Update from last post (31 eggs collected = 1 frozen) if has any comments please

[Scarlett32]

Update: information from the embrologist.

Of the 31 oocytes collected, 24 were mature and injected using ICSI with 20 showing signs of correct fertilisation.

On day 3 of development, 10 embryos were at the correct cell stage (we expect embryos to be between 5 and 10 cells at this point) however when looking at the cell size/shape and the amount of fragmentation in the embryo, 3 of these were considered 'good quality' which means the embryos were graded as having less than or equal to 20% fragmentation and typically even cells. Essentially, even divisions suggest that the embryos contents are being evenly distributed, and low fragmentation means that as much of the energy supplies within the embryo are available for ongoing development. We therefore look at these parameters because it can indicate the probability of embryos being able to progress to the blastocyst stage (the stage needed for freezing). Embryos with high fragmentation and uneven cell size typically struggle more. We would hope that approximately 80% of embryos are at the correct cell stage on day 3 of development, therefore in your cycle there were slightly fewer 'on-track' than we would hope. It would be suggested that as the egg drives development in the early stages, egg quality would have had a factor to play in the slightly lower than expected embryo quality on day 3.

From day 3, approximately 50% of embryos on track on day 3 progress to a blastocyst, with 50% of these meeting the grade required for freezing. Based on your day 3 observations, having 3 blastocysts form but only one being suitable for freezing in within our expectations. I wouldn't describe your cycle as having embryo developmental arrest as we never expect all embryos to have the ability to progress to a blastocyst.

All fertilised eggs were cultured until day 6, excluding the embryo that was frozen on day 5.

     In more specific detail your embryos were graded as below:

2 x 833 ( one of these progressed to your freezable blastocyst: 4Bc)

1 x 832 (progressed to a 5Cc blastocyst on day 6)

1 x 733

1 x 722 * (progressed to a 5Cc blastocyst on day 5, grade maintained on day 6)

1 x 721

2 x 622

2 x 521

1 x 433

1 x 422

1 x 421

1 x 322

2 x 321

1 x 222

1 x 221

1 x 211

1 x fragments

The above grades describe the appearance of your embryos on day 3 of development and where specified day 5 or 6. Where it is not specified, these embryos did not show any change on day 5 or 6 of development. For the day 3 grades, the first number reflects the number of cells in the embryo (ideally between 5 and 10 cells), the second relates to the evenness of the cells and the third relates to the fragmentation. The evenness of the cells and fragmentation are graded between 1 and 4, with 4 being our 'top grade'.

For the blastocysts on day 5 and 6, the number reflects the size of the blastocyst (4, fully expanded and 5 hatching), the first letter the inner cell mass (cells that hopefully go on to give baby) and the second letter the trophectoderm (cells that hopefully implants to the endometrium an forms the placenta and other extraembryonic structures). The ICM and TE are graded as A, B or C - embryos graded Bc or higher are considered for freezing. Unfortunately, whilst the 4Bc embryo did meet our freezing criteria, the 5Cc embryos did not. This is due to the sparsity of cells within the embryo - these embryos were comprised of too few cells which means they would be extremely unlikely to tolerate the freezing and warming process. It is embryologists that decide on which embryos will be frozen in each cycle - for your cycle one embryologist graded your embryos in the morning and a second in the afternoon prior to freezing.

3) Unfortunately there are no specific tests that can be carried out to directly assess egg quality

4) Unfortunately, I'm unable to comment on whether past surgeries have affected your egg quality, if any supplements would be recommended or if the prescribed medication is having na affect on your fibroids- I would recommend that you discuss this at you follow up consultation

Any comments are much appreciated x

[Spicycurry]

I’m sorry. Have you been offered IMSI instead of icsi? Has your partner’s sperm been analysed for high dna fragmentation?

[MyLittlePinkness]

I don’t have anything to say to help you but that is a very detailed account from the embryologist!!!! I’m sorry you’re cycle didn’t go as you hoped, sending you lots of hugs💕💕💕💕

[Backagain987]

Definitely recommend you book a follow up with your consultant asap. I think they will advise a different protocol next time.

Fibroids and fibroid surgery are very unlikely to impact egg quality, its more about implantation and scar tissue.

Keep soldiering on, hope you get some answers.

[GranolaLoverBaby]

I am so sorry to read this. That was a very thorough report and I hope it provides the closure you need. My clinic doesn't grade or PGTA test embryos because they believe that even those that do not look the prettiest or if lower grades can still go on to be healthy babies. Would it be possible to consider Day 3 fresh transfers in future for those that do not seem freezable? I have heard stories of people and doctors who said that the "lower grade" embryos seemed to survive better within the mum than in the lab and usually went on to be healthy babies.Best wishes to you