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Tuesday, September 9, 2014

The much awaited fertilization report




Blastocysts which were frozen on day 6

Growth arrested embryos

This post is going to be easy for me. I will just copy and paste Dr. Sai’s emails.

On day 1, I had 15 embryos. I guess one egg matured in the lab, so there were totally 15 mature eggs out of 19 retrieved, and all were in the 2 PN stage on day 1. This means all ICSIed eggs fertilized, a 100% fertilization rate! This is just awesome and clearly shows the technical expertise of Dr. Sai.

The Day 2 gradings of your embryos are as follows:
2x 5-cell grade A
4x 3-Cell Grade A
6x 2-Cell Grade A
3 Embryos got arrested at 2pn Stage.

There are total 8 Top Quality Embryos on day 3.
Day 3 Grading is as follows:
5 x 8-cell grade A
3x 7-Cell Grade A
1x 6-Cell Grade A
1x 5-cell Grade A
3x 4-Cell Grade A

Day 4 Grading of your Embryos as follows:
3x MORULA
6X 8-CELL Grade A (COMPACTION OF CELLS SEEN)
.
2X 6-CELL Grade A
1X 4-CELL Grade C

Day 5 Grading of your embryos as follows:
1x blastocyst grade 1AA
1X EARLY BLASTOCYST
6X MORULA
2X 8-CELL Grade A 
1X 6-CELL Grade A
1X 4-CELL Grade C

Day 6 (One must keep in mind that, on day 1, fertilization of eggs were done during late evening!)

We are Freezing Total 6 Blastocysts today on day 6.

All morulae Stage Embryos have Become Blastocysts.

Although Exp Blastocyst in image Cap1020 doesn't have great Trophectoderm (the last blastocyst in the above collage) we are freezing it becauze it has got a good Inner Cell Mass.

Altogether I got 7 blastocysts out of 12 cleaving embryos, this means 50% blastocyst formation rate. This is  a great result ! Normally women below 35 years old can expect a blastocyst formation rate of 40%
I am already getting queries regarding how it was possible to get so many eggs. I have no clue too. My AMH was infact low but my AFC count was high. Honestly, I didn’t expect such a good outcome. But, I had lots of faith in Dr. Malpani’s team. Dr. Malpani designed the protocol, Dr. Anjali monitored me very closely and decided when to give the trigger shot, ofcourse, as always, she did a great job during egg retrieval, Dr. Sai was excellent in doing his part of the job and my ovaries cooperated too well! I didn’t take any supplements. Two and a half years ago, when I had my first IVF cycle with Dr. Malpani’s clinic I took DHEA 75mg for 6-7 months and I thought might be DHEA helped me to get many eggs. But this time I took nothing and I do understand now that DHEA might  not have contributed to the improved outcome previous cycle. My first five cycles which I had in Germany were terrible (http://myselfishgenes.blogspot.in/2012/05/my-ivf-journey-timeline.html). I was much younger at that time, had great AMH value, yet, I had only very few eggs to work with.In short, I am very thankful to God and to everyone who helped me to get 7 blastocysts. In the beginning, prognosis of this cycle looked very bleak, but it ended up much pleasant and successful than expected.
There were 6 blasts frozen on day 6. What happened to the remaining one? :) Was it transferred to Rita and what happened thereafter? Keep reading ! :)
Dr. Sai was kind enough to provide the pictures of embryos which got arrested during its development. I have given the pictures of blastocysts frozen on day 6 and the ones which stopped growing in the above collage.

60 comments:

  1. Hi Manju!

    I would like to ask why is it so that different embryos have different cells on any particular day. Like on day 3, some may have 8 cells and some only 6?
    Does it depends on quality of the eggs retrieved?
    Also would you share your protocol for this IVF here? And what was your AFC count?
    How many eggs can one expect if each ovary had 6 Antral follicles?
    Also, what do you think about agonist protocol.?
    I am asking so many questions as I will soon be undergoing an IVF cycle which depends on these questions.
    Thanks in advance.

    ReplyDelete
    Replies
    1. Different children grow at different rates :)

      It is believed that embryos which grow appropriately (according to their age!) has best implantation potential and are chromosomally normal. Some embryos are slow to start but catch up later, some start to grow fast but end up getting arrested in growth. No one knows why !

      When we say bad quality eggs, we mean chromosomally abnormal ones which when become embryos either get arrested in lab or in the uterus. A bad quality embryo could very well look beautiful and a chromosomally normal embryo ( created using good quality egg) can look ugly. But the general assumption is good looking embryos are most probably ( not necessarily !) implant and give rise to a healthy baby.

      Please refer to my previous posts, I have given the protocol used ! I had an AFC count of 18 !

      Good luck for your forthcoming cycle ! Please read my blog, there are lots of articles on embryo development. It is hard to summarize everything here.

      Normally you can expect the same or one or two eggs more than your AFC count.

      Agonist protocol, do you mean long lupron ?

      Delete
  2. Hi Manju,

    Though the science behind the fertilisation report goes a bit way over my head, I am really happy as you seem to be happy with the outcome. More good things to come your way. You take your time to dissipate others anxieties through your knowledge. It is such selfless act. May God bless you even more for your thoughtfulness. Sometimes reading good news like this makes my day. It seems like the AMH value alone should not be relied on. Do you mind if I ask what was your AFC for this cycle? Should AFC be measured on a particular day in the cycle.

    Wishing you the best of everything for the rest of the cycle. Love and prayers
    MM

    ReplyDelete
    Replies
    1. Thank you so much MM for the kindness ! :)

      I had an AFC count of 18.

      Yes, AMH is not reliable as one might think. Even improperly stored blood sample during AMH measurement or the measuring technique itself can create lots of discrepancy in the result. It is always wise to interpret AMH value with AFC count.

      AFC must be measured day1-day3 of your menstrual cycle using ultrasound.

      Delete
  3. Hi Manju,

    Happy for you and good to know about this great progress.My best wishes. Do you have pictures of the embryos considered for transfer?

    ReplyDelete
    Replies
    1. Will definitely post it later. Now I don't have it. It must be in the file but the file is in India. But, I can ask Dr. Sai or Dr. Malpani for it.

      Delete
  4. Very happy to hear this Manju!! All the very best to you!!

    ReplyDelete
  5. All the best Manju!!
    Yes, it is the long lupron ( agonist protocol) which we are trying.
    Do you think it has any significance over antagonist protocol?

    ReplyDelete
    Replies
    1. Can you let me know your age, AMH value and the reason for IVF so that I can answer your question in a better way ?

      Delete
  6. Manju, congratulations on having so many frozen embryos. Please keep updating as i am longing to hear how things continue to develop for you.

    ReplyDelete
    Replies
    1. Thanks :) I will try to update as quickly as I can. But please understand I do not do anything wantonly or delay updating in order to create a drama. I have a very valid reason to do so slowly. And, more importantly I too don't know the end for this story.

      Delete
  7. Hi Manju

    Happy to see the progress you are making. Can you please let me know which transfer is better?
    Fresh or Frozen. What are the advantages and disadvantages?

    ReplyDelete
    Replies
    1. Thanks :) http://myselfishgenes.blogspot.de/2012/12/in-past-standard-was-transfer-best.html?m=1 Could you please read this ? If you have more questions I will be happy to answer.

      Delete
  8. Hi Manju,

    Very Happy to see such great results for you. You have crossed a major hurdle successfully. I hope that the next steps go well too. No Rush. Just update when you feel comfortable. All the best !!

    ReplyDelete
  9. My age is 31, AMH 2.5 and reason for IVF is male factor.

    ReplyDelete
    Replies
    1. When was your AFC measured ? You are young, AMH looks pretty good then why is it that your AFC is only 6 !

      Whatever protocol is used, if your AFC is 6, you might expect around 6-9 eggs. Instead of long lupron, a flare protocol might be beneficial and will be much easier on your body. Perhaps you must talk to your doctor about it and ask his opinion. You must also understand that the first IVF will be more like a trial and error, only when you start stimulation you will know how your ovaries will respond to meds. Lots of good luck !

      Delete
  10. Hi Manju,
    Its 6 in each ovary, i.e. total 12 is AFC count.

    ReplyDelete
    Replies
    1. I think then it's great :)

      Long lupron will be fine.

      Delete
  11. Thanks for the reply, Manju!
    and wishing you luck and success in your journey ahead!!

    ReplyDelete
  12. This is very exciting news!! Can't wait to read more!

    ReplyDelete
  13. Your baby(ies) are amongst those embryos. Congrats!

    ReplyDelete
  14. Anh, beautiful picture of you and your LO. Is this that little frozen embryo ! How cute, so happy to see you and your LO.

    ReplyDelete
    Replies
    1. Hi Manju, so glad you remember me! Yes this is my lil Popsicle dream come true. And soon you lr dream will be realized too. Love your blog and will follow you to your success!

      Delete
  15. Manju, We are waiting for an update from you regarding the current cycle.

    ReplyDelete
  16. Hi Manju!
    I have a doubt. It may sound bit weird to you.
    But which process is better for embryos?
    Growing them to blastocyst and then vitrification or freezing first ( at 2 or 3 days) and then growing to blastocyst stage during transfer? Or both are same in terms of outcome?
    My clinic follows the later and embryos are hardly grown to morula stage before transfer. Does it alters outcome in any way?

    ReplyDelete
    Replies
    1. Many clinics freeze blastocyst stage embryos because they freeze better and when thawing loss of cells is minimum. This means, it is better to grow them to blastocysts and then freeze. But, you must remember that if you leave the embryos to grow to blastocyst and if they don't grow to blastocyst you will be left with nothing to freeze. It is widely believed that embryos that don't grow to blastocyst in vitro will not survive to blastocyst stage inside the uterus too. If this is true, it is better to freeze embryos in blastocyst stage. This will save you time and money. You do not have to undergo a fruitless FET.

      My clinic thaws embryos just before transfer. So I have no idea whether the lag in growth after thawing the embryo is normal and hence it is hard to guess whether it compromises outcome.

      Hope this helps !

      Delete
    2. The only weird or stupid question is the one which you don't ask :)

      Delete
    3. Thanks for the reply Manju.

      Delete
  17. Hello Manju

    Hope you are doing good. 3 months back my AFC count was 18. Today as part of starting the stimulation cycle had my E2 blood work and ultrasound. Right ovary had 5 follicles plus couple of very small ones. Right ovary they see a cyst and no follicles. I am waiting for my nurse call to see whether they will proceed with this cycle or not.

    Can you please let me know what could be the reason for the cyst. Also do you think it is advisable to proceed this cycle on stimulation.

    Thank You!

    ReplyDelete
    Replies
    1. You didn't tell me what your e2 result is, did you get the value in hand. Perhaps your e2 is high because of the cyst. High e2 levels can suppress FSH and as a result recruitment of antral follicles from pre antral follicles is compromised. This might be the reason for low antral follicle count this cycle. If I were you I wouldn't go on with stimulation this cycle and definitely not if your E2 level comes back high. Please wait, a cysts is a very normal occurrence and there is nothing to panic. Perhaps taking a month of birth control pills will get rid off the cyst. Then you are OK to start.

      Delete
  18. Thank You so much Manju. Dont have the E2 results yet. Waiting for the nurse to call me with the results.

    ReplyDelete
  19. Hi Manju..i m yet to get the blood results but just nurse called me saying that cyst on left ovary is 15.8 mm...she said with the suppression medicine (cetrotide) i may not be making multiple follicles. there can be follicles behind the cyst. Based on the blood results, it will be decided to proceed on stimulation or not.

    ReplyDelete
  20. Hi Manju

    Got the blood work results estrogen 68 and progesterone 0.44. Doctor has mentioned to go ahead on this cycle. Please let me know if that makes sense or not.

    ReplyDelete
    Replies
    1. Many doctors like to see e2 below 50 when stimulation starts. Yours are not so high. But, what bothers me is your AFC count. If what you said about your AFC count is correct then I would really talk to your doctor about why he thinks it is ok to start. If the cyst is left like that does it suppress the growth of other follicles ? I think you must talk to him and advocate for yourself. Good luck !

      Delete
    2. May I know your age, AMH value and the reason for IVF ? Were you on lupron ? What protocol you are going to be on ?

      Delete
  21. Hi Manju

    I m 33. IVF due to male factor. I m starting stimulation injections from morning tomorrow. I was on cetrotide for 3 days prior to period. My nurse said it is suppression check ultrasound which was done today and follicles weren't to be counted. I m not very clear on this though.

    ReplyDelete
    Replies
    1. Did your doctor give you the entire protocol regimen ? Can you please post it here ?

      Delete
    2. Cetrotide in luteal phase is thought to help women who are poor responders to stimulation. It is used for women with high FSH and DOR. It is thought to help in the synchronous growth of follicles.

      Is this your first IVF ?

      I think it is wise to follow your doctor's suggestion. Hope the cycle goes well. Keep me updated if possible !

      Delete
  22. What would be the best time to check on this cyst? I ll have my next ultrasound four days after my stimulation injections

    ReplyDelete
    Replies
    1. After 4 days you will know about your cyst's status during ultrasound.

      Delete
  23. hi Manju
    still waiting for hearing good news from you present cycle.
    i had a tele consultation today , the second one after my IVF cycle and the doctor said that on my first cycle i had some dark eggs. what does it mean?what are the causes? could you please help me?on my husband side he said that the best on the next cycle is to do a testis biopsy , to see if we can use is sperm or a donor. we want to try it again on next november. i asked him to send my IVF report. can i share it with you?
    best regards
    maria

    ReplyDelete
    Replies
    1. Maria, a diagnosis of granules in cytoplasm and dark spots in eggs mean that the eggs are atretic. That is they are dying or about to die. This happens because of your age and hence poor egg quality.

      manjupadmasekar@yahoo.com

      You can send me your reports to this mail id


      Delete
    2. Dear Manju
      many thanks for you help
      i already sent my IVF report to you email
      i am very happy to hear that you finally met Rita and everything is ok.
      cheers and all the best

      maria

      Delete
    3. I will get back to you Maria.

      Delete
  24. Thank you Manju for your response. This is my second IVF. Will definitely keep you posted.

    ReplyDelete
  25. Hi Manju

    I had my scan repeated today on D7. No cyst today. Right had 8 follicles, left had 4. Wanted to let you know. Thank You so much for all your help and support.

    ReplyDelete
    Replies
    1. That sounds really, really good. Good luck ! Let me know how the outcome is, how many embryos, quality etc. I am eager about the cetrotide protocol. Thanks a lot !

      Delete
  26. Sure Manju. Will keep you posted.

    ReplyDelete
  27. Hi Manju

    I am the one on Cetrotide protocol. This is the response i received from lab today. Asked them to send me a note, as what they told me didnt make any sense to me. Please see below and let me know.
    *******************************************************************************************
    You had 21 oocytes retrieved, 16 of those were mature and ICSI’d, 7 of those fertilized normally (9 did not look like they fertilized, but we held them in case we missed the window to detect fertilization). On day 3 all 7 fertilized embryos were in the cell range we like to see (6-10 cells). Of those embryos 5 had 10% or less fragmentation, and 2 embryos had 10-20% fragmentation. All but 2 of the 9 questionable embryos did not cleave. The 2 embryos that did cleave are fairly far behind the normal range. These 2 were held, but are not expected to make it to the blastocyst stage.

    ReplyDelete
    Replies
    1. Thanks a lot for the update !

      I would expect minimum 3-4 blastocysts. Lower fertilization rate may be due to poor sperm quality, I think so. Everything looks fine. I hope this IVF cycle is yours. If you are young please consider a single embryo transfer! Lots of good luck and my prayers are with you. Keep me updated :)

      Delete
  28. Thank You Manju! Take care of yourself.

    ReplyDelete
  29. Doctor has suggested me to do a frozen embryo transfer.

    ReplyDelete
    Replies
    1. That's a great suggestion. But, please do SET if you have good quality blastocysts.

      Delete
  30. Hi Manju..what is SET? Please let me know.

    ReplyDelete
  31. LOL. I try to enjoy the opportunity i get to laugh now adays. That helps to keep me and my husband light.
    I really laughed reading the expansion.

    ReplyDelete
    Replies
    1. May your happiness and laughter last forever :)

      Delete
  32. Thank you Manju! We had 5 blastocyst frozen. 3 on D5, 2 on D6. Please let me know if I need to ask anything specific before planning FET. Nurse mentioned transfer would be done 4-6 weeks once transfer I'd initiated.

    Also Waiting To Hear Your TEST Result. I m praying for positive.

    ReplyDelete
    Replies
    1. That's a great outcome :) Good luck! Thanks too!

      FET must be very easy. They will give you estrogen to grow the endometrium and do the transfer once the lining has reached appropriate thickness. I hope this cycle is for you and you will update us with a positive pregnancy test :)

      Delete
  33. Thank you so much Manju! Hope your words come true.

    ReplyDelete

Please do write to me! It makes me happy :)

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