What are the Common Questions that patients ask while undergoing IVF Treatment
I am the Senior Embryologist at Malpani Infertility Clinic. The IVF lab plays an extremely important role in the success of your IVF treatment, and we are very proud of the work we do in helping you to have a baby.
When we show our patients their embryos in our lab, this is often a highly emotional moment for them.
Here are some of the common questions they ask. I'd like to share my answers.
1) How do you grade embryos ?
Grading Multicellar Stage Embryos (Day 2 and Day 3 embryos) :
We grade the embryos as A, B, C, D ("A" being the best and "D" being the worst)
There are 3 factors which are considered, while grading the multicellar stage Embryos:
a) Cell number
- Embryos should be at 2 to 4 cells at 48 hours after egg retrieval (Day 2 embryos) and preferably about 6 to 10 cells by 72 hours (Day 3 embryos)
- The cells in an embryo are also refered to as "blastomeres"
2-Cell (Day 2 embryo)
4-Cell (Day 2 embryo)
6-Cell (Day 3 embryo)
10-Cell (Day 3 embryo)
b) Cell regularity - degree of regularity of size of blastomeres
- It is generally best if the size of the individual cells (referred to as blastomeres) in the embryos are similar in size.
- If they are not, it is better if they are close to the same size, as compared to very different in size.
- A Grade A embryo is one which has equal sized cells in it.
- 4-Cell Embryo with irregular Blastomeres
4-Cell Embryo with irregular Blastomeres
c) Degree of fragmentation
- Fragmentation, is a process where portions of the embryo's cells have broken off and are now separate from the nucleated portion of the cell.
- Fragmentation in human embryos is quite common and many beautiful babies have resulted from implantation of embryos with fragments.
- A grade A embryo is the one which has no fragmentation or less than 10% fragmentation.
GRADE A :
10-Cell Grade A embryo
- Regular Blastomeres.
- No Fragmentation.
GRADE B :
10-Cell Grade B embryo
- Regular Balstomeres.
- > 10 % Fragmentation.
GRADE C :
8-Cell Grade C embryo
- Irregular Blastomeres.
- > 10 % Fragmentation.
GRADE D :
8-Cell Grade D embryo
- Irregular Blastomeres.
- > 20 % Fragmentation./p>
Grading Blastocyst Stage embryos (Day 5, Day 6 embryos) :
- A Blastocyst is an embryo which has developed to the point of having 2 different cell components and a fluid cavity.
- Human embryos, in culture in an IVF lab, or developing naturally in the female body, usually reach the blastocyst stage by day 5 after fertilization.
A Blastocyst is graded considering 3 factors :
- Size of the Cavity , Expansion and Hatching status.
- Inner Cell Mass (ICM) Quality.
- Trophectoderm (TE) Quality.
- Inner Cell mass is marked as "ICM"
- The cavity is Marked as "C"
- Torphectoderm is Marked as "T"
- Cavity is very small or fills less than ½ embryo's volume.
- The grade for Cavity in Early Blastocysts will be 1.
- The Grade for Early Blastocyst generally will be 1AA, 1AB, 1BA.
- The Cavity fills more than ½ Embryo's volume or completely fills the embryo's volume.
- The Grade for Cavity in Intermediate Blastocysts will be 2 or 3.
- The Grade for Intermediate Blastocysts generally will be 2AA, 2AB…… or 3AA, 3AB.
- The Embryo Expandes, The Cavity completely fills the Embryo's volume.
- The Grade for Embryo will be 4.
- The Grade for Expanded Blastocysts generally will be 4AA, 4AB, 4BB.
- The embryo hatches means comes out the shell called Zona.
- The Grade for Embryo will be 5
- The Grade for Hatching Blastocyst generally will be 5AA, 5AB.
Completely Hatched Blastocysts
- The embryos comes completely out of the zona.
- The grade for embryo is 6.
- The grade for Hatched Blastocyst generally will be 6AA, 6AB.
2) Maximum how many embryos can be transferred ?
We transfer 2 blastocysts on Day 5.We recommend Single Blastocyst transfer. This is now our preferred option. We try to individualise this for each patient, taking into account many variables such as: Patient's Age and Previous History (multiple failed cycles)
3) Why sometimes the Embryo quality is Bad?
The embryo quality depends on 3 factors, Sperm, Egg and Lab conditions. If other patient's embryos are good, we can't blame Lab conditions for poor quality. So it is usually poor Egg quality which is responsible for poor embryos. Poor sperm usually do not affect embryo quality after ICSI
4) Why sometimes the embryos grow slow? What are the chances of pregnancy with slow growing embryos?
Since the embryos are growing slow, their viability is suspected. But they can still become a baby. But the Probability is less compared to good ones.
5) Why sometimes the fertilization rate is poor?
- IVF – sperm ? sperm function. Next ICSI
- ICSI :
- If eggs quality wasn't good. If most of the eggs were immature.
- Sperm quality should not affect fertilization rate after ICSI.
6) If the embryo Quality is bad, what are the chances of pregnancy?
Even Poor Quality embryo can become a baby. The probability for it to become a baby is lesser compared to good quality embryo.
7) If 3 blastocysts are transferred, what are the chances of multiple pregnancy?
The chances of multiple pregnancy is more with 3 blastocysts, being transferred.
8) Does Day 5/6 Embryo Transfer (Blastocyst) help increase the chances of pregnancy?
No. Blastocyst Transfer doesn't increase Pregnancy rate. But it enables us to transfer less no. of embryos compared to Day 2/3 Transfer, thereby reducing the chances of multiple pregnancy.
9) Does Assisted Hatching help increase the chances of pregnancy?
No. Assisted Hatching doesn't increase pregnancy rate. Zona of an embryo has 2 layers, inner layer and an outer layer. When we do assisted hatching, we zap outer layer. But the outer layer would anyways be very thin. And zapping inner layer is risky, as a blastomere could easily come out while handling the embryo.
10) Do we need to do genetic testing before embryo transfer?
Genetic testing or PGD is not mandatory before Embryo transfer. It is done only if there is risk of any genetic disorder to the resulting baby.
11) Will sequential embryo transfer help increase chances of pregnancy ?
Yes. Sequential Embryo transfer does help increase pregnancy rate. But it also Increases the chances of multiple pregnancy. So Selection of patient for Sequential embryo transfer is critical such as :
- Patients Age – more than 35
- Grade of Embryos.
- Previous History- Repeated failed cycles.
12) How do you ensure that the eggs and sperms of different patients don't get mixed?
Each and every biological cell is labeled with patients name. For e.g.
- The Container for Semen collection is labeled with both Husband and wife's name before it is given to the patients.
- The dishes in which the eggs and embryos are kept are labeled with patients name.
- The chambers of Incubators are labeled with patients name. The labels are discarded once the patient's embryo transfer is over.
- The embryologist and the doctor are informed by patient's name at the start of every procedure i.e. Ovum Pick Up and Embryo Transfer.
- The Nurse stands as witness , while the Embryologist loads embryos and handing over catheter to doctor for transfer.
13) How long can we store the embryos once we freeze them ?
There is no time limit for storage of frozen embryos. The embryos can be stored for years, once they are frozen. However Proper maintenance of cryocans in which the embryos are stored should be ensured.