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Dr. Sai, Senior Embryologist, Malpani Infertility Clinic Pvt. Ltd.
While most infertile patients know quite a lot about their scans and medications, most are very poorly informed about what happens in the IVF lab! At Malpani Infertility Clinic, we show all our IVF patients their embryos before transferring them. There are lots of questions patients ask me.
Here are some of the common questions, and their answers.
This depends upon which Day we grade them.
We grade the embryos as A, B, C, D (A being the best and D being the worst)
There are 3 factors that are considered.
2-Cell (Day 2 embryo) 4-Cell (Day 2 embryo)
6-Cell (Day 3 Embryo) 10-Cell (Day 3 Embryo)
4-Cell Embryo with Blastomeres of unequal sizes. This is Grade B embryo
10-Cell Grade A embryo
10-Cell Grade B embryo
8-Cell Grade C embryo
8-Cell Grade D embryo
Do remember that a Grade C embryo does not mean that the baby will be abnormal! It just means that the chances of implantation are reduced, as compared with a Grade A embryo. Fragmentation in human embryos is quite common and many beautiful babies have been born even after transferring embryos with fragments!
Inner Cell mass is marked as ICM
The cavity is Marked as C
Trophectoderm is Marked as T Early Blastocysts
We usually transfer 3 embryos on Day 3. We try to individualize this for each patient, taking into account many variables, such as:
Ans: Embryo quality depends on 3 factors, Sperm; Egg; and Lab conditions. If other patient's embryos are of good quality, then we can't blame Lab conditions for poor quality embryos. It is usually poor egg quality which is responsible for poor embryos. Poor sperm do not affect embryo quality ICSI is done
Ans: In each batch of embryos, some will be healthy and others will be unhealthy. It's impossible to predict this in advance. Embryos that grow slowly can still become a baby, but the chances are less, as compared to rapidly dividing embryos.
Ans: Even poor quality embryos can become a healthy baby. However, the probability for implantation is lesser, as compared to a good quality embryo.
Ans: This is because the chances of high order multiple pregnancies are very high. More is not always better ! Transferring more than 3 embryos just increases the risk of multiple pregnancies, without improving the chances of success. This is especially true if the patient is young; and the embryos are Grade A.
Ans: No. Blastocyst transfer doesn't increase the Pregnancy rate. However, it does allow us to select the best quality embryos, because we allow the embryos to compete amongst themselves, and then choose the best. Thus, it enables us to transfer fewer embryos as compared to a Day 2/3 transfer, thereby reducing the chances of multiple pregnancies.
Ans: Yes. Sequential Embryo transfer does help increase the pregnancy rate. But it also increases the chances of multiple pregnancies. This is why very few clinics offer this.
Ans: Each and every biological cell is labeled with the patient's name. For example,
1) The Container for Semen collection is labeled with both Husband and wife's name before it is given to the patients.
2) The dishes in which the eggs and embryos are kept are labeled with the patient's name.
3) The Incubator chambers are labeled with the patient's name. The labels are discarded once the patient's embryo transfer is over.
4) The Nurse witnesses the procedure while the embryologist loads the embryos and hands over the catheter to the doctor for transfer.
Ans: There is no time limit for the 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, to make sure they are filled with liquid nitrogen regularly. Also, there is a storage fee which needs to be paid annually
Ans: When we describe cell division, we say that one cell divides into two; two divides into four, and four divide into eight. However, do remember that these cells can divide at different times. Thus, if the first cell divides at 4 pm; and the next at 8 pm, and we check the embryos at 6 pm, then this embryo will have 3 cells.
Ans: Even though an embryo may look completely normal, this does not mean that it is genetically normal. Human reproduction is not very efficient, and over 60% of all embryos even in young fertile couples have been proven to be genetically abnormal.
Ans: Genetic testing or PGD is not useful as a routine prior to embryo transfer. It is done only if there is a risk of any genetic disease.
Ans: These embryos stop dividing after the embryo transfer because they are not viable. When the cells die, they are reabsorbed like all other dead cells. This is a microscopic process, and there is no pain or bleeding when this happens. The death of these embryos does not affect the other embryos, which will continue to implant normally.