Saturday, April 26, 2008

ET was today

I had my 2 day transfer today.

at ER we had 9 eggs retrieved which is exactly how many my RE thought we'd get based on my E2 levels.
Out of the 9 7 fertilized with ICSI.

We did a 2 day transfer of our 3 best embryo's however only 1 looked promising.

Embryo #1 was 4 cells and had even cells (meaning all the same size) and 1 nucleus in each cell. This embryo is a high quality.
Embryo #2 had slightly uneven cells but was a 4 cell embryo. 2 of the cells had 1 nucleus but the other 2 cells had multiple nucleus.
Embryo #3 was a 4-5 cell embryo. they said it was cleaving and starting to divide. I can't remember what the cells had for nuclei but I am pretty sure this was the lowest grade of the 3.

I'm not sure of the quality of the rest of my embryo's. I had a 2 cell and I think the rest were 4 cells but I'm pretty positive that the rest were abnormal in one way or another. I tend to get embryo's that are multinucleated (which is poor quality and leads to decreased pregnancy rates. These embryo's often don't survive)

here is what I found on the internet that might help explain how my clinic grades embryo's:


Eggs retrieved from the ovaries are inseminated with sperm during therapeutic in vitro fertilization (IVF). Fertilization must be confirmed by the embryologist and embryo development carefully monitored thereafter. On the first, second and third days of development, embryo quality is evaluated based on key morphological markers, including the number of cells, cell size and symmetry, multinucleation (more than one nucleus in each cell) and the presence of cytoplasmic fragmentation. The thickness of the zona pellucida, the protective shell surrounding the developing embryo, is also a consideration for embryologists as they select the "best" embryos for replacement in the uterus.

The rate of cleavage (cell division) is an important predictor of an embryo’s developmental potential. Evidence indicates that early cleavage, embryos with four cells on day 2, and embryos with seven to nine cells on day 3 result in higher implantation rates and establish more pregnancies than those with fewer or more cells at those time-points. Based on this, we preferentially replace seven to nine cell embryos on day 3 and consider others for cryopreservation if they meet additional quality standards.

Uneven cleavage is common among human embryos developing in-vitro and there is general agreement that replacement of embryos with this characteristic results in lowered pregnancy and implantation rates. This may be due to an unequal distribution of cellular components among uneven cells or the occurrence of more nuclear abnormalities among them. As a result, these embryos generally are not selected if others are available.

A. A normally fertilized egg showing two pronuclei

B. An uneven 6-cell embryo with one multinucleated cell

C. An 8-cell embryo with minor cytoplasmic fragmentation

Following the first division, some blastomeres in human embryos show multiple nuclei rather than the normal single nucleus. Possible causes are the lack of appropriate oxygen levels during follicular development or a rapid response to hormones during ovarian stimulation. Regardless of the cause, implantation and pregnancy rates decrease with increasing proportion of embryos with multinucleated cells replaced in the uterus. These embryos also have a considerably reduced ability to reach the blastocyst stage in extended culture. The selection of such embryos for replacement is avoided if at all possible.

end quote:

I wish I had pictures of my embryo's to share but I forgot to ask for them. I'll call on Monday and when I talk to the embryologist I'll see if they took some but I doubt it. At my old clinic I was used to them automatically taking the picture and giving it to me.

As you can tell from reading the above criteria only one of my embryo's is promising. However that's more then I've had in a year so I'm over the moon that I have a perfect embryo. Granted I am still holding out hope for my other two. I guess you never know...but an embryo with multiple nucleus is chromosomally abnormal.

I bolded a part I thought was important. I just assumed that meant that I had crappy eggs, when in reality maybe it means that all this time my eggs/body didn't respond well to the medications. I do tend to respond a tad quicker. and lots of my embryo's grew with in the last few days of my stim's. most of my cycle I had 7 embryo's, it wasn't till the last few days where the other 6 showed up so they grew rather rapidly.

This does give me a slight hope that I can conceive naturally. however the abnormal embryo's could just be becuase I have poor quality eggs. it's possible that we just have a high number of chromosomally abnormal eggs. Some of the eggs we have are abnormal and will NOT make a baby. Which is why almost no one gets pregnant right away. It's why it can take up to a year for perfectly healthy people to get pregnant. Unfortunately I guess I just have a high number of abnormal eggs.

All in all this batch did look better then the last batch I think. Most were "even" as in they were 2 or 4 cells. Unlike last time where I had mostly 3 cell embryo's and some 4-5 cell's that were extremely abnormal.

I'm going to talk to the embryologist on Monday for 2 reasons. 1 is to get an update on if my embryo's survived the weekdend (by Monday they should be at the day 4 stage, morula. My embryo's have NEVER made it this far. But i also want to pick her brain about my embryo's. What the chances are of a multinucleated embryo making a baby. I'd kind of like to know what my chances are. I'm not sure switching clinics will help me at this point. This RE has proven that he can get double or triple the eggs my last RE did.

Side note. The RE today asked me what I did for a job. He thought I was in the medical field because I knew what I was talking about. I chuckled and said "nope I'm just obsessed with having to know every single detail, I've spent hours on the internet researching." My husband then replied "those hours have probably added up to days and weeks by now." LOL

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