading, what are the chances going fwd of a complete pregnancy? Is it still to early to celebrate? Or is this a good sign with good chances? She goes back tomorrow for another blood test to ensure her levels are still increasing.
    Thanks for your time.
    Rob

  • Carole Says:

    Dear Rob,
    First, let me say Congratulations!! I can’t tell you what your chances are for the pregnancy to go to term. Your doctor would be the better person to ask about your specific situation. I will say this. You just need to take each day one day at a time. If I were you, I would enjoy every bit of good news that you get, just realize that it is early. Some couples wait until the end of the first trimester to share their pregnancy news with their family and friends because the pregnancy is less likely to be lost the longer it goes. But every successful pregnancy has gone through these early days that you are going through now so every pregnant day is a good day and you don’t want to rob yourself of today’s joy because you fear the worst. Frankly, as a parent, you will always fear for your child- this is only the beginning. I wish you and your wife every happiness and Much Good Luck!! Carole

  • Rob Says:

    Carole,

    Thank you, and very sound advice. We are very excited and thus far all good news. Each day that passes and new tests are performed, my wife is doing splendidly.
    I did not phrase my question as clear as I intended. What I should have asked was are there any differences between IVF using blasto’s vs. normal pregnancy from the moment a mother knows (or is told) she is pregnant? Meaning, blasto’s are artificially placed so is there a greater chance they may not “take” or once we are told of the status pregnancy is it safe to assume they have attached/taken? More simpler, once pregnancy is established, is there any difference from that point on between a normal conception and an IVF conception? Or from that point on, equal in chance for the most part? My wife must still do Progesterone injections which a normal conception would not be doing so I do see differences in that regard. Is the primary intention of the meds to increase chances?
    Thank again for all your time and expertise,
    Rob

  • Carole Says:

    Hi Rob,
    Whether pregnancy comes about through intercourse or through transferring a healthy blastocyst to the uterus, in both cases the blastocyst stage embryo burrows into the uterine lining and produces hCG, the hormone produced by the trophoblast/future placenta which is detected by the pregnancy test. So yes, if you find hCG in the blood or urine. the most likely explanation is that you have implantation. (There are exceptions –you can have a false positive result if an IVF patient tests too soon before the hcg from the trigger shot is cleared from the blood; also some tumors can cause hcg production (testicular cancers have been detected this way)) From implantation on, an IVF pregnancy and an intercourse pregnancy should be highly similar, if not identical. The reason your wife needs supplemental progesterone now is to counterbalance the overly high estradiol levels produced by ovaries in response to the stim drugs. The uterus needs to have a progesterone dominant hormonal balance to support the pregnancy and placental development. Later in pregnancy, the placenta is a big enough organ, producing enough progesterone on its own so that the supplemental progesterone is no longer needed. Unfortunately, as you know, pregnancies can fail later in pregnancy for a host of reasons so a good start is no guarantee. Your iVF doctor, who is a reproductive endocrinologist, should be able to give you a very good explanation of all of these questions and what to expect going forward. I would still urge you to discuss these medical questions with your doctor- he/she is the hormonal expert. I hope this helps. Good Luck!! Carole

  • Kim Says:

    Hi. Thank you for this blog. Your responses to others have been very helpful. I am 33, husband is 32 and we are currently in the 2ww. I don’t have any issues that I know of, husband has bad morph of 1% and low but not terrible motility, and average count. Had 10 eggs retrieved, 8 mature, 6 fertilized. On day 5 we had only 2 embryos remaining and were not to the blast or morula stage. The embryologist said they were compacting 20 cell embryos that were still growing- just slow. We had them transfered and embryologist said we had a good chance and that they see embryos like mine turn to blasts on day 6 all the time. I am skeptical. I hear about success stories with morulas on day 5 but nothing really earlier than that. Are they only morulas when they reach 30 cells? Mine were deffinitely forming a center mass so perhaps in a couple hours they would have been. In your opinion, what are the chances of embryos like ours turning into blasts post transfer and thus viable pregnancies? If this doesn’t work out should we shop for a new clinic? I read on this site that the success rate should be at least 50% for the lowest age group. Our clinic has 43% for MFI cases (36% for all cases) and they do 500+ cases per year. Or is this type of embryo development to be expected for MFI cases with bad morph? Thank you so much for your time.

  • Carole Says:

    Hi KIm,
    The 2ww is very stressful. It is true that embryos routinely make blasts on day 6 as well as day 5–but generally most blasts become blasts on day 5, not day 6. The pregnancy rate with day 6 blasts is typically lower than with day 5 blasts, but pregnancies do occur. Which day favors the majority of blastocysts will vary among clinics, depending on their culture system and media used as well as on the progression potential of the embryos themselves. Unfortunately, you’ll have to wait and see how this turns out. Why do some embryos progress more slowly than others? MFI could help explain slow progression but that is only one possible factor. Almost every possible factor has been proposed to account for slow embryo development (egg factors, sperm factors, genetic problems, culture problems) but there is no way to look at the embryos and know what’s going on.

    Because you are thinking of changing clinics before you even know whether you are pregnant or not, I am guessing that you have been dissatisfied with your program along the way. The pregnancy rate you quote is not terrible and not infrequently observed as patient volume goes up or as new staff/doctors are added. Part of what works well for patients is having an individualized treatment plan–this takes more care, time for patients and attention to detail. Some programs scale up and do this well, others struggle and their rates may drop. If you are pregnant, all these questions will be of no consequence. If you aren’t pregnant, then you can consider whether you can get better treatment elsewhere. A program can’t guarantee that you will get pregnant. But they should be able to guarantee that they will address all your concerns, answer all your questions, provide some well-considered treatment options for your consideration based on a careful review of your situation and help you decide what to do next. If you have options of going to a clinic with higher rates that do at least 200 cycles a year, by all means consider a change if you have other reasons to be dissatisfied with your current program.

    In the meantime, please try to distract yourself with other things that you enjoy or are otherwise important to you -that may have gotten ignored lately or might have been on the back burner –to make this 2WW time go by as quickly as possible. Above all, Good Luck!!

  • JennyLou97 Says:

    Hi! I found lots of information here so thank you for your website. I am a carrier and although this is the 4th time I have done this, only one other time was a 3 day transfer so I forget some things. We had 13 retrieved with 11 fertilizing and all progressing to the 3rd day. On day 3 we had six 8-cell compacting embryos and the rest of various sizes from 6-cell to 4-cell. We transferred (1) the best 8-cell compacting embryo that we had. I know that compacting is a very good sign but is there any more specific data about the success of a compacting day 3 embryo? Donor is 35 and there are no fertility issues.
    Thanks for your help!

  • Carole Says:

    Hi JennyLou97,
    I don’t have any specific data on the success of transferring one day 3 compacting 8 cell from a donor- but you should be in really good shape. (Your clinic may track their patient data to look at their success rates with transferring one embryo so I would pose this question to them. Also, data from their clinic would be most applicable to your embryos. The CDC data isn’t parsed that finely. You have good progressing embryos from a donor. So I would feel optimistic at this point. Good Luck!! Carole

  • Colleen Says:

    Hi Carole,
    Thank you for all of the information you provide on this blog. I just had one 4AA blastocyst transferred on day 5. The blastocyst was actually in the process of collapsing when the embryologist took a picture of it for us. How common is this? From your description it sounds like it happens frequently, but after reading the info on the Payne study I became a little concerned (less about the possibility of twins and more that it could indicate a problem). Have there been other studies to date that expand her findings? Thank you for any information!

  • Carole Says:

    Hi Colleen,
    Blastocyst collapse (and subsequent re-expansion) is very common and I would not be concerned about it. For vitrfication, the blastocyst is deliberately collapsed for better freezing. I am not sure which article by Payne you are referring too, but embryos collapse and re-expand without any obviosu effect on embryo viability. Good Luck on your transfer! Carole

  • sara Says:

    Hello Carole,

    I wrote to you about a month ago asking about athe chance of a slow growing embryo. I would just like to update and confirm I achieved a pregnancy with a slow growing 6 cell and a 5 cell day 3 embryos and yesterdays scan confirmed I was 8 weeks pregnant with a singleton.
    The reason for my update is to just give hope to those people that don’t have perfect embryos. I hope my story helps someone.
    I would also like to thank you as you provided quick proffesional advice which gave me alot of confort and reassurance when I needed it most!

  • Carole Says:

    Hello Sara,
    Congratulations on your pregnancy! I am very happy for you and glad that I could help in a small way. :) Good Luck and Best Wishes! Carole

  • Babelyday Says:

    test

  • Kimby Says:

    Is this still active?

  • Carole Says:

    Yes, I have not closed any of the comment boxes. You can ask questions here or email me privately at info. Best Wishes, Carole

  • Kimby Says:

    I emailed you! Thank you!!

  • Carole Says:

    You are very welcome. Good Luck!! :)

  • cindy Says:

    Hi,
    I’ve had two failed FETs of 5 day blasts..both rated high quality by my clinic. Both times, the embryo was reported to be “collapsed”. Both times, the RE informed me this was nothing to worry about –that everything was fine and there was no reason to think the embryo wouldn’t stick. Both times it didn’t. Then I met with my RE who said that likley the fact they they were collapsed embryos is implicated in why i didn’t get pregnant. She’s proposing to now thaw 2 and transfer the least collapsed one and discard the other. I don’t like this plan–because if indeed the other two REs were correct and a collapsed embryo has the same chances as non-collapsed embryos–then I’m just tossing good chances away. Am I right? Is there a implantation issue with collapsed embryos? They were collapsed for freezing–and both looked to be partially reexpanded prior to transfer. I have photos of each if this helps your comment..
    thanks–just looking for info as I make my next decisions..

  • Carole Says:

    Hi Cindy,
    I am sorry you are having a hard time. I don’t think that being collapsed at thaw is a problem, especially if you have evidence that the blasts were in the process of re-expansion before transfer. The fact that they were re-expanding is good evidence that they survived the thaw and were alive. If you just want to transfer one, I would thaw one and wait a few hours to see what it does before transfer. If it doesn’t look viable–ie doesn’t begin to expand at all, a second can be thawed. Even if the embryo is alive, it does not guarantee implantation. Both the embryo and the uterus have a lot of collaborative work to do to make a healthy placenta and pregnancy. Also the embryo needs to have a normal chromosome number or it usually doesn’t continue to a term pregnancy, if it is able to implant at all. So it is very hard to determine why the last two transfers didn’t work-could be many reasons. If blasts do not re-expand ever, it is probably because they are no longer alive- and did not survive thaw. If yours were re-expanding, they were alive. Good Luck!

  • Cindy Says:

    Thank you so much for responding so quickly.
    It matters so much to know I wasn’t fed a line by the REs who told me it was fine to proceed with collapsed embryos. It also helps me plan my next steps–particularly if future embryos are just slow expanders.. I don’t want to throw embryos away just because one doc seems to think they have a poorer chance. So thank you!

  • DAVE ZINNA Says:

    My wife and i just did a 5 day transfer, on day 3 we had 2 8’s, 3,6s and a 5. they called the morning of day 5 and said the trasfer was on, we were very excited, but when we got there, we found out that the 8’s had only turned into one 10 and one 11, thoses are the ones the implanted.by the pictures they gave me they looked like they where about to turn morula. Our R.E. said we still had a chance of pregnancy of about 30%, whats you option on this, we are very depressed.

  • Carole Says:

    Hi Dave,
    I am sorry that you are disappointed. Yes, we like to see embryo progress to morula on day 4 and blastocyst on day 5. The embryos you describe are a little behind. Having said that, it is too soon to be without hope. Embryos do surprise us, all the time. I am wishing you much good luck for good news! If this cycle does not work, there will be a follow-up appointment. You will want to find out what your doctor can propose doing differently next time. Best Wishes for a good outcome!!! Carole

  • Nat Says:

    I just had a 3 day transfer yesterday of a 5 cell embryo that “looked great” according to the RE and embryologist, but just a “bit behind”. Out of 4 eggs retrieved, 3 mature, this is the only one that fertilized and we did ICSIthis time. This is our 2nd ivf and our first one was same antagonist protocol with slightly lower dose of meds and we got 6 eggs and 4 fertilized properly without icsi. That was in June and 3 made it to day 5 ans they transferred a morula and early blast and it was a bfn. In September we tried a MDL protocol and my body didn’t respond at all so my re had me take dhea for 4-5 months to see if it would be helpful to get more eggs. I am 35 now and have severe endometriosis with an endometrioma so large on 1 ovary that she can’t get any eggs from that side. I’m worried that, a 5 cell on day 3 transfer just won’t work and also I’m confused as to why fertilization seemed better without icsi and why we got less eggs after taking dhea. My amh went from 1.6 a year ago to .33 last month after taking dhea. My fsh stayed basically the same though. I really appreciate your insight!

  • Carole Says:

    Hi Nat,
    I am so sorry you are having such a hard time. IVF isn’t working very well for you. You have a complex history and several hurdles to overcome. As an embryologist, I can say that the 5 cell on day 5 is significantly lagging, and although nothing is absolute, the chance of pregnancy is low for an embryo that is lagging to such an extent than for one that is on target. The AMH decline is most troubling but I can’t advise about the endocrinology since that is outside of my expertise. The accumulation of hurdles over time (endometriosis, only one available ovary to retrieve eggs from, and rapidly declining AMH.) even in a young woman are significant issues and can well explain the poor outcomes– like lower fertilization the second time even if you did ICSI. I would, of course, follow up with your own doctor to explain what, if anything, might be done differently in another try if this one doesn’t work. If you can find another RE with good SART statistics (greater than 50% take home baby rate in the under 35 age group), you might benefit from a second opinion and another perspective on whether it is worth it to continue down this road or whether it is time to consider other options- donor eggs, surrogacy or embryo “adoption”. I wish I could offer more help!! Wishing you Much Good Luck!!! Carole

  • Nat Says:

    Carole,

    Thank you for your response! My 5 cell embryo was actually on a 3 day tranfer, does that mean it is not so significantly lagging? Thank you for your response. I really appreciate you taking the time!

    Nat

  • Anonymous Says:

    Carole,

    Thank you for your response! My 5 cell embryo was actually on a 3 day tranfer, does that mean it is not so significantly lagging? Thank you for your response. I really appreciate you taking the time!

    Nat

  • Carole Says:

    Nat,
    Thanks for your clarification. 5 cell on day 3 is a better picture, still not ideal (8 cell is what we like to see) but better. If it was observed early and on the verge of dividing, it could be a 6 cell by transfer. Good Luck!!! Carole

  • Tyson Says:

    Hello and thank you in advance,
    We started with 11 fertilized eggs, on day 5 we had 4 morulas and we transferred two, we got a call a few days later saying that the other two made it blast on day 7. Is this a cause for concern or does it just mean we have some VERU slow growers?

    We are both in our late twenties, here is a photo of the two we put in :
    http://m743.photobucket.com/albumview/albums/tysonito/morula.jpg.html?o=0&newest=1

  • Carole Says:

    Hi Tyson,
    Having a morula on day 5 is somewhat slow. We prefer to see blastocysts on day 5. Likewise, seeing a blastocyst stage only on day 7 is quite delayed. There are some studies that show pregnancy rate is best with day 5 blasts, somewhat reduced with day 6 blasts and pretty rare with day 7. In my experience, most labs don’t freeze day 7 blasts. The good news is that you are very young and youth is such a positive factor it overcomes other issues- so you and your partner might well get pregnant. So don’t give up on this cycle!!!

    Having said that, I would have expected better embryo progression and better compaction in embryos from most young patients- unless there are other complicating medical issues. Have you checked the live birth rates reported to the CDC for your clinic? You can look these up on the CDC site or on the SART site which is slightly more user-friendly http://www.sart.org/find_frm.html If you don’t get pregnant for this cycle, it might be time to get a second opinion. I always suggest that patients look for clinics that report at least a 50% live birth rate in the under 35 age group patient. Another issue that can contribute to less than ideal embryo progression is if the lab just recently started growing embryos to blast or made other changes in lab personnel or protocol. There may be lab problems but those are impossible to diagnose from the outside. If you discover a really low pregnancy rate or inexperience with blastocyst culture, it might be time to look for a more successful clinic.

    In any case, I wish you Much Good Luck for a positive pregnancy test and birth from this transfer!!!
    Carole

  • wszopix Says:

    Hi!
    I need to get some information about financial future in East European coutries like Slovakia. I’ve found a website przyszlosc finansowa and I’m surprised that post-russian countries are rapidly growning and it’s a good place to move company to. I recommend to everyone .

  • TobBoymn Says:

    Good business!

  • Jo Says:

    Dear Ms. Carole,

    Good day. I am 37y.o., married for more than 7 years. I had natural cycle ivf recently but not successful.
    I have also sent a private email to you. Pls see email with attached pictures.

    One fertilized embryo reached blastocyst at day 6. Clinic graded it at grade C. It was my first time to have a blastocyst from all my ivf .

    When it was transfered, the blastocyst is not yet expanded, the embryologist said it will expand in the uterus. Should I have waited it to expand before transfer? How long is the maximum hours can we wait after thaw, before transfer?

    I would like to ask if I should have transfered on day 4, 8 cell instead of waiting till it reached blastocyst at day 6?

    If ever next time, it would not be a slow growth embryo, should I transfer on 8 cell stage? Knowing I only usually produce 1-2 fertized egg. What if 8 cell at day 4, is it still good to have a fresh transfer?

    Is morulla at day 5 good to be transferred? What if it is a morulla at day 3?

    Can we still have an embryo transfer on day 6?

    I had many conventional IVFs- stimulated cycles. One successful (after 3 ivf cycle) but the baby died at 18 weeks due to twisted umbilical tube. It was a day 3 transfer at 8 cell. During this cycle the doctor include saizen growth hormone with the other stimulation medicines. I am thinking if I can include saizen in natural cycle ivf? Will it help the growth and quality of embryo? Can I also drink amino acids?
    http://www.ncbi.nlm.nih.gov/pubmed/16447100 I have also come across this article stating using saizen in the culture? What is usually the best contents in the culture?

    Thank you. Hope to get your views and replies.

    Jo

  • Carole Says:

    HI Jo,
    RE: your photo: it looks like it slowed a little at the transition between cleavage and morula which persisted but the appearance of the blast is good.

    I will try to answer your lab-related questions below, but as I am not a medical doctor, I can’t answer all of your questions.

    RE: When it was transfered, the blastocyst is not yet expanded, the embryologist said it will expand in the uterus. Should I have waited it to expand before transfer? How long is the maximum hours can we wait after thaw, before transfer?
    It is fine to transfer unexpanded blasts. If they are healthy, they will re-expand in a few hours whether they are in the dish or in your uterus.

    RE:I would like to ask if I should have transfered on day 4, 8 cell instead of waiting till it reached blastocyst at day 6? Embryos have been transferred at every stage of development with success. The fact that the embryo seems to be a day behind is a little concerning but even so, pregnancies do result with lagging embryos.

    RE: If ever next time, it would not be a slow growth embryo, should I transfer on 8 cell stage? Knowing I only usually produce 1-2 fertized egg. What if 8 cell at day 4, is it still good to have a fresh transfer? Again, any stage will work. We grow longer in culture in order to select the embryo who progress at the proper rate and look healthy. If we are doing genetic testing, we may cuulture longer to wait for test resuklts. Culturing more or less does not affect whether the embryo will implant, if it is healthy.

    RE:Is morulla at day 5 good to be transferred? What if it is a morulla at day 3? We want a morula on day 4, that is the right progression.

    RE:Can we still have an embryo transfer on day 6?
    Some programs report good results with day 6 embryos. In our program, most of our embryos reached blast on day 5 , so most of our transfers were on day 5.

    RE:I had many conventional IVFs- stimulated cycles. One successful (after 3 ivf cycle) but the baby died at 18 weeks due to twisted umbilical tube. It was a day 3 transfer at 8 cell. During this cycle the doctor include saizen growth hormone with the other stimulation medicines. I am thinking if I can include saizen in natural cycle ivf? Will it help the growth and quality of embryo? Can I also drink amino acids? This question is better for your doctor, not me.

    RE: http://www.ncbi.nlm.nih.gov/pubmed/16447100 I have also come across this article stating using saizen in the culture? What is usually the best contents in the culture? I am not familiar with this additive.

    Wishing you Much Good Luck.

  • Sallyb Says:

    Hi Carole,
    What a wonderful, informative site you have. I’m not sure if there is an answer to this question but I was wondering if there is any known reason that embryos begin to compact at different stages. I had an 8 cell transferred on day 3 that was showing no signs of compaction but there was also a 5 cell that was already showing signs of compaction and it went on to become a day 5 blast (now on ice). I would have thought that they would all reach a similar number of cells before being able to advance to the next stage.

  • EllieS Says:

    Hi Carole
    Thank you so much for responding the all of these questions;already the answers from others have helped me understand the process better.
    I am 41. Amh 20.1. No known male factor – just my age.
    I am having (I hope) a five day transfer tomorrow. I feel I have been blessed with how things have worked to far. I has 15 eggs retreived, 15 fertilised, and still 15 ‘top quality’ with less than 10% fragmentation on day 2.
    On day three three embryos had fallen behind to five cells but the lab said that 12 were top quality at their expected 6-8 cells.
    Today, day four I have 8 morulas, 4 x 12 cells ‘top quality’,
    (should I be thinking these are a bit slow)? , two eight cells (slower again) and one prob arrested and still at 5 cells. They have done assisted hatching on them alll on day 3.
    I wonder if you might be able to estimate how many might make it to freeze and also advise if the assisted hatching would help or hinder the freezing process.
    Also I understand assisted hatching increases the chance of identical twins so am now wondering if I should consider a single embryo transfer with the hoped-for cushion of FET in the future, the lab says they have a 10% chance of multiples in my age group but I don’t know if that’s not taking assisted hatching into account…
    Sorry I know I am fortunate with my numbers so far, I am happy, just such big decisions to make imminently…
    Many thanks for any thoughts you can give…

  • Carole Says:

    Hi Helen,

    Re: Today, day four I have 8 morulas, 4 x 12 cells ‘top quality’,. these are actually right on target- morula on day 4 is great. The other 4 my be a little slow but only lagging a day- may still be fine. Your program will probably transfer some of the ones that are morula today because they should be blastocysts on day 5 when you are expecting a transfer. I really can’t estimate how many will make it to freeze but since you are doing real well so far, I’d expect 4-6 to freeze from the 8 morulas, depending on how many are transferred. Depending on program policy, any blastocysts on day 6 may also be frozen.

    I am always a fan of SET, if you can afford multiple transfers, since your chance of being pregnant is reduced to one chance per transfer, not two. Like buying two lottery tickets instead of one. :) Singleton pregnancies are more likely to have fewer, if any, obstetrical complications. I think you are on the right track. Good Luck!!

  • Carole Says:

    Hi SallyB,
    Good questions. I have observed compaction occurring with a variable number of cells. I don’t think we understand what the triggers are. The most popular scoring system gives better grades to embryos with more cells at the blastocyst stage but I have seen plenty of pregnancies from embryos with less than stellar scores so not sure how important any of these variables are. There is still much to understand but research with humans is difficult and embryo research is especially difficult to perform so we work by trial and error. Carole

  • EllieS Says:

    Hi Carole
    Thanks so much for you reply- you’re very kind to spend your time doing this!

  • blogspot.com Says:

    Hey there! This is my first visit to your blog!
    We are a collection of volunteers and starting a new project in a community in the
    same niche. Your blog provided us valuable information to
    work on. You have done a extraordinary job!

  • Kelly rr Says:

    Hi there

    Hoping this will be an easy one for you!

    I am currently on the two week wait, I had a 5AA blastocyst transferred on Tuesday 18th. I was told it was perfect and couldn’t get any better!? I am 29 years old and our only problem is I have slight pcos. Do you think our chances are good for implantation if the blast was already hatching?

    I am pulling my hair out already.

    Many thanks in advance

    Kelly x

  • Carole Says:

    Hi Kelly rr,
    Based on what you have told me, you have a very good chance of getting pregnant. The fact that the embryo was already hatching means it is doing what it is supposed to do. That doesn’t hurt your chances. Good Luck!!

  • LouBConn Says:

    Hello there, On Monday my husband gave his sample, for my donor eggs, she is younger then me I am 45. On the Wednesday of the same week I had a ET with two, 4 cells embryos, I have no medical issues to prevent me from carrying, but when I look for success rates they are pretty hard to find for my age group, and especially with donor eggs. I have been reading our blog and am a little worried that you talk about the embryo being 8 cells at day 3 but both mine were 4 cells, do I need to be worrying, I am also suffering with tummy cramps but have had no spotting or bleeding, but jut the discomfort which does feel like period pains.

  • Carole Says:

    Hi LouBConn,
    Worrying doesn’t do any good so if you can distract yourself with work or other engaging activity, that will make you feel better. You didn’t say how young the donor is but your expected pregnancy rate should be similar to the age of the donor, assuming no other issues exist. Four cells on day 3 might be slow but depending on how early in the day the embryo scoring was done, the embryos may just have been on the verge of a cell division in each of those 4 cells and the embryos would quickly get to the 8 cell stage. Every scoring event is a snapshot in time so is best used as a guideline, not a marker of either certain pregnancy or certain cycle failure. So, since you can’t do anything about it at this point, just try to busy yourself with all the other things important to you until you can have the pregnancy test and know. Wishing you much good luck!!!

  • LouBCon Says:

    Hi Carole, I did a test at day 11, as I was hoping that HGC would be detectable by then, but test was Neg, could I be perhaps a day slower as they were only 4 cells on transfer, I’m past my period due date which was today Sunday, bt haven’t bleed at all, but this could be the effects of the progestrone I believe. My clinic has asked me to confirm on Wed this week with a home pregnancy test only, should I get blood drawn though to determine either way, as I’m in the services I can get this done free of charge. If so can I get it done before the 14 days, or will it be a waste of time, desperately hoping here that it’s a positive.

  • Carole Says:

    Hi Lou B Con,
    I am sorry that you are having such a hard time. Yes, sometimes an initial pregnancy result can be in error. Blood tests are considered the most reliable pregnancy test but urine tests are getting almost as good. I would follow your doctor’s instructions regarding your follow-up testing. They have all your information and also have the experience of how and when they can get reliable pregnancy test results for their IVF patients. Programs vary testing dates based on the day of transfer so there is some variation between programs and patients depending on transfer date. I wish you much good luck! Carole

  • Louise Says:

    Hi Carole

    Thank you so much for giving up your time to answer so many questions. Your blog is a great source of information and your help is greatly appreciated.

    My background – I am 33 years old and have previously had 4 natural pregnancies which sadly resulted in miscarriages. The first was identical twins with only 1 slow heartbeat which then stopped, the second I went into early labour and lost my son at 19 weeks, the third was a blighted ovum and the fourth a slow heartbeat which stopped early on. All tests for me and my husband came back normal and testing on the last miscarriage showed that the baby was chromosomally normal. It was recently discovered that my amh is 10 and we were then referred for ivf because of this reason. I was told that as I have less eggs than I should have then it is more likely that I could have more “bad” ones.

    I am currently 1dp5dt following my first IVF cycle. I had 13 eggs retrieved of which 8 fertilised and all were frozen at the 2pn stage due to OHSS (I had 50 follicles). The embryologist advised thawing all 8 and going to day 5. On arrival for transfer we were informed that only 1 had made it to blast but it was an early blast. It had not yet started to expand. The embryologist was very positive and explained that the different cell types could clearly be seen. She also said that it could have expanded in the couple of hours since she had last looked at it. At the transfer however, the early blast was exactly the same as a couple of hours previous and it had not changed. In your experience would you have expected there to be a definite change to full blast or could the fact that it was the same still be quite normal?

    I have read lots of success stories with early blasts and on the whole I’m keeping positive. There was one other embryo (not quite sure of its stage) which was being checked today at day 6 to see if it could be frozen. I do not know the outcome yet but as it is slow developing I am realistic that our best chance is hopefully snuggling in right now.

    I am also curious if only 1 making it to day 5 early blast and potentially 1 other is normal for someone my age? Could my amh be the reason for this? Or could they be slower because they had been thawed?

    Sorry for the huge message. Any help or advice you could give would be much appreciated.

    Thank you so much
    Louise

  • Carole Says:

    Hi Louise,
    I am glad you find the blog useful. Re: your question: “In your experience would you have expected there to be a definite change to full blast or could the fact that it was the same still be quite normal?” Two hours is probably not enough time to go from an early blast to expanded blast so I wouldn’t worry if there was not a lot of change. RE; your questions, “I am also curious if only 1 making it to day 5 early blast and potentially 1 other is normal for someone my age?” It can be normal for anyone at any age. There is a huge range in outcomes. Re: “Could my amh be the reason for this? Or could they be slower because they had been thawed?”, AMH is related to the number of eggs you have ( your ovarian reserve) and not necessarily quality so it’s not obvious that AMH is the explanation. Thawing, likewise, should not really slow them, unless they are damaged. I would feel really hopeful about the early blast transfer you had– Good Luck!!!

  • Tasha Says:

    Hi Carole,

    I am so thankful that you have such a great and informative website!

    My husband and I recently went through an IVF cycle for family balancing. We currently have 2 boys naturally.

    I am 30 and he is 32. We were on low doses of stims and were informed that egg quality was good. We had 14 retrieved, 11 mature and all 11 fertilized by ICSI. By day 5, we had 8 “nice looking” embryos to biopsy for PGS screening.

    Out of those 8, we had 2 HB (1 with monosomy, 1 with no DNA detected which could be normal but will have to be retested at some point), 2 XB (both abnormal monosomy), 1 morula (complex abnormalities), and 3 compacted/early blasts (2 were abnormal, but 1 is our healthy girl).

    We are planning an FET in the spring with our healthy girl compacted/early blast, but I wasn’t really sure what that meant? Does that mean she is almost a blast or is further along with a morula and starting to develop a fluid cavity?

    The doctor and embryologist feel we have a great chance with her and strongly feel it will work and that we may not have to cycle again (given our fertility history, other embryo progression into HB, age, etc?), but I am still nervous since she is a little slow it sounds in development. This is a good clinic with a 60% success rate in my age category with 300+ cycles per year. We were also concerned with having so many abnormals, but karyotypes came back normal, so that was attributed to bad luck…

    Do you think we have a good chance with this embryo?

  • Carole Says:

    Hi Tasha,
    I am glad you find the blog helpful. I will try to answer your questions below.
    RE: We are planning an FET in the spring with our healthy girl compacted/early blast, but I wasn’t really sure what that meant? Does that mean she is almost a blast or is further along with a morula and starting to develop a fluid cavity? A compacted/early blast means the embryo is midway between the morula stage and the blast stage. The technician sees a tight ball of cells with the tiniest beginnings of a fluid-filled space. This is perfectly fine and we have had many pregnancies over the years with embryos at this stage. Yes, I think you have a good chance with this embryo. Good Luck! Carole

  • Tasha Says:

    Thanks so much!!

    I am glad we have a chance.

    Is this embryo considered to be behind at all?

    Can you think of a reason why the embryo would be a little behind, considering it is chromosomally normal? The quality of our embryos is fine according to the doctor and embryologist. I am guessing this could also be why we had expanded and hatching blasts?

    I thought it was odd that our only normal was a little behind in development and the abnormals were so advanced!

    Their plan is to thaw the healthy embryo overnight in hopes that it will have expanded and potentially hatched by the morning of transfer (5.5 days?) I am guessing if it expands it has a good chance to hatch since it was biopsied for PGS. Does that sound right to you?

    Thank you so much again!!

  • Carole Says:

    Hi Tasha,
    Here’s the thing. We have certain expectations of when embryos reach different stages, but for each of these, there is some latitude in hours (a range) of time that the embryo has to reach the milestone and still be normal. Just as for milestones for small children. On average, children walk at about 12 months, but normal range is a few months before and a few months after the middle 12 month mark. Also, the time at which development starts can be different for a group of embryos. If you imagine fertilization to be the start point of the race, this can happen over several hours among a group of eggs. Not every egg will start their journey of post-fertilization development at the same exact time. So I would lose absolutely no sleep over the fact that your embryo was scored as an early blast. Also, the genetic content of an embryo can be abnormal (for instance, the 3PN embryo) but 3PNs grow into beautiful looking blasts with no developmental future that can result in a baby. So again, don’t assume a perfect one-to-one correlation between genetic normality and appropriate progression. Regarding expansion- expansion is a prerequisite to hatching so yes, expansion is a good sign. Don’t worry, be hopeful. Good Luck!!

  • Stephen Says:

    Hello Carole,

    Thanks in advance–this site/you are great.

    We transferred two embryos as shown here: http://s1242.photobucket.com/user/aazark/media/20130910_175535_zps52f17fac.jpg.html

    These are day 5. We were told that these were in the morula stage and did not have a very high chance of success because they are slow growing. In looking online, these look like early blasts to our uneducated eyes. We were wondering if you would offer your input on what we are seeing here.

    We also did not choose assisted hatching and are wondering if we should have. These were all originally frozen on day 1 of retrieval.

    On day 3, we had two embryos that were 8 cells, some 6, 5, and 4 cells. We were curious if the two that we transferred were likely the two 8 cells from day 3. We were told that we probably would not have any left to refreeze.

    We are worried that if the two cells are late/slow growing that she will get her period before they have a chance to hatch and implant. Do you know how long it would take, theoretically, for the two implanted embryos to expand and thus hatch?

    Thanks.

  • Carole Says:

    HI Stephen,
    Thanks for your kind words about the blog. From the picture you sent, these embryos are likely morulas, but without being able to roll them over (they could have a small space on the side we can’t see), the best guess is morula stage. They might be slightly lagging but I wouldn’t worry about being out of sync with your wife’s endometrium. The uterus has a several day window to acommodate the kind of lagging you see here (just one day probably). I see that the zonas are fairly thick but I don’t know if you “should have” done hatching. If this doesn’t work, that still doesn’t mean you needed hatching. There’s really no way to be sure you need hatching. IF the lab’s hatching technique is poor- you also can prevent implantation – if embryo is damaged- so nothing is risk free. What I am trying to tell you is, I know it is hard but don’t second guess, beat yourself up over your choices. You may very well get pregnant this cycle. Try to be cautiously optimistic while you wait. To answer your last question- Check out this great link which lists the days in the life of the embryo after transfer http://www.nyufertilitycenter.org/ivf/embryo_transfer. I am wishing you Much Good Luck for a positive pregnancy test!! Carole

  • Diane Says:

    Thank you for helping so many people! We are looking for some reliable data to help guide us emotionally. Our first lab retrieval: 19 follicles but by day 5 we ended with 1 good embryo, 2 fair and 1 poor. We were advised, as a result of our age to go through another cycle. Our second retrieval started out with 26 eggs, but by day 2 we had 9 good eggs, 6 fair and rest poor. By day 5 we had 2 fair embryos and 2 poor/fair – Zero good.
    Q: Should we be concerned that all our Good eggs died off by day 5? Is there a coloration with fair embryos and a successful term pregnancy?

  • Carole Says:

    Hi Diane,
    I am sorry you are having a difficult time. Embryos can fail to progress for two primary reasons- first, problems inherent to the embryo, sometimes genetic problems arising from either sperm or egg or both, or secondly, the lab is not able to culture embryos reliably to the blastocyst stage. The first questions might be to assess whether the lab has been doing day 5 culture for a long time (at least a year) or just a few months and what percentage of patient embryos -on average- make it to blast stage. You don’t mention your age but say that it could be a factor. Older couples- both men and women, are more likely to have aneuploidy issues (an abnormal number/structural issues of chromosomes in egg or sperm – which can cause problems with embryo progression. Although I have seen fair and even poor quality embryos (as judged by their appearance or morphology) produce pregnancy and live birth, we expect better outcomes with better looking embryos so yes, poor morphology generally reduces your odds of pregnancy. I would recommend addressing these concerns with your doctor and asking what their specific experience is with patients like you and your husband (age, underlying conditions etc.). This should give you more information about what might be best for you as a next step. I wish you Much Good Luck going forward!! Carole

  • VP Says:

    Hi Carole,

    I had EC yesterday (25th Sep) and they have 5 eggs collected. Today embriologist said 4 out of 5 fertilised (IVF)and 3 are strong comparatively and 1 is a bit slow. They are asking us to choose between day2 or blastocyst. I am 32 and had been slow responser with PCOS and low AMH during stimms.

    Please can you advise me which one is best option for us, we are really confused?
    Thanks for your help

  • Carole Says:

    Hi VP,
    Normally, I like day 5 transfer, especially if you have a lot of embryos in culture- because it helps to identify the best growing embryos- assuming that the lab is good at extended culture. In your case, if it is possible to distinguish the top two best embryos on day 3, you probably will be okay with a earlier transfer. Good Luck!! Carole

  • VP Says:

    Thanks Carole,

    I am at peace now. The clinic just rang up and said that they had 2 embies at 4 cell stage and growing good. They are also suggesting to day2 transfer and hope this will work.

    You are doing a great job..keep it up.

    VP

  • Dee Says:

    Hi Carole:

    I am 41 years old and just transfered 4 embryos 3 days past retrieval. One of them was an 8-cell, two were 6-cells, and one was a 7-cell that was missing its zona. They were all graded 2 (on a scale of 1-5, with 1 being the best). I’ve never heard of an embryo with a misisng zona pellucida and it’s throwing me for a loop. Do you know anything about this and how this my impact my chances of succes? Is this something associated with AMA or is it genetic? Thanks! Dee

  • Carole Says:

    Hi Dee,
    We sometimes find an egg with a missing zona. The zona is a carbohydrate shell and can become cracked, torn if it is thin or fragile, and fall off. SOmetimes we see it come off as we move it around in pipettes. Once we had a problem with many cracked zonas and found that the retrieval pump pressure was set too high and was damaging the zonas. When during development the zona is lost makes a difference. if it is lost before the morula stage (= day 4 of culture) , the cells are not stuck together and the shell is what keeps them in association with each other so they can go to the next stage. So if this happens early, you might not have enough cells remaining together to forma morula and functioning embryo. IF it happens after the morula stage, the embryo stays together. We have transferred the occasional blastocyst without a shell and gotten pregnancies. Without the shell, the embryo tends to be more “sticky” and might want to stay in the catheter at transfer but protein in the media usually keeps this from happening. I don’t think there is any evidence that the occasional loss of zona from one of a group of eggs is related to either AMA or genetics. However, we have seen a rare patient before whose zonas seem particularly fragile– there could be a genetic basis if ALL the eggs are fragile or without zonas. The zona is laid down in layers of carbohydrate while the egg matures in the ovarian follicle. Like any biological process, there could be genetic basis for missteps in the process.

    I really would not lose any sleep over one egg with a lost zona. Good Luck!!! Carole

  • Dee Says:

    Thanks for the quick response!

  • Alex Says:

    Hi Carol.  

    This is a great blog. Lots of great information. Thank you for helping us all.

    Im 42 years old last month.  I have a 9 year old son conceived naturally at age 32. I have since been preganant twice, at age 37 and at age 40, the last resulting in a miscarriage at week 7.  After many failed tracking cycles and 1 failed IUI cycle we decided to start IVF.  I have just completed my 4th cycle.   In my first long cycle, we collected 6 eggs, 4 fertilised, 1 went to PGD but not viable.

    In my second long cycle, I ovulated way before egg collection so we had to cancel the cycle.  

    In my third short (antagonist) cycle, 12 eggs were collected, 6 mature, 4 fertilised, 3 went to PGD, none viable.  

    I had a 2 month break then…..

    In this last cycle (antagonist again), 12 eggs were collected, 7 mature, all 7 fertilised, 5 made it to PGD as the other 2 were only 4 cell on day 3 and couldnt be biopsied.  At my appointment today (day 5) where I was hoping for a viable transfer, I was told all 5 were not viable.    

    However, 1 of the 2 that were only 4 cell on day 3 had developed to a nice looking morula and the doctor gave me the option to implant that.  I asked if it could be biopsied now and she said no that they only biopsy day 3.  She was obviously concerned for its quality and a probable miscarriage etc.  Even though I felt the stats were against me, I made the decision to implant the morula.  I didnt think I would ever stop wondering if it was my one and only ever viable

    Im worried about my decision.  

    For the last 3 months I have been taking chinese herbs for liver/kidney qui deficiency and they have dramatically improved my pms symptoms etc. and I have been having acupuncture weekly for about 6 months.   I am otherwise very healthy, eat very well, exercise regularly, take supplements etc.  My fertility issues have come down to age and egg quality. My partners sperm result was quite strong and genetically also.   Do you know of any miraculous way of possibly improving egg quality?  

    Im starting to lose hope.  

    Thanks  

    Alex

  • Carole Says:

    Hi Alex,

    I am sorry you are having such a hard time. First off, since you are waiting for a preg test- keep hopeful. The embryo did make it to morula stage. THat is a good sign. I am sure your doctor will recommend follow-up testing during your pregnancy- CVS or amniocentesis, to check whether the fetus has health problems.

    When you describe multiple (3 or more) disappointing cycles, it becomes clear that IVF is not working well for you. The question is, if this cycle is not positive, how much more can you take of this? Unless you have limitless financial and emotional reserves, everyone with these experiences reaches a point where they have to reconsider their approach and decide what is the most important thing to them? Is it having a genetically related child? That option is the most limiting and biology can place some hurdles that can’t be overcome with current technology/medicine- although there is a lot of research going on trying to change that!!. Maybe upon reflection, you decide that raising a child, even one that is not genetically related to you is most important? If the second is true, than you have many more options– egg donor, accepting a donated embryo from someone else and traditional adoption. So there are many paths to parenthood. You might even decide that your life can be full, interesting and meaningful even if you don’t have children. There are NO WRONG or RIGHT ANSWERS. It is ok to decide one way works for you, the other doesn’t. IVF is very process oriented and even addictive in the sense that with multiple negative results you may start to believe that the next cycle must work- when sadly, it may not ever work.

    So, my advice is wait and see how this transfer turns out. If you are disappointed again, take some time to reflect on what matters to you. Your path will reveal itself. Wishing you Much Good Luck!!!!

  • Brooke Says:

    Hi Carol,
    I’m 36 yrs old going into 4th round ivf. My husband is 53 & has 13 yr old vasectomy ( has daughter.) Our 1st round was using old sperm from vasectomy which Dr’s feel was frozen incorrectly b/c was very poor. I had 11 eggs, 7 mature & 100% fertilization. Embryos didn’t make it to day 5. 2nd round, used pesa sperm (frozen)- i had 9 eggs /6 mature, 75% fertilization- two made blast & were cgh tested- one normal. No pregnancy. 3rd, same pesa sperm, i had 13 eggs/7 mature- same good fertilization. Day 3 embryos had one 6 cell & rest fewer w/ a good bit fragmentation. No blasts ( no transfer.) I’m confused as to why 2nd was better. Changed re’s. Still local. But now wondering if a clinic like cornell w/ co culture would make a difference for us. Drs don’t know if it’s egg or sperm, but we can make normal embryos. I’m also so on the fence about day 3 vs day 5 transfer… I’ve read in a study that some poor embryos have better chance in uterus than petri dish?
    So conflicted.. :(

  • Carole Says:

    Hi Brooke,
    I am sorry you are having such a hard time. I think I would probably give you the same advice as Alex in this same thread. IVF is not working very efficiently for you. Fertilization rates are decent but then embryo development is poor. Of 7 fertilized embryos, two were tested and only one was normal. This result plus the observation that most of the embryos do not seem to reliably go to blast could suggest that there is an underlying genetic or chromosomal aneuploidy issue. Either sperm or egg- or both- could cause that. I don’t have any reason to expect that co-culture would help if there is an underlying genetic/chromosomal aneuploidy problem in the embryos. Shorter culture also does not correct genetic issues. The issue with longer term culture is that some animal studies suggest that genetic imprinting may not be normal with extended culture but there is no consensus as to whether that is a real problem with human embryos- since IVF children are generally healthy. I wish I could offer a better solution. IVF can solve some problems but not all- it might be time to re-evaluate all your options. Good Luck!!!

  • Alex Says:

    Thank you for your quick response Carol. I have hopes for my little morula still. My body reacts big time to hcg so i guess ill have a better idea in a few days if it has implanted?? I guess my partner and I feel that we have jack, our son, so if we can’t have a genetic sibling we will move on and focus and him and us and having more holidays as he is now a great age to go almost everwhere :). With or without a sibling we are very lucky and blessed. Im not done with ivf yet though. Call me stubborn ;) i have great health on my side. im going to have a break for a few months – I have an overseas trip planned for December and then try again in February. I hear stories all the time of people my age getting lucky after many attempts. A few months will give us a pause from the financial hit of ivf too. The last round was not as tiring as the 3rd round and the antagonist cycle is much easier than the long cycle. My doc told me that he wont suggest I give up til my 44th bday. Not sure ill make it that far. To everyone else on this blog I wish you all the best of luck. Thanks Carol

  • Roxy Says:

    We transferred 2 blasts this morning. One was graded an 18 was looking great and within 2 hours of transfer it started to collapse. Is this bad. We were told when they collapse it can be a poor outcome. Can you explain please

    On 5 IVF

    Thanks

  • Carole Says:

    Hi Roxy,
    I don’t have enough information on your case to advise you but I can make general comments. Blastocysts fill up with fluid that they pump into their central cavity. If they collapse, they usually reform these fluid filled cavities, by pumping more fluid in. It’s not an problem for a healthy blastocyst. In fact, when we prepare to freeze a blast, we often purposefully deflate our blasts by making an opening between two cells so they freeze better. Upon thawing, they reseal the opening and re-inflate, assuming they survived the thaw. I don’t understand their comment that collapse is a sign of a poor outcome. I think you need to go back to them and ask them to explain exactly why they are concerned about the collapse. They may have other information to inform this opinion. Good Luck!!!!

  • smts Says:

    We received donor eggs from a 24 year old donor — 22 eggs retrieved, 13 mature, 13 fertilized, 6 made it to blast, and of those, only 3 were chromosomally normal. This seems like a low rate of normals for such a young donor…what do you think? I’ve seen many estimates of the percent of normal EGGS based on age, but little about the percent of normal blastocysts — from what I have read, it seems that more abnormal embryos arrest before blast stage?

  • Carole Says:

    Hi Smts,
    We have seen this puzzling result in our egg donors before. Since the blasts were abnormal, it is possible that the abnormal chromosomes arose during the early cell divisions and may not have been present in the egg–or they may have been. There are also problems with testing. Sometimes not all cells in an embryo are identical –some cells may be abnormal sitting right next to a normal cell- called mosaicism. Sampling more cells is one way to deal with this potential problem. There is also an inherent error rate in the testing- even when conditions are perfect of 2-5%. That means for every 100 embryos, 2-5 will have the wrong result reported. Embryos can arrest at any stage, even after implantation, causing a miscarriage. Unfortunately, I can not explain why there are so few normals in the scenario you describe. I can only list some of the possible causes. Wishing you much good luck with your transfer! Carole

  • smts Says:

    Thanks, Carole — I mostly wanted to know if this was typical or not — sounds like it’s not typical, but not unheard of either. What would be a typical or average result for a young woman (under 30), given a mature egg count of, say, 15 eggs. How many normal blasts would you expect to see?

  • Carole Says:

    Hi smts,
    It’s a really hard question to answer because embryos from egg donors have a paternal factor too. Generally speaking, I might –on average–expect a fertilization rate of 80%, so about 12 eggs fertilized if you start with 15, and I would expect 50-75% of those to make it to blast stage so 6-9 blasts might be an average result in in a young egg donor. Of course, I have seen better and worse so there really is no simple answer. Hope this helps. Carole

  • smts Says:

    Hi again — the gap in knowledge (not yours, but overall!) seems to be how many blasts should be expected to be chromosomally normal, given a young donor. There are a few studies I looked at, and all showed an average normal blast rate of around 50 – 55%, but they either included all ages (average age = 37) or broke it down into over 35/under 35. My lab suggested to me that with a 24 year old donor, we could expect 4 to 6 of our 6 blasts to be normal, and we ended up with 3. (doesn’t seem like a huge difference, but it was a shock to start with 22 follicles and end up with 3 viable embryos…)

  • Jacky Tsui Says:

    Just wonder in the lab , how is the euploidy or aneuploidy rate for early clevage EC embryo ? or not much signifcant difference with Non-EC embryo

  • Carole Says:

    That’s a good question. The degree that rate of development (earlier cleavage rather than later cleavage) and aneuploidy may be linked are poorly understood. I think that with the advent of routine time lapse imaging of embryos coupled with aneuploidy testing, we’ll be able to answer that question more completely. I think we already have some evidence that very slowly dividing embryos may be more often aneuploid, but that is not always the case. So, hopefully we’ll know more in a few years as labs start to publish their experience with time-lapse coupled with aneuploidy testing. C.

  • Harry Says:

    Hi Carol
    I’m 34 years old and just underwent a FET today with 2 blasts- my husband is azoospermic so we used donor sperm. The first IVF cycle we had (age 33), we got pregnant but sadly miscarried at 8 weeks. The two blasts we transferred today were originally graded a 4bb and a 3bb and our clinic doesn’t regrade after thawing. They said today that they had thawed ok but they had re-expanded (or were re-expanding) a little more slowly than they would like, but hopefully would continue to develop once back inside me. I think they started to thaw them around 10 and then transfer was at 2. Is it a cause for concern that they’ve not re-expanded quickly enough? Many thanks, Harry

  • Carole Says:

    Hi Harry,
    I don’t know of any guidelines about what rate of expansion is either too slow or too fast. At this point, it is best to be optimistic since you did have two blasts to transfer. I know it is hard not to be anxious but please try to distract yourself with something else during the two week wait. Wishing you Much Good Luck!!! Carole

  • Harry Says:

    Thanks for getting back to me Carol, I will try the distraction- finding this blog a brilliant source of info so thank you so much for making your knowledge available! Harry

  • Susie Says:

    Hi Carole, I just had a 3 day transfer of 3 frozen donor embryos. A transfer two years ago from the same set produced my son and a twin which sadly was lost in the first trimester. With my son and his twin we had two grade 1 8-cell embryos that were compacting. This time we have a grade 1 8-cell embryo, a grade 1 10-cell embryo and a grade 4 3-cell embryo (this last one not expected to grow further) but no compacting yet seen on the 8 or 10 cells. My question is whether these are essentially the same “quality” from your perspective as my first successful transfer? In other words is the absence of visible compaction on day 3 a bad thing with otherwise grade 1 embryos at 8 and 10 cells? And yes I compared pictures and they look the same to me, but I don’t know what compacting looks like exactly. Many thanks!!

  • Carole Says:

    HI Susie,
    I wouldn’t worry about lack of compaction on an eight cell embryo on day 3, this is typical. We usually see compaction on day 4, where all the cells sort of squish together like a mulberry and become attached to one another. These sound just fine. Good Luck!! Carole

  • Susie Says:

    Thanks so much for your super speedy reply! If I may, would you put the 10 cell in this same category?

  • Carole Says:

    Susie,
    Yes, the 10 cell probably would still fall in that category but I would hope to see compaction starting pretty soon after 10 cell. Good Luck! Carole

  • Susie Says:

    Carole, thanks so much for your reassurance! I am in fact pregnant, with a beta that went from 87 to 188 on days 11/13 post transfer. So it looks like one of the two took! Thanks again!

  • Carole Says:

    Susie-
    Fabulous news! Congratulations! :)

  • sm Says:

    Carole, I just received PGS results stating that we have 12 euploid (frozen) blasts, and the clinic states that, because they only freeze high quality (BB or higher) blasts, they select the embryo/s to thaw and transfer based on which one matured first. I asked to see the grading, anyway, just because I’m interested, but I’m curious what you think…would it make sense to ask them to select an embryo that reached blast stage a little later (all 12 reached blast in 5-6 days) if it was graded higher? One interesting fact is that the very first embryo that got to blast was actually anaploid, as were 4 others. The clinic has great success rates.

  • Carole Says:

    Hi sm,
    I think that any euploid blastocyst will likely have a good chance to implant. Since you have so many chromosomally normal embryos to choose from, trust your clinic to pick the one that, in their experience, will do best in their system. It is in their best interest to get you pregnant ASAP. Wishing you MUCH GOOD LUCK going forward! Carole

  • Rachel Says:

    Hi Carole,

    Great site! Very informative!
    I wonder if I could have your insight into my situation with slow developing embryos?

    IVF#1 2 follicles, 1 egg. On the morning of transfer (day 3) it was only a 2 cell, it went to a 4 cell in the afternoon before transfer. It was otherwise perfect in terms of cell size and fragmentation and got the highest grade. Negative result.

    IVF#2 12 follicles, 11 eggs, 5 mature, 4 fertilised. On the morning of day 2 there was one 2 cell and one that was just about to split, the other two where still just 1 cell. By late afternoon of transfer day (day 2) the leading embryo was still 2 cells and the one that was splitting went back to a 1 cell and another one had made it to 2 cells. Again both of these embryos where otherwise perfect and got the highest grade. Transferred both, negative result.

    Both cycles have been the long protocol, down regulation with buserelin injection and stims with gonal f. Both times I have ended up on my clinics max dosage of gonal f (450iu) as I respond poorly and my follicles stop growing/slow down (although I started at a higher dose the second time). We are both in our mid to late 20’s with no problems except for me having a low-ish AMH. I previously have responded well to clomid (2-4 follicles each time at 100mg) so I’m inclined to believe its the protocol/drugs that is the problem…..

    Any advice/insight would be very much appreciated :)

  • Carole Says:

    Dear Rachel,
    I am sorry you are having such a difficult time. In each case, the fact that the embryos did not reach 8 cell stage on day 3 is consistent with the negative outcome. It may be due to the stim propotocol but unless you have IVF data from the CLomid stims (these are usually combined with intercourse or IUI) it is comparing apples and oranges. By this I mean, that two follicles on ultrasound after clomid does not mean that the eggs would have necessarily progressed any better in the lab. Had you gotten pregnant on the CLomid cycles, it would provide evidence that at least one (maybe two) mature high quality eggs were available for fertilization. Having said that, I would probably get a second opinion from another RE who has very good pregnancy statistics. There are many variations on stim cycles and some REs are better versed on all the options available for difficult to stim patients. Good Luck!! Carole

  • Rachel Says:

    Thanks Carole, I did think that about the clomid but thought it was worth a mention anyway! Very few people I have found seem to have this as a recurring problem and I have begun to wonder if its an explanation for the ‘unexplained’ infertility. I have read lots about slower embryos having less chance of success but nothing about why they are slower or what is causing it/what can be changed. My clinic seem unable to explain it so I’m just trying to research as much as possible before our 3rd cycle.

  • Louise Says:

    Hi Carole
    On 7th August 2013 I posted that following an IVF cycle we had transferred a day 5 early blast. I was initially concerned that out of 8 fertilised embryos this was the only one available for transfer and it hadn’t yet developed into a full blast. I just wanted to feedback to you and others who may be reading this and in a similar situation that it worked and I’m currently 24 weeks pregnant. We couldn’t be happier!
    Thanks for your help and advice.

  • Carole Says:

    Congratulations!! Thanks for sharing your great news, I wish you and your family all the best in this New Year.

  • Malie Says:

    Hi Carol
    I just would like to ask regarding the embryo development.
    at my day 4 , there is only 9 cells ? is there still a chance for this to go to next stage on day 5 or 6 ( Blastocyst ) ?
    and be frozen for the next cycle?

    I am 37 years old.

    Thanks

  • Cally Says:

    Dear Carol,
    Thank you so much for the great blog! You are providing us all with so much instructive infos! I am very gratefull for the time you decided to dedicate to this!

    I am 36 years old, my husband is 43, it is our 2nd cycle of IVF. I got 14 eggs retreived and now I have 6 expanded blasts but only 1 is graded B/C and the other are C, then 2 regular blasts 1 B/C and 1B, all were frozen, no fresh transfer ( I think they said it was better to avoid any risk of OHSS)
    I was wondering how the grading influences the outcome, are there any studies about the Relationship between grading and chances of pregnacies/birth.
    I red in the thread that some clinic would only freeze “top quality” bastocycts, that would meen in another lab I would have found myself with maybe 1 or 2 embryos left -only instead of 6 if they had kept only the “good quality” ones? Am I getting my hopes up in wishing I can get 2 pregnancies out of this “batch?” Our dream is to have 2 kids so with that in mind, would it be safer to have another cycle before FET in order to “bank” more bastocycts before I get even older?….I would really appreciate your input even though I know the odds in that matter are highly unpredictable ;)

  • Carole Says:

    Hi Cally,
    I think you are in good shape and should try not to worry too much. I am sure that you feel disappointed that you didn’t have a fresh transfer but there is research showing that with the current freezing techniques (vitrification) you are often better off NOT to have a fresh transfer ESPECIALLY if your estradiol levels got very high, not just to avoid OHSS but also because implantation is less likely to work in an heavily estrogen dominant uterine lining. So this is probably all for the best. And I also would not stress about the grading. Yes, there are lots of papers about grading and implantation rates and little agreement. You can get pregnant with embryos that “scored” poorly and not get pregnant with embryos that scored high. The important point is that you have a lot of embryos that reached blastocyst stage, regardless of grade. You are 36 so that’s only a little beyond what is considered young in IVF so no, I wouldn’t bank a lot of embryos and delay an FET. I would try not to worry too much, distract yourself with other things and plan to have a great FET when your doctor thinks the timing is good. WIshing you MUCH GOOD LUCK!!! Carole

  • Mira Says:

    Dear Carol,
    Thank you so much for the great blog! Lots of great information. Thank you for helping us all!

    I am 39 years old, my husband is 52. We have had 2 IVF attmepts.
    During the first IVF, I’ve got 14 eggs retreived, out of them 10 matured, 10 fertilized. On day 5, 2 blastocist were transfered – grade 3AB and 3BA. No embrios were frozen.The result was negative.
    Durung the second IVF attempt, I’ve got 9 eggs retreived, out of them 5 matured, 4 ferlilized. On day 5, 2 blastocist were transfered – grade 5AB and 4AB. No embrios were frozen. The result was negative again.
    1.Do you think the negative results are due to a bad embrios or other reasons and what they might be?
    2. During the next attempt, do we have to consider a third day transfer?
    Thanks for your help and advice
    Mira

  • Carole Says:

    Hi Mira,
    Thanks for your kind words about the blog. In answer to your question about why you have had a couple of negative results, one of the likely possibilities is that some of these embryos have an abnormal number of chromosomes (either more or less). This condition is called aneuploidy and is probably the main reason why older women (over 35) have difficulty conceiving. As we age, the final steps in the process to make a mature egg become less well regulated and more mistakes happen. Talk to your doctor about the possibility of pre-implantation genetic screening (PGS) which involves sampling a few cells from each embryo (embryo biopsy) and checking whether the embryo is genetically normal or not- then only transfer the normal ones. If you want to do this, be aware that it adds several thousand dollars to the cost of the IVF cycle. You’ll also want to know that the lab you pick is very experienced with the process. And there is a chance you might find out that all the embryos are abnormal which is upsetting.
    In order to get the benefit of the genetic testing, you have to let the embryos grow out to day 5, to get a good biopsy of several cells from a blastocyst stage embryo and you might have to freeze all the embryos while you wait for results from the genetic testing lab. I don’t see any advantage for you in doing a 3 day transfer. Your embryos are reaching blastocyst stage so that is not the issue. Talk to your doctor and perhaps get a second opinion from another doctor before you do another cycle to make sure you understand all the options and the risks vs benefits for each. Good Luck!!!

  • Kirsten Says:

    Hi, thank you for all this great information. I am a 43 year old with secondary infertility. In my previous ivf cycle 12 months ago, I had 31 eggs, 24 fertilised, most went to 5 day but only 6 were used in my treatment (2 x fresh, 2 frozen, 2 not survived freeze) I had successful implantation on the fresh but mc. Bfn on the fet. I am wanting to do aCGH this time but clinic is resistant and only offers 3 day biopsy. From what I’ve read 5 day biopsies are most reliable, least invasive and have best results. Do you agree? Are there any reasons a 3 day biopsy might be preferable. I expect a goid quantity of fertilised eggs this cycle so am of the mindset at the moment aCGH is a good course of action for me. Thanks so much for your insights.

  • Nicole Says:

    I am 29 with borderline FSH (10.1) but good AFC (30) and amh (3.97). I just failed my first fresh IVF with a SET of 1 – 3 day grade A(A being the best my clinic gives) 8 cell compacting embryo. My estrogen was 3,300 on the day of trigger. 22 embryos were retrieved, only 8 were mature. ( I only stimmed for 7 days)
    Out of my 8 embryos,
    1 – 8 A compacting (transferred)
    4- 8A
    1-8B
    1-6A
    1-5A
    All 7 remaining embryos froze. We just thawed two – 8A. They were thawed the afternoon before transfer. Both thawed perfectly with all cells still in tact. One was an early morula, the other was a 12A.
    The RE that did my FET said that we have a great chance that both will stick due to my age and the quality. but then she said that we had a 40% chance at pregnancy. Does that seem right for the stage of the embryos? Also, is it possible that since I have only been pregnant once ( ended in a blighted ovum may 2013) that something could be wrong with my embryos? I have since had another HSG and a saline sonogram and everything checked out fine.

  • Carole Says:

    Dear Nicole,
    For your age, even with a few borderline lab results, it seems that the stimulation might be less than ideal because you had fewer mature eggs than would be expected. In the follow-up appointment with your doctor, ask her to explain what she might do differently in a second stim cycle. In our program, when the stim was so short (7 days) the docs would do what they could to coast the patient on lower doses so that they could get a few more days of stim in before the trigger. My guess is that your doctor would plan to adjust the protocol to get more mature eggs next time with a few days more stim. If she plans to use the exact same protocol again, you might benefit from getting a second opinion from another doctor. You can also ask your doctor what she bases the 40% pregnancy rate on? national statistics? Her own patient’s statistics? To get an idea what average rates are for women your age, look up pregnancy results for all the programs in your state at wwww.sart.org. Good Luck!! Carole

  • Nicole Says:

    Carole,
    Thank you so much for your quick reply. I did ask my RE, he said that he wasn’t sure what happened but he wasn’t concerned due to my 8 embryos looking so good. I assumed it was due to my protocol. I started the cycle with an AFC of 30+. On the day of trigger, I had 4 follicles @ 17nm, the rest were between 9 & 15mm. After my fresh cycle failed, I met with him as I just needed answers, I just drained my savings for the one thing in life that would make my life complete and I just needed reassurance. His reply was, there’s nothing wrong kid, you’ll get pregnant. We’ll just put two in next time. So that’s what I did and now I wait. Are you a fan of ESET or do you favor transferring 2?

  • Carole Says:

    Nicole,
    You’re very welcome. I do favor transferring one at a time, generally speaking, because if the conditions are right, and the embryo is healthy, you will get pregnant. Twin pregnancies are the largest risk factor attributed to IVF. I wrote a blog about this topic based on the latest findings from the ASRM meeting in October, 2013. You can read it here: http://fertilitylabinsider.com/2013/10/asrm-2013-update-art-safety-the-twin-effect/ The good news is that even if you have twins, obstetricians have more and more practice from IVF twins so it is usually manageable, even if not ideal.
    Wishing you Much Good Luck! Carole
    Carole

  • Samantha Upchurch Says:

    Hello
    What a great blog! My question is this: I am 42 1/2 and on my 7th round of IVF for unexplained infertility. On round 3 we had a wonderful healthy baby boy, and now want a sibling. We are really running out of money and time so want this next round to work. Our clinic does Eeva which we have used on our last 2 rounds, got 6-8 blastocysts each time, implanted 2 each time but never got pregnant and never had any to freeze. For financial reasons our next round will be our last. Should we continue with Eeva or would PGS /array CGH be more likely to give a better outcome given my age? (The latter will be more expensive but it’s worth it f it’s better). I can’t find anything on relative outcomes of these 2 techniques for women of my age, perhaps because they are both quite new? Thanks so much

  • Carole Says:

    Dear Samantha,
    I think the field is still trying to figure out the role of time lapse with or without PGS/array CGH. I am not sure whether eeva alone is a substitute for aneuploidy testing. At 42.5 years old, your probability of pregnancy is most likely reduced because many of your eggs would be expected to be chromosomally abnormal (aneuploid) which is what the PGS tests are for. The problem is that you may find that all your eggs in a particular cycle are aneuploid which would explain why you are not getting pregnant but won’t help you achieve the pregnancy you want. You have to decide whether gambling on another round of IVF with or without PGS will be useful to help you decide about next steps. How many more IVFs can you afford to put yourselves through? At the end of the next one, if you aren’t pregnant, that cycle should at least have some utility to give you information about next steps. I am not sure any of this is really helpful advice for you. Some people in your shoes would try egg donation, embryo donation or regular adoption, all of which are statistically better bets for a sibling for your son. But I understand that these options aren’t necessarily the right choices for you, I just hope the next cycle is more than just another cycle— but that it gives you more information, even if it does not succeed in getting you pregnant. Wishing you MUCH Good Luck!! Carole

  • Samantha Says:

    Dear Carole,
    Thank you so much for your very quick reply! I do realise that the odds are stacked against us and that aneuploidy is probably the reason why we’re failing, but we’re not yet ready for egg donation although we may consider it in the future. I was just thinking there’s less of a ticking clock on egg donation so wanted to throw everything at having our own genetic child first before I hit 43. I understand that on average at my age about 90% of my eggs are likely to be aneuploid, (ie 1 in 10 will be ok) so I was thinking if I do enough rounds and we have enough info on the eggs then maybe we could find that one egg. We can afford one last round with our own eggs, then if that fails we’ll pause to earn a little more, then go for a donor egg (as I could do that any time in my early 40s wheras I wouldn’t expect my eggs will be useable beyond 43). So for the best chance on this last round would you suggest PGS? Or do you think Eeva would do as good a job of finding the elusive egg (if indeed there is one) at less cost? Also do you think there is any merit in trying to improve my egg quality eg with melatonin as I believe there is a small scale Japanese study suggesting this might be helpful?
    Thank you so much
    Samantha

  • Alisa Winslow Says:

    Hi Carole:

    I am amazed at what you are doing, you clearly have a passion for your profession. Thank you.

    I am 38 and working with CCRM. Today we transferred our last CCS normal embryo. 100% of cells survived and the embryo was a 5BB in January when it was frozen but today had completely hatched, a 6BB. The embryo was a day 6 blast prior to the second freeze. It had to be thawed in January because the first CCS test was inconclusive.

    Transfer was at 11:45 and the thaw process started at 9 AM. We were reassured by the hatching and also the cell survival, but I am very concerned by the very slow expansion. I am also confused about how it would hatch without expanding and would appreciate your thoughts on that.

    When I asked the doctor he would not give me any stats and deferred to the embryologist who had already instructed me to ask the doctor for his thoughts. So… now I am relying on the internet for reassurance and am not finding much.

    I have a 2 year old daughter from our 34 year old embryos but it took us 4 cycles and 11 embryos to get her (they were 2 day transfers though). We switched to CCRM after 4 of our 2 day embryos failed to survive the thaw from my old clinic.

    At CCRM we had 12 retrieved, 11 fertilize, 5 make ti to blast, and 3 CCS normal. 2 of the normals took until day six to make it to the blast stage and one of those was transferred today.

    Two of the embryos were transferred in January and didn’t make it. This one is our last.

    Here is a picture,

    http://laughterthroughtearsblog.files.wordpress.com/2014/03/img_6698.jpg

    What are your thoughts? And can you help explain how it would hatch without expanding?

    I am off to go be positive… but would love your insight and expertise.

    Thanks in advance!

  • Alisa Winslow Says:

    Hi- I tried to post earlier but it didn’t show up here. Wondering if it was because I mentioned my clinic.

    Curious about my one remaining CCS normal embryo. It was a 5BB when frozen. Had to be thawed for testing after the first test was inconclusive. So today at transfer was a second thaw.

    Embryologist said it appeared we have 100% cell survival, but expansion was slight. Embryo was thawed around nine and transferred at 11:45/ It had also hatched and was rated a 6BB.

    I am confused as to how it hatched without expanding.

    Here is a photo. Appreciate any guidance you can give because I did not receive much after talking to both the embryologist and the doctor.

    I have a two year old daughter from my 34 year old cycles (two full cycles, 4 transfers, 11 embryos transferred). This cycle is my second full cycle for baby number 2. 2 CCS normal embryos failed to implant back in January.

    http://laughterthroughtearsblog.files.wordpress.com/2014/03/img_6698.jpg

    Great resource. THANK YOU!

  • Alisa Winslow Says:

    OOPS… and now mu earlier post is magically there. Sorry!

  • Carole Says:

    Hi Alisa,

    The picture you sent was a little blurry, but I wouldn’t get too distressed about the “hatched without expanding” comment. Embryos must expand in order to hatch but just because we didn’t get a picture of it, doesn’t mean it didn’t happen. Embryos can expand, and then collapse, only to reexpand and hatch. Or hatch and collapse. We collapse embryos deliberately before freezing sometimes and they re-expand at thaw. I think your embryo did expand but it may not have been documented or observed. Good Luck with your transfer! Carole

  • Alisa Winslow Says:

    Thanks so much Carole. I wonder if it hatched at the time they thawed it for the second go at the biopsy for CCS testing and just didn’t document it. Either way I hope the little guy expended and is settling in now.

    Appreciate your quick response. This is a terrific and informative site.

  • Lara Says:

    Hello Carole.

    Thank you for all of your very informative responses. My husband and I have done our first cycle of IVF. I have unexplained bilateral tubal blockage, after consisting our son naturally.

    I was on 300 gonal-F and 300 Menopur a day because I have an AMH level of .8. They were able to retrieve 15 eggs, 12 were mature and healthy. Husbands sperm appeared good on all levels, but only 1 egg fertilized. We had a day 3 transfer of a grade a, 12 cell embryo and did the assisted hatching to try to help it as much as possible.

    I have three questions please:

    1. What do you believe would be the possible causes of only 1 egg fertilizing?

    2. How often in a lab do you see a 12 cell day 3 embryo make it to the Blastocyst stage?

    3. With assisted hatching and 12 cells at this stage, would you expect the hatching to occur earlier then a 6 or 8 cell on day 3?

    Thanks so much for your time!

    I

  • Carole Says:

    Hi Lara,
    I am sorry you are having such a hard time. Re: your first question: This very low fertilization rate can be due to at least 3 possible issues – in no particular order- lab technical error or incompetence, immature eggs or a problem with either egg or sperm that was not previously detected (missing sperm or egg receptors). You don’t mention whether it was regular IVF or ICSI but such a low fert rate is more common with regular IVF. Your second question- a twelve cell may be dividing a little too rapidly to be normal-embryos with either faster or slower division rates are more likely to have an abnormal chromosome number (aneuploidy) and so are more likely to stop growing before blast stage.).Re: Q3: Not sure what you are asking re day 3. If it takes longer for a blast to get to blast stage, it would probably also hatch later in time than it’s faster sibling. If you are talking about assisted hatching, not sure what you mean- the tech can hatch the zona before blast stage or any time at blast stage. Clinic protocols vary by clinic. Good luck! Carole

  • Linda Says:

    Hi Carole,

    I am over 40 and struggling to make blasts. I just did an FET of my lone 5BB and it was not a success. I am contemplating whether I should do day 3 transfers or even day 2.
    Two questions:
    1) I am wondering why day 4 transfers are not more commonly done as opposed to day 3, since you are closer to the ideal location of where the embryo would be naturally in utero, but not risking not making it to blast.

    2) I doubt any studies have been done on this, but I started wondering about the “one-size-fits-all” sequential culture media that is used to culture to blast and wondered if older women’s embryos might have different “biochemical” requirements than someone in their 20s and 30s (i.e. might women over 40 need more customized sequential media due to the differences in our bodies biochemically (and eggs and resulting embryos) compared to our younger cohorts) or is an embryo just an embryo regardless of age other than aneuploidy issues? I thought it was an interesting hypothesis anyway…

    Thank you for all that you do with this website to enlighten, calm and teach us!

  • Carole Says:

    Hi Linda,
    I am sorry you are having such a difficult time. There are several reasons why labs persist in offering day 3 transfers: 1) they can’t reliably culture to blast stage, 2) the patient only has 1-2 embryos which would typically be transferred so there is no need for longer culture to pick the 1-2 best among many and 3)it is more labor intensive to culture embryos for 2-3 additional days in culture. It is possible that culture medium could be optimized for some populations of patients but that has not been shown scientifically. Frankly, we are still learning about what embryos need. I don’t know if day 2 or day 3 transfer would be helpful in your case. If the problem is due to aneuploidy, the time in culture would probably not make a difference in the final outcome. If there is another cause related to metabolism, maybe shorter incubation in suboptimal culture may be better. If IVF is covered by your insurance plan or you can afford another cycle easily, you might contemplate an additional cycle to feel you have tried everything but otherwise, it might be time to consider all the possibilities available to you to build a family including egg donation, embryo donation or even adoption. I wish you all the best going forward!! Carole

  • yvonne Says:

    in this life you leave to remember some helpers , as for me i will forever remember and be grateful to ashra spell temple,(ashraspelltemple@gmail.com) i have been married for more than 13years with no child, i have done all that is needed to be done ,visited hospitals and fertility clinic and so many other herbalist, but no result , until i was told by a good Samaritan of ashra spell temple . i tried and i ashra told me to do a cleanse and pregnancy spell that i will have to buy the items that will be used to do the spell, i though it was scam and so i refuse to send any money or buy the items that i was ask to buy here, and when my ivf failed me , i almost committed suicide ,because there was nothing i was leaving for , then i just said let me give ashra a try after all i was down and i didnt have any other hope , i did buy the items and a cleanse and pregnancy spell was done , to my greatest surprise , i didn’t even notice i was pregnant until i was feeling dizzy and went for check up , lol am 18weeks pregnant and the doctor said am doing fine , my advice to others is never give up until you have contacted ashra and ashra is legit and am a leaving witness ,
    i will leave ashra spell temple contact address for any one to verify and also get help
    email:ashraspelltemple@gmail.com
    mobile no:+2348058176311
    name:ashra spell temple

    regards

    yvonne

  • Sarah Says:

    Hello: yesterday we did a 3-day transfer of one 5 cell and one 11 cell embryo. I am 43. Do those sizes (I.e. Not 8 cell) indicate likely failure? We are at an excellent center. They retrieved 19, 16 were mature, we fertilized with icsi (non obstructive azoospermia), 3 fertilized, only the two we transferred made it it to day three. If this cycle fails, do those number indicate anything about future chances in another ivf (obviously age is against me). Is producing 16 mature eggs a positive (if at my age 1/10 eggs is bad does being able to produce around that number of mature eggs make it more possible to find one useable one)? For women in my age range is there data indicating what are the characteristics of the few successful ones? Thanks in advance.

  • Carole Says:

    Hi Sarah,
    While it is true that cell numbers much lower or higher than 8 cells on day 3 bode less well, it is too soon to give up on this cycle. The more mature eggs you produce, the better your odds that one or two might be normal, but as you said the odds are against you, based on age alone. As far as selecting the successful ones, the most common approach is to use pre-implantation genetic testing for aneuploidy and only transfer those embryos with a normal chromosome number. Consider asking your physician about this option. Other alternatives are donor egg or donor embryo. Wishing you much good luck going forward.

  • Heather Says:

    HI Carole,
    Love your blog! I’m hoping you can give me some advice. I had a IVF-ICSI cycle with TESE sperm when I was 28 (my husband has idiopathic obstructive azoospermia). I had 2 4AA blasts transferred, both took but I gave birth to one baby (I had a vanishing twin at 7 weeks). I have four blasts frozen from this cycle (4AA, 4AB, 4AB, and 4BA). Unfortunately they were frozen using the slow freeze technology. My dr says the thaw rates are about 80% and the success rate is 35- 40% for FET. I have a FET coming up and I’m not sure if I should transfer one or two embryos, especially since they were fertilized with TESE sperm (higher chance of chromosomal abnormalities?) and because they were frozen using the slow freeze method. What would you recommend? Thanks.

  • Carole Says:

    Hi Heather,
    I think that you’ll have more information on the day of the thaw because the embryologist typically evaluate them for their post-thaw quality- which is especially important with the older slow freeze technology. Here is a link to the ASRM practice committee opinion on how many embryos to transfer http://asrm.org/uploadedFiles/ASRM_Content/News_and_Publications/Practice_Guidelines/Guidelines_and_Minimum_Standards/Guidelines_on_number_of_embryos%281%29.pdf Basically, ASRM recommends 1 embryo for women under 35 with a favorable prognosis and 2 for those with a non-favorable diagnosis. The favorable vs non-favorable variable allows for your physician to include other particulars about your case that might argue for 2 embryos. Unless, there is some reason why you think you can’t afford another FET or can only have one FET procedure, I would probably thaw one and transfer it. If this FET doesn’t work, thaw one and transfer one in a second cycle, and so on. You are more likely to avoid having twins in this one at a time approach. Twins is the biggest obstetrical risk from IVF and carries the potential for trouble for both mother and child. In your case, you have already proven that two of two transferred can implant so the risk of twins is quite real. You need to balance the obstetrical risk of twins against the risk of not becoming pregnant from any single transfer attempt. You don’t need to decide now. At time of thaw, you will have more information about embryo quality post-thaw and can discuss the best option for transfer at that time with your doctor. Good Luck!! Carole

  • SoHopeful Says:

    Hello Carole,

    Thank you so much for your devotion of time to so many anxious and hopeful individuals and couples. Here’s our question:

    Our day 3 lab results were
    2 3-day morulas
    2 good 8 cell
    1 good 7 cell
    1 fair 10 cell
    And a few rated poor

    The doctor asked us which we wanted to transfer, and not knowing we asked him to choose. After consulting with the embryologists they chose to transfer the two morulae.

    Now I’m looking online and finding that 3-day morulae may not be auspicious. Did they make a mistake?

    Thanks so much for your insights.

  • Nam Says:

    Hi Carole,
    I stumbled upon this blog and am glad I found it. You are doing a wonderful task by helping us anxious souls!
    History: I have had 2 m/c and 1 ectopic, trying naturally. So we decided to go for IVF. This is my first IVF/ICSI cycle. !3 eggs retrieved, 11 mature and 9 fertilized.
    Today is day 3 after retrieval. Here are my results:
    2 – 9 cells
    4 – 8 cells
    1 – 7 cell
    1 – 5 cell
    1 – compacting

    We have been advised day 5 transfer. I was thinking that the two 9 cells or the compacting embryo that are “overachievers” are the best to transfer, but on more reading I don’t think this is the case.
    What according to your opinion looks good at this stage to transfer? (I understand things change every day so thigns may look different tomorrow).

    Also, give we have had recurrent pregnancy losses, would you recommend PGD to us? My RE has done all thorough genetic testing and doesn’t think we need it. I am very scared of going through another loss.

  • Carole Says:

    Hi Nam,
    With our new understanding from image capture of embryo development, it seems that being exactly on time (an 8 cell on day 3) might be a better indicator of implantation potential than being faster developing than expected (compacting morula). But you’ll know more on day 5 and then the quality of the blastocyst can also be evaluated. Regarding PGS testing for aneuploidy- that is very much in debate right now. In theory, it should be very effective in preventing recurrent miscarriage but in practice, it has not always worked out that way. Whether that is due to a problem with PGS or it’s implementation by the lab is unclear. You are in pretty good shape right now. Take it one day at a time and be hopeful! Wishing you much good luck!! Carole

  • Carole Says:

    Dear So Hopeful,
    I assume that the other stage appropriate embryos were cryopreserved so even if this transfer does not result in pregnancy, you have future chances ahead of you. Having said that, I wouldn’t assume you won’t get pregnant this time. The embryologist most likely chose the embryos that they expect to do best in their lab under their conditions so be hopeful. Wishing you all the best!! Carole

  • Danam Says:

    Is a 10 celled embryo good. I did a late morning 3 day transfer.
    Thanks

  • Carole Says:

    Hi Danam,
    !0 cells on day 3 would be about right- especially later in the day. Wishing you much good luck!!

  • Tamika Says:

    Hi Carole,

    I am so grateful I stumbled across this blog. I’m 42 and had my 1st IVF in March, fresh cycle of 2 4th. The results were negative. Shortly after I learned about embryo donation and was grateful because my husband and I could not afford another round of IVF and we could not afford purchasing eggs. We were offered 3 2pn embryos which all 3 thawed successfully. The donor is a 31 year old female and 29 year old male who completed their family and donated the remaining 3. Before the cycle my RE discovered that a fibroid that she saw previously was entering the uterus, we postponed cycle to remove the fibroid. On day three I went in for a scan because there was fluid in my uterus and my RE suggested PIO would obsurb the fluid and if none was found on day 3 we could move forward. She found no fluid and said we could go either way, transfer day 3 or wait to day 5. I was already so excited I choose to move forward. Today is day 6 for my embies and the one graded as an A- stopped developing at the morula stage. I am ready so much now on how 5th is the preferred practice and wondering if I made an error…deep sigh. I’m out of money so this is our only hope.

  • Tamika Says:

    Oh forgot to mention the 2 transferred were grade A

  • Tamika Says:

    Geese sorry also forgot to mention the 2 A’s were 8 cells, no fragmentation aND the A- was a 7 cell a little fragmentation.

  • Carole Says:

    Dear Tamika,
    I think you are in good shape with the embryos you transferred. Their appearance and the score is just part of the picture and no one can accurately predict what will happen. Just because one left behind did not progress does not mean that the ones you transferred won’t be fine. Try not to worry too much and distract yourself with something else while you wait. Wish you Much Good Luck for your test! Carole

  • Diz Says:

    Hi Carol,

    What an amazing person and blog!

    This will be my 9th IVF. I had a miscarriage last year after my 6th IVF at the age of 41. We then decided to move on to donor eggs April of this year, the donor was 27 and we got 12 eggs, 9 made it to blast. We were told that the embryos were excellent due to the young donor and my husband’s very good sperm we transferred 3 but the fresh cycle ended BFN. We tried again three months later with 3 FET but that again ended BFN. We have now used the last 3 for our FET which took place last Thurs. We’ve tried intralipides and Accupunture, before and after transfer to assist. I’m now on day 3 of the 5 day transfer and I ‘m trying hard to remain positive. I know there are other options but I’m not ready to give up yet on IVF but don’t know why I’m not getting pregnant. We have had each of our 9 cycles at 3 different clinics.

    Many thanks in advance!

  • Diz Says:

    Hi Carol,

    Just another quick question during my last 2wk wait I have experienced no symptoms and feel that this cycle has not worked just like my previous cycle. Is it truly possible to experience little or no symptoms and still get a BFP.

    Once again many thanks!

  • Carole Says:

    Dear Diz,
    I am sorry that you have not become pregnant yet after so many tries. Since you have been to 3 different clinics with equally poor results, it becomes more difficult to understand what may be going on. There may be some forms of infertility that we do not yet understand and your case may fall into that category. I really would consider other options after 9 cycles- if this one does not work. But hopefully you will have some good news this time. Wishing you MUCH GOOD LUCK!! Carole

  • Carole Says:

    Hi Diz,
    Yes it is possible to have no symptoms or lots of symptoms (even spotting) and still be pregnant. You won’t know before you have the official blood test and maybe even a follow-up blood test if the first one is very low positive. Good Luck!!

  • Renee Says:

    Hi Diz,

    My question is: why would a doctor recommend waiting approximately a month after the embryo retrievals (day 6), CGH biopsy, and freezing, to do the embryo transfer versus doing the ET soon after genetic testing results are received? Is there a benefit to giving the body a rest from the hormones to aid to improve the chances of the embryo implanting?
    Thank you in advance,
    Renee

  • Renee Says:

    Hi Carole,
    Oops, I apologize for my mistake of writing my question to “Diz”, and also I meant to say “egg retrieval” not “embryo retrieval”.
    Thank you so much for the opportunity to educate myself about ivf. My 39 y.o.daughter is about to begin ivf/cgh after giving birth to a 32 week stillborn child with trisomy 13 in July,

    Renee

  • Gomez Says:

    Hi Carole

    I am from India 29yrs married since October 2008. Had a right tubal pregnancy in July 2009. Miscarriage in July 2012 at 8 weeks. Went through IVF treatment in April 2014 BFP with one 4AA fresh embryo. Identical triplets – monochronic triamniotic triplets .I had minimal bleeding at 16 weeks and got hospitalized on 28th July & the water broke for one baby on 29th still had hopes as the fuilds were re filling. On 31st the cord of first baby was seen out and had to go for labour and delivered all the three normally. I have 3 4AA frozen embryos. What the chances of multiple babies again? When can I get the embryo transferred?

  • Carole Says:

    Hi Renee,
    Yes, there is actually evidence that waiting a month and transferring the embryos in a frozen embryo cycle yields better pregnancy rate because the uterine lining can be optimally primed for implantation. When you transfer in the fresh cycle, the high doses of hormones needed for egg production are less than ideal for the uterus. So in this case, not a bad plan to wait. This earlier blog explain this http://fertilitylabinsider.com/2012/07/freeze-all-ivf-with-later-fet-may-increase-your-pregnancy-rate/ Good Luck!! Carole

  • Carole Says:

    Hi Gomez,
    This really is a much better question for your physician and outside of my area of expertise. Good luck!! Carole

  • Diz Says:

    Hi Carol,
    Many thanks for your reply!
    I have another question. From having no symptoms, on day 8 past 5dt I started spotting lightly (brown) and having period like symptoms, this lasted until day 10 then stopped. I thought that my period was coming but now that it has stopped I don’t know what to make of it. What do you think it could be?
    Many thanks for your response in advance!

  • Carole Says:

    Hi Diz,
    Another great question for your doctor. But I think that good news is still very possible- even with a little spotting. It is not uncommon. Good Luck!! Carole

  • Diz Says:

    Hi Carol,a quick update…I’m pregnant and my Hcg level is 186 !!

  • Carole Says:

    Congratulations Diz!! Fabulous news!

  • Amanda Says:

    are you able to grade my 3 embryos or tell me if they look good if I post a photo?

  • allison Says:

    I was wondering if you ever thought of changing the structure
    of your blog? Its very well written; I love what youve got to say.

    But maybe you could a little more in the way of content so people could connect with
    it better. Youve got an awful lot of text for
    only having 1 or two pictures. Maybe you could space
    it out better?

  • Annie Says:

    Hi Carol,

    I was just wondering: would a chromosomally abnormal embryo with a condition that is compatible with life (e.g., Trisomy 21) typically develop similarly to a chromosomally normal embryo? Does growing the embryo out to day 5 lessen the odds of implanting a chromosomally abnormal embryo, even without PGD, just based on appearance alone?

    Just curious. Thank you so much!

  • Carole Says:

    Hi Annie,
    Good Question. Unfortunately, even embryos with an entire extra set of chromosomes (triploid embryos) can grow into lovely looking blastocysts. In fact, we routinely cryopreserved these abnormal embryos for technical proficiency training because they were indistinguishable from normal embryos through blastocyst stage. Later on, these abnormal embryos fail to implant or in the Trisomy21 example, implant and develop and result in the live birth of a baby with various levels of physical and mental challenges. So the take home message is that the only way you can determine whether an embryo has an abnormal number of chromosomes, or a abnormal sequence in a particular gene, you have to do pre-implantation genetic testing on the embryo. Carole
    Carole

  • Carole Says:

    Hi Allison,
    Yep, I have gotten that feedback before. Unfortunately, I don’t have copyrights to most of the pics I would like to post to illustrate points. Carole

  • Annie Says:

    Carole,

    Thanks so much for responding to my question. I asked because we transferred an embryo that apparently “even the embryologist” was excited about, and my doc light heartedly said it is hard to get embryologists excited about embryos since they see so many :)

    The embryo did take, but I have my nuchal ultrasound next week, and I’m very nervous. This feels like our last really big hurdle in the first tri to overcome and then I can finally get excited that we are finally pregnant!! I am in my early 30s though, so trying to reassure myself that the statistics are something to be positive about. Just looking forward to getting this last test out of the way and really hoping for the best.

    thanks so much for your input, though I’m a little disappointed to hear the abnormal ones can look just as great as some normal ones! Boo.

  • Dr b Says:

    Hi carol M 29 years old had my iist FET yesterday with two day 5 morulas .according to my embryologist one was good n one not ..can u tell me what r the chances of getting pregnant in this situation ???

  • Rosario Says:

    Appreciating the time and effort you put into your website and in depth information you provide.
    It’s great to come across a blog every once in a while that
    isn’t the same out of date rehashed information.
    Wonderful read! I’ve saved your site and I’m including
    your RSS feeds to my Google account.

  • Dr b Says:

    Hi carol m waiting for your reply

  • Carole Says:

    Dr. b:
    What’s your question?

  • Dr b Says:

    Hi I m 29 years old had my FET on 19 th of this month with two morulas at day five ,my embryologist was of opinion that one is good n one isn’t .they didn’t grade the embryos.its my first cycle it wasn’t done with fresh embryos because I had a uterine polyp which was removed.now today is 7post transfer day.i have asked u about chances of pregnancy in my case.thanks

  • Carole Says:

    Dr b,
    Your youth (29) works in your favor which is no small thing. It would be better if your embryos were blastocysts on day 5, but pregnancies happen with morulas too. I would ask your embryologist why they decided one embryo was good and one wasn’t. Even if they didn’t use a formal scoring system, they have some basis for that opinion which they should be able to share with you. Regarding your absolute chance of pregnancy, because there are so many variables, again your clinics data on past patients –like you with similar age and infertility issues- would be the best guide to your chances of pregnancy. But your age is a great advantage and the fact that you did an FET, means that your endometrium wasn’t subjected to the high levels of FSH (and thus E2) from superovulation, which makes for a better uterine environment. SO I would be hopeful and try to distract yourself with other things while you wait the remaining week for your pregnancy test. Good Luck!! Carole

  • Dr b Says:

    Thanks carol:) I was waiting for ur reply and m more than happy to see ur reply .my embryologist didn’t discussed much n to b very honest I didn’t ask her as I haven’t gone through ur blog and didn’t had much Idea.
    Thanks for your input .i will keep posting

  • Dr b Says:

    Hi carol
    I have got negative b hcg it says<1.20
    Should I go for another one as my FSH was high when checked before procedure .

  • Dr b Says:

    Hey carol
    My doc told me to continue the medicines n do the test after two days .i wanna ask does this happen to hcg to rise after showing this little increase ???

  • Carole Says:

    Dr b,
    Yes,please follow your doctor’s instructions regarding the medicines and the timing of the test. Done too soon and it might be either falsely high because the hCG in trigger shot could be persistent and what’s being detected or –if the test is too soon, hCG may be low and not risen after implantation. Good Luck!

  • Dr b Says:

    Hey carol
    I did it on 10 post FET day as told by may doc.what’s the correct time to do it?if I keep on taking medicine like cyclogest (progesterone ) progynova (estradiol)duphaston (dydrogesteron) will I bleed if there is no pregnancy ???sorry for bothering u a lot

  • Carole Says:

    Dr b,
    Please keep with your doctor’s orders. He/she has the experience with the particular protocol you are on. At my programs- remember I was in the lab- the nurses would tell the patients to stay on the protocol, take the progesterone as prescribed and take lab tests as scheduled. That is the best way to avoid problems. You don’t want to “invent” your own protocol. Good Luck!!

  • Washington Says:

    Hi Carole,

    Thanks for your amazing blog! I’d love it if you could share your insights and tell me what you think about my particular predicament.

    About us: I’m 39 and hubby is 40. We have a 6 year old daughter who we concieved naturally fairly easily. We have been trying unsuccessfully for a long time to have another child.

    Medical stuff: I have PCO (I had few periods in my life but that changed when I got a regular cycle since giving birth, but I still have lots of follicles on my ovaries. I’m “thin”, I have no insulin resistance problems and AMH is high at 41). I also have mild endometriosis and had it excised recently. Hubby has 2% sperm morphology.

    We have done 2 antagonist rounds of IVF ICSI now. In the first one, I had 250 iu Gonal F which resulted in 5 follicles, 4 mature eggs, 3 fertilised and only 1 made it to day 2. It was a 4 cell and it was transferred fresh but unsuccessful.

    In our most recent cycle, I had 275 iu Gonal F with 75 iu Luveris for the duration of the whole protocol. This time I had 12 eggs retrieved but only 7 were suitable for injection. Today (day 2) I got the news that now there are only 3 left. Again it seems a very small number of our embryos can make it past the first stage. 3 were multinucleated. Of the remaining 3 embryos, 2 are 4 cell and 1 is 5 cell. They have all been graded 3 (where Grade 1 is perfect) due to fragmentation. We are not implanting any fresh this time as I need a month off to recover from the drugs.

    So today we had to make a decision to either freeze what we’ve got today or try and grow them out. Our Dr advised us to take a chance and try and get a 5 day blastocyst, rather than transfer 1 and have a 10-15% chance of success. He said that it would probably give us “false hope”. But we are taking a big risk because we will maybe end up with nothing.

    My questions to you are this:

    1. What in your opinion would be causing so few of our embryos to get to Day 2?
    2. Is this abnormal considering our age and medical situation?
    3. If we were to do a third (and final) IVF stim cycle, would there be anything that could possibly improve the quality of our embryos?
    4. Is there much chance that our Grade 3 cleaved embryos could make it to become viable blastocysts?

    Thanks in advance for your advice.

  • Carole Says:

    Dear Washington,
    I am sorry you are having such a hard time. What is curious is that some of your embryos are failing before day 3. Day 3 is a very important day in the life of the embryo because genome activation happens. Genome activation is when the embryo starts using the new combined genetic set of instructions from mom and dad to write the code (RNA) to make proteins. Before that , the embyro was using the last of mom’s stockpiles of RNA. You also mentioned multinucleation in the embryos which can result from either 1) too many sperm getting into the egg or 2) the egg doesn’t toss out the extra maternal chromosomes as it should just as it is getting ready for fertilization. There are a couple of tests that are useful in identifying which embryos are likely to go on. At great expense, you can have your day 3 or blastocyst embryos genetically tested to see if they have a normal number of chromosomes- this is really only useful for you if you make a lot of embryos and need to choose among them. Continuous imaging of embryos in the incubator is another method that provides data that can be used to predict which embryos go on to the next stage. Here’s a article about that. http://www.ncbi.nlm.nih.gov/pubmed/20890283 That also is only useful if you have a lot of embryos and most of them go on.

    Even though you had a child together easily six years ago, it is not unusual to have secondary fertility as you age and especially with the other issue – PCO. This is a very possible cause of embryos failing to progress- at any stage. It sounds as though your doctor tried several protocols with no great improvement in embryo progression which also suggests that IVF is not likely to work for you. I am not aware of any magic cure for getting embryos past this block- unless it is due to poor culture conditions. Years ago, we couldn’t grow embryos past day 3 until sequential medias were developed but – if culture conditions were a problem- this would be happening with all the labs cases, not just yours.

    I would not have great enthusiasm for more IVF cycles- IVF has not been very good for you. IVF was designed to bypass bad or absent fallopian tubes and give the egg and sperm another place to fertilize and grow (in a culture dish). Nothing about IVF fixes genetic issues or chromosomal abnormalities. I think your doc is trying to give you this message with his low estimate of success and the “false hope” statement. There is always a chance that the embryo does better than it should so there is never zero chance. If you don’t have the happy ending you hope for this cycle- I would consider some other pathways to parenthood- and not spend your resources on another IVF cycle. I wish you much good luck going forward. Carole

  • james Says:

    Hi, it has been very helpful reading through all the questions and answers and has set my mind at ease.

    My wife and I are both 29 and had 19 eggs, they fertilised 15 of them and by day 2 we had 12. Of these 12 a number of these skipped from 1 cell to three cells and the clinic said these would not be viable. We are on day three and have 5 eggs which they think look good. They said that we had 7 eggs that looked like they would go to blastocyst but a further 2 eggs jumped from stage 6 to 8.

    We are using the eeva technology to allow best egg selection.

    My question is what causes the cells to jump from stage 1 to 3? And the other two that jumped from stage 6 to 8 supposedly look perfect, can you give me any more info the dangers of implanting with one of these 2 eggs? As they are still growing nicely.

    Thanks

  • james Says:

    It is also worth noting that we are doing icsi due to my sperm count being very low. My wife’s fertility is normal

  • Carole Says:

    Hi James,
    I am not sure what you mean by “skipping stages”. At most programs- without eeva or similar technology- the technicians only look at embryos every other day so it might look like they are “skipping” from fertiized egg to 4 cells but it is simply a feature of timing of when you look at it. There was a two cell stage, but no one was looking. WIth eeva, you have continuous monitoring- so the video can be stopped at any stage for a closer look- so not sure how anything can be skipped. To get from 6 cells to 8 cells, one of the 6 cells divides into 2 cells and -VOila- you have 8 cells- so there was no 7 cell stage. Maybe this is what you are thinking of. And it is common for there to be some variation among a group of embryos with a half day or day difference in their stages.I wouldn’t worry about these small differences. You seem to be in good shape. Good Luck!

  • james Says:

    Hi carole,

    Many thanks for the reply. As we are using tine lapse thay have been able to monitor closely. I meant a couple of the embryos skipped from 1 cell to 3 cells.

    The clinic didn’t go into details but said that instead of dividing from one to two to three it went straight from o w to three which isn’t a good sign. I was hoping to k ow what his might mean.

    Thanks

  • Carole Says:

    Hi James,
    Some people aren’t good at explaining. You might have to go back to the embryologist on this one. There is no zero cells- you always have one- a fertilized egg- to start. Don’t be afraid to ask. Most embryologists/docs will be happy to explain once they see you really are interested. He/she is probably referring to asynchronous cell division but I don’t know for sure. Good Luck! Carole

  • Lapre Says:

    Hi Carole,

    My identical twin sister is going through IVF, she just had her egg retrieval done on Tuesday 10/7/14 in which 21 eggs were retrieved. She received a phone call yesterday regarding the eggs progress and she was told that out of the 21 eggs, 13 actually fertilized but only 9 fertilized normally. Today she received a call and they said that all of the eggs are doing great 1 of the eggs however is developing rapidly and is currently at cell stage 8 and the other eight eggs are currently at cell stage 4. According to your post above, she would be on day 2. With this said, does the egg that is developing much faster than the others suggest this could be a set of twins in this egg?

  • Carole Says:

    Hi Lapre,
    I don’t know of any research to suggest that a much more rapidly dividing embryo is more likely to be a twin. Data from embryo progression continuous taping systems like EEVA, suggest that the embryos with the best implantation potential are those that are just on time for each embryo stage, not particularly early or late. Good Luck to your sister! Carole

  • Lapre Says:

    Carrole,

    Thank you for getting back with me. I will keep you updated on my sisters progress for others on your forum.

  • Lapre Says:

    Hi Carole,

    I just wanted to give you an update on my sister. She had two grade “A” embryos transferred yesterday morning. She felt nothing during the procedure which was great! I wish I could attach a picture of her embryos so that you could see them, they are beautiful perfect circles that are the exact same size. After the procedure, she felt a slight pinching sensation in two different locations not to far from one another. Literally, the spots were one on top of the other. Now we wait to find out what the pregnancy test says on the 24th I believe. I am so excited!! She feels normal today no pain just tons of energy. She took off today and has been cleaning all morning long. Thank you so much for this forum, it really helps to know you can chat with someone who knows what they are talking about. Also, the embryo that I mentioned in my earlier post that was ahead of all the others actually slowed down tremendously in development progression and was unable to be used. She has 6 other grade “A” embryos remaining that will be frozen for future IVF procedures!! We are hoping for twins!! Keep you fingers crossed for us!!

  • Carole Says:

    Hi Lapre,
    I wish your sister much good luck and a happy result! :) Carole

  • Lapre Says:

    Thank you Carole!!

  • April Says:

    Hi Carole –

    I recently had a day 3 FET of one 8 cell and one morula. Both had perfect grading with zero fragmentation. Remaining five in batch were also perfect grading and zero fragmentation – and I believe all 8 cell at day 3. Egg was from proven donor who has had five successful cycles with no failures. I ended up with a BFN/failed cycle. I have been pregnant 10 times including recently (7 losses). My clinic has about a 70% success rate with frozen donor embryos.

    Is the transfer of a day 3 morula a problem? Embryologist was selling it as a great thing… But I have read that a day 3 morula is going to be out of sync with my lining and thus not have a good implantation. Additionally, I have read that once the morula starts to attempt implantation, the lining with change to allow a very short window for the 8 cell to implant. And since the 8 cell will not be ready to implant early, both embryos will be lost. At my 6dpo u/s, my lining was already HH. Normally my 8dpo lining is IA/HH (which my doc is fine with). So it seems that my lining may have been ahead of schedule due to morula’s attempted implantation…

    Thanks!

  • Carole Says:

    Hi April,
    I am sorry you are having such a hard time. The window of implantation is several days so I don’t think that the difference between an 8 cell and a morula on day 3 is likely to be the issue. Assuming that that donor has no aneuploidy issues- and past pregnancies with her eggs would seem to make this less likely- a uterine issue might be more more likely. The uterine priming protocol may have been less than ideal. Also, I assume you have been evaluated for uterine plups or other anatomical abnormailities that can interfere with implantation. Even with a donor, you can have embryos that don’t implant which is why I am surprised that they didn’t grow out the embryos to day 5- blastocyst stage- this is helpful to provide further evidence that the embryos really do have the staying power to implant. I really do not know why your cycle didn’t work. There is always a follow-up meeting and I would encourage you to ask your doctor why he/she thinks it didn’t work and what they might suggest for the next attempt. I wish you much good luck moving forward. Carole

  • Denise Says:

    Hi Carole!
    After failed IVF’s, my husband and I are doing embryo adoption. We are having 2 embryos transferred this Tuesday! One is a 3AA Good/vitrified and expanded blastocyst frozen on day 6 embryo. The genetic Mom did get pregnant from this group of embryos. The other is a 5AB vitrified blastocyst frozen on Day 6. How are our odds do you think???

  • Denise Says:

    Oh and one donor was 27 yrs old, the other was 34. Thank you!!

  • Carole Says:

    Hi Denise,
    Both embryos sound very good- and from young donors. You might consider transferring one this cycle and one, if needed, in another cycle, to reduce your risk of twins. Twins is not really an ideal outcome- obstetrically speaking, even though I understand the appeal of a “2 for 1 cycle”, particularly for couples who have been struggling with infertility for a while. Still, it might be something to discuss with your doctor. Good Luck with whatever you decide! Carole

  • scabies Says:

    I do trust all of the concepts you’ve introduced for your post.
    They’re really convincing and can definitely work. Nonetheless,
    the posts are too brief for starters. May just you please extend them a
    little from subsequent time? Thank you for the post.

  • Denise Says:

    Thank you so much Carole! Terrific input and I don’t think brief at all! I have also come down with a head cold/ sinus infection. Will that affect anything for tomoorow afternoon? I am not taking anything for it and don’t feel too bad.

  • Anna Says:

    Hi Carole,

    I had my embryo transfer on Thursday. The Dr. Said that the embryos had a “fair” grade, but not great.

    2 embryos were transfered at grade 2, with more than 10 cells, compact, incomplete symetry. A third embryo was also transfered with 12 cells, moderate symetry. The report says 0% fragmentation for all 3.

    When I talked with the doctor before the transfer, she did not seem to have much confidence that they would implant. How big of a concern is it that the embryos had 10+ cells?

  • Denise Says:

    We just got back from our transfer and all went well. My only worry is that the two 5AB embryos were slow frozen not vitrified since they were from 2009. Once thawed, they were expanding though. But only rated as fair for now?? He said they will continue in uterus. The doctor and nuse said my sinus infection won’t affect things.

  • Carole Says:

    Hi Anna,
    It depends on what day the transfer was. If they were transferred on day 5 of culture, then 10-12 cells would be considered very slow progression- or the embryo has stopped. On day 3, 10-12 cell embryos would would be slightly faster than ideal, but you can’t rule them out yet. It turns out that embryos often surprise us! An early compacting embryo can be asymmetric as it turns into a morula (the stage between cleavage stage (day 3, approx 8 cells) and blastocyst stage (day 5, 50-100 cells). Transferred morulas do very well so I would be hopeful at this point!

  • Carole Says:

    Denise,
    It is great news that they were expanding! That’s an excellent sign of good health. Slow frozen embryos often get a lower score at thaw- that’s typical for slow frozen embryos. None-the-less, these expanded and so they are ready to go. I’d be inclined to take the nurse’s advice not to worry about the sinus infection. Discuss any meds you are taking for it though with your doctor- you might be pregnant soon!! Good Luck!

  • Denise Says:

    Thank you Carole!!!

  • Abby Says:

    Hi Carole!
    I will be 39 in dec. I’m currently going through ivf, I’ve done 3 (IUI) in which I had BFP in the 1st one that later resulted in m/c at 8wks when I was 36yrs 3 month old. Later discovered that I had asherman’s syndrome (intrauterine adhesions/scarring) due to missed miscarried. I had an operation concerning this and immediately got pregnant one month later in feb. 2013 m/c due to thin endometrium 4mm. Since then I’ve been Trying with 2 other (IUI) but no success. Now I’m undergoing my 1st ifv. My FSH is 8 and I was given 300UI with orgalutran from day 5 of stimulation in which we retrieved 9 eggs, 7 matured all fertilized and all have 8 cell at day 3 of retrieval with grade 1 embryo, the embryologist told told me to do the day 5 transfer due to the growing of the cells. I’m ok with whatever they ask of me but my problem is my endometrium. My endometrium at the day of trigger shot was 8mm. So this is my question 1. Is it possible to get more blastocyst from day 5 due to my age? 2. Is it advisable to do the transfer this cycle due to my endometrium 8mm. 3. If I eventually do the transfer at day 5 with good blastocyst, how many should I transfer and what is the percentage of me getting pregnant due to my age? Thanks in advance for replying me and I will be very grateful if you answer all my questions.

  • Carole Says:

    Hi Abby,
    Your questions are all very good ones but I don’t have the information to answer these because they are very clinic specific and patient specific. Please ask your doctor these questions. I think you are doing quite well so far and likely to have nice blastocysts in a few more days. Generally speaking, 1-2 blastocysts is the most that anyone should transfer at a time- to reduce the risk of multiples. I really have no expertise regarding the endometrium lining questions you have. Ask your doctor about the option of freezing all the blastocysts this cycle- does he think that the endometrium might be better for you in a follow-up FET cycle? I wrote on this option in a previous post: http://fertilitylabinsider.com/2012/07/freeze-all-ivf-with-later-fet-may-increase-your-pregnancy-rate/ And here is a previous post on the topic of thin endometrium: http://fertilitylabinsider.com/2013/10/q-from-u-causes-of-thin-uterine-lining-and-treatments-to-improve-receptivity/ Please discuss all these issues with your doctor, he/she has all the information that applies to your situation- don’t be shy about asking them to explain why they are recommending a course of action to you. Wishing you much good luck in whatever you decide! Carole

  • Abby Says:

    Hi Carole!
    Thank you so very much, you are a nice and kind person for taking your time to answer my questions. This is first time someone will take his/her time to answer me, all other blogs that I’ve writing to is either they are rude or they don’t give adequate information but in your own case it’s not like that, u take your time to answer the ones you know and gently refer us to a site that can help us with the other questions or to ask a Dr that is specialize in that aspect. You are a good person, please keep up the good work. You are doing a wonderful job. Thanks once again.

  • Carole Says:

    Abby,
    You are very welcome. Good luck!! :)

Join the discussion