Embryo stages, progression and pregnancy outcomes
November 10, 2010Carole 101 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.
November 11th, 2010 at 11:10 pm
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.
November 12th, 2010 at 8:02 am
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!!!
December 12th, 2010 at 6:26 pm
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?
December 12th, 2010 at 7:19 pm
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.
December 30th, 2010 at 10:48 pm
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
December 31st, 2010 at 10:02 am
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!!
January 2nd, 2011 at 7:04 pm
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
January 2nd, 2011 at 8:39 pm
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.
July 4th, 2011 at 10:29 am
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
July 4th, 2011 at 6:16 pm
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
August 29th, 2011 at 5:43 am
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
November 25th, 2011 at 9:53 pm
[...] 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 [...]
December 6th, 2011 at 7:19 pm
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
December 12th, 2011 at 10:27 am
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.
December 17th, 2011 at 4:40 pm
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.
December 18th, 2011 at 8:45 pm
Hi Sydney,
Best wishes,
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.
Carole
December 19th, 2011 at 7:52 am
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!
December 19th, 2011 at 11:13 pm
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?????
December 20th, 2011 at 5:29 pm
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
December 20th, 2011 at 9:43 pm
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?
December 21st, 2011 at 8:51 am
I would feel optimistic at this point. They haven’t stopped dividing! Best wishes!!
December 22nd, 2011 at 6:23 am
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
December 22nd, 2011 at 6:27 am
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.
December 22nd, 2011 at 7:06 pm
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
January 6th, 2012 at 12:08 pm
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.
January 6th, 2012 at 7:54 pm
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
January 12th, 2012 at 8:27 pm
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
January 26th, 2012 at 2:41 am
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?
January 27th, 2012 at 2:13 pm
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
January 27th, 2012 at 2:33 pm
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
February 1st, 2012 at 11:08 am
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?????
February 1st, 2012 at 1:10 pm
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
February 2nd, 2012 at 11:23 am
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!
February 2nd, 2012 at 11:32 am
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
February 3rd, 2012 at 3:19 am
Hi Carole
Just wanted to tell you thanks SO much for answering my question. You made me feel much better!
Melissa
February 3rd, 2012 at 3:26 am
[...] 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 [...]
February 3rd, 2012 at 7:09 am
You are very welcome! Good Luck!! Carole
February 4th, 2012 at 11:21 pm
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?
February 5th, 2012 at 8:53 am
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
February 5th, 2012 at 9:58 am
on day 3 i did embryo transfer with 18cells it is good or not scared can anybody help me with this please
thanks
February 5th, 2012 at 10:22 am
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
February 5th, 2012 at 2:07 pm
thank you so much Carole! Its so nice to have this forum!
February 9th, 2012 at 10:47 am
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?
February 9th, 2012 at 11:13 am
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
February 9th, 2012 at 8:18 pm
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…
February 11th, 2012 at 9:07 pm
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…
February 12th, 2012 at 7:32 pm
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
February 12th, 2012 at 10:43 pm
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?
February 13th, 2012 at 7:15 am
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
February 13th, 2012 at 10:19 am
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.
February 13th, 2012 at 11:10 am
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
March 4th, 2012 at 1:41 pm
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.
March 4th, 2012 at 4:36 pm
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
March 9th, 2012 at 11:38 am
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
March 9th, 2012 at 12:08 pm
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
March 10th, 2012 at 4:26 am
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
March 12th, 2012 at 4:55 pm
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!
March 13th, 2012 at 8:11 am
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
March 13th, 2012 at 11:46 am
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.
March 16th, 2012 at 12:01 pm
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
March 16th, 2012 at 1:35 pm
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
March 17th, 2012 at 3:20 pm
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!
March 17th, 2012 at 8:54 pm
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
March 17th, 2012 at 9:23 pm
Thank you so much for taking the time to write!
March 21st, 2012 at 6:08 am
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
March 21st, 2012 at 5:27 pm
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
March 22nd, 2012 at 2:04 pm
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
March 26th, 2012 at 10:01 pm
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
March 27th, 2012 at 7:32 am
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
March 29th, 2012 at 5:14 pm
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.
March 29th, 2012 at 5:16 pm
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.
March 29th, 2012 at 6:07 pm
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
March 29th, 2012 at 6:15 pm
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
April 11th, 2012 at 10:38 am
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.
April 11th, 2012 at 1:03 pm
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!!!
April 11th, 2012 at 2:07 pm
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.
April 12th, 2012 at 5:33 am
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
April 12th, 2012 at 7:44 am
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
April 12th, 2012 at 7:47 am
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
April 14th, 2012 at 7:12 pm
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.
April 16th, 2012 at 7:44 am
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
April 16th, 2012 at 9:04 pm
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.
April 17th, 2012 at 5:14 am
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?
April 17th, 2012 at 7:53 am
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
April 17th, 2012 at 8:11 am
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."
April 17th, 2012 at 8:11 am
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
April 18th, 2012 at 4:20 pm
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.
April 19th, 2012 at 7:53 am
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
April 20th, 2012 at 10:39 pm
[...] 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 [...]
May 6th, 2012 at 5:30 pm
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.
May 6th, 2012 at 7:29 pm
Hi Cori,
Yes, I have seen pregnancies with embryos with less than optimal grades. It’s too early to give up. Good Luck!!
May 10th, 2012 at 7:58 pm
[...] Embryo stages, progression and pregnancy outcomes | Fertility Lab Insider [...]
May 13th, 2012 at 6:59 am
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
May 13th, 2012 at 9:11 am
Hi Janie,
Good Luck!! Carole
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!!
May 13th, 2012 at 12:41 pm
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.
May 17th, 2012 at 11:47 am
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
May 17th, 2012 at 12:39 pm
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
May 18th, 2012 at 2:48 pm
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
May 18th, 2012 at 3:03 pm
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
May 18th, 2012 at 3:52 pm
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
May 18th, 2012 at 5:19 pm
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