IVF. What You Should Be Asking

April 26, 2016
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Usually, soon after patients have decided to proceed with treatment, they go through a number of events. At this point, they have already spoken with their IVF nurse coordinator, agreed to an IVF medication protocol, found the best way to purchase medication, settled most financial obligations with their clinic, booked their travels (where applicable) and are all set for their upcoming cycle. But then… they stop getting phone calls about medication reminders and scan appointments and some completely new information starts to flood in!

The avalanche of information now coming is all about the numbers of eggs retrieved, the number of mature eggs, cell numbers, quality, and the list goes on! For us in the IVF Laboratory, this might be an everyday routine, but for our patients we recognize that it is all their hope and effort translating into numbers and scientific terms that are unknown and can be somewhat confusing.

As infertility is a disease where different factors are involved, patients can feel very vulnerable and anxious during the treatment. As embryologists we try to support them and at the same time inform them in an accurate way, without creating more confusion.

Patients do have a lot of questions and we try our best to answer each one. No question is irrelevant and no question is absurd as long as it makes the patient feel more secure and informed.

This week is National Infertility Awareness Week and we encourage our patients to ask questions. Below are some questions that should be answered by your Embryologist and clinic when going through IVF.

  • How Many Mature Eggs do I have? : On the first day after the egg collection you the patient should be informed about the number of mature (ICSI cases) and fertilized eggs.
  • How are my embryos progressing? What Quality are they? : As your embryos progress, the number of cells on each day as well as the quality plays the most important role. The embryologist should inform you of this progression. On Day 2 the embryos are expected to be between 2-4 cells whereas on Day 3 this can be anywhere between the ideal 6-8 cells. The cells should be as equal as possible and not a lot of fragmentation (small fractions of cytoplasm inside the embryo) should be noted.
  • Should I have a Day 3 or Day 5 embryo transfer? Does the day of transfer matter? This is the most commonly asked questions.. Here is what we know:

Although transfers on Day 5 seem to produce a higher clinical pregnancy rate, this is because Day 5 transfers are usually preferred when the patient has a lot of embryos. It is considered a “selection step”, especially when we are aiming to transfer up to 2 embryos in order to avoid a multiple pregnancy. Statistically the numbers are in your favour as the more embryos, the better the selection will be.. BUT…this does not mean that a Day 3 transfer cannot be successful, especially in patients of younger age.

  • Why didn’t all my embryos make it to blastocyst? From the start, we know that all the embryos cannot make it to the blastocyst stage. The percentage of embryos that will go onto make blastocyst in the average cycle is about 40%, depending of course on the egg quality, the sperm quality and the quality of the subsequent embryos. So the fall off in the numbers of embryos that progress as we go on to Day 5 is absolutely normal.
  • Can you tell if my embryo is a boy or a girl and if it is healthy? Unfortunately, in a regular cycle we cannot tell whether the embryos are genetically healthy or their sex, as this is information that needs further testing of the embryos, through a biopsy and a procedure called PGS.

Scientific information can always be overwhelming. The key is to take it one day at a time and trust that we, the scientific team, are doing our best, as your success is our success.

At the end of the day we only need one embryo to make it! And we have witnessed that countless times!

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