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| Grading human preimplantation embryos. Courtesy : nature.com |
Your embryos are
graded according to their microscopic appearance and are given a rank (like
grade A, grade B, grade C and so on). A
day 3 embryo which gets the topmost grade will have 8 cells which are equal in
size, with all cells having single nucleus , without any fragments. If you have
10 embryos, not all of them will be of top grade on day 3. Some will have a
fewer number of cells, some might have uneven cells, while others may have lots
of fragments. The doctor will select the best embryos from amongst these (the
top grade embryos) , and transfer these to the uterus . The remaining embryos
can be frozen, if they are of good quality. But what happens if all your
embryos are of poor quality? Why does this happen ? There are 2 possibilities :
- The embryology lab had some technical problems, and failed to create good embryos
- The quality of your egg is not good , which is why the cells did not divide properly, and hence the embryos appear poor morphologically
To rule out the
first possibility , insist that your embryologist show you photos of the
embryos of other patients who were treated on the same day . If these are good
quality, this means the chances of their being a lab problem are small.
If this has been
ruled out, then remember that the commonest reason for poor quality embryos is
poor quality eggs. It’s the mitochondria in the cytoplasm of the egg which
provide the energy for cell division. If the eggs are of poor quality , their
mitochondria cannot provide enough power to drive normal cell cleavage, which is why the embryo may
arrest; or the cells may have lots of fragments. Unfortunately, there is no
method to test egg mitochondrial quality as yet.
However, do
remember that grading is a very crude tool and that the appearance of your
embryo cannot predict its ability to give rise to a baby accurately. Poor grade
embryos do give rise to a healthy baby , while many good looking embryos fail
to do so !
So after the embryo transfer, any failure that happens is because of the eggs (apart from hla matches or immunological issues)? The sperm quality doesn't play a role?
ReplyDeleteMost probably not ! 90 percent of genetic defects arise from the egg and only 10 percent from the sperm
ReplyDeleteHi Manju,
ReplyDeleteI have also tried IVF 4 times. I am also in the medical field but nothing prepares you for something like this. The very first cycle the embryos did not survive and all arrested by day 5. The second time around, they did a Lupron (down regulation) cycle and 17 eggs retrieved. 12 fertilized ok and I ended up with 4 on day 5. 2 were transferred (no pregnancy) and 2 were frozen. They put the 2 I had left in for a FET cycle and I was pregnant but no fetal pole was established and I had to have a D&C. Have you heard about this before? I went to another clinic where I tried again. only 8 eggs retrieved and 3 survived Day 3 - then arrested day 5 and again I am left with nothing...I don't understand. I have no gyn history of anyting, all my testing is "normal." This is a MFI issue (missing vas deferens) so we have been using TESE samples. I have no idea what is going on and no doctor seems to be able to give me an answer. The only thing I have left to look to is trying again with Chinese/Ayurvedic medicine simultaneouly. What do you think? Do you think there a medical reason for this?
May I know your age, AMH and day 3 FSH and e2 value ?
DeleteDoes your husband's lack of vas deferens due to congenital reason ? Was he tested for genetic mutations in CFTR gene ? I am not sure whether it can be done. Men with mutations in CFTR gene lack vas deferens. And CFTR gene is also involved in early human embryo development and blastocele formation. Perhaps this can be a reason for poor blastocyst formation. You said during one IVF cycle 4 day 5 embryos were obtained. Do you have the pictures ? Are they of good quality ?
Please read this : http://m.molehr.oxfordjournals.org/content/8/8/758.full
I am not sure whether my reasoning is correct. But just gave you some information to think about. Is anyone else suffering from infertility in his family ? Any of his siblings ?
I forwarded your query to Dr. Malpani and this is what he replied
Delete:
She needs a PESA-ICSI ( www.drmalpani.com/pesa)
We can give her a guaranteed pregnancy option
I hope this helps !