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Embryos should undergo a process called "compaction" at the tail end of the 8-cell stage (prior to dividing to the 16-cell stage). During compaction, the individual cells of the embryo stick together and become a tight ball called a morula. Embryos must undergo compaction prior to development to the blastocyst stage, the stage at which embryos develop the capacity for attachment and implantation (i.e. no compaction, no blastocyst formation, no implantation). Delayed compaction (i.e. an embryo that has divided beyond the 8-cell stage but has not begun compaction) may have compromised developmental potential and arrest development prior to the blastocyst stage.

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Thank you doctor.

I just found out that the 12 cell arrested, so it was indeed abnormal.

Any opinions on 8 cell grade 1 & 2 embryos? They seem to be on track for 3 days, right?

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Yup. Best of of luck.

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I am age 41. After starting with 25 eggs, I am now left with only one poor quality (others have chromosome abnormalities). This egg was at 12-cell stage on day 4 and is still at 12 cells on day 5. I have been advised that if it does grow more cells on day 6 it may still be worth implanting.

I would appreciate your opinion on what you would recommend in this case.

Many thanks.

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The embryo must undergo compaction (see post above) to reach the compacted morula stage by Day 6 in order to be worth transferring. Hopefully it will. If it doesn't reach the compacted morula stage by tomorrow am, I would advise against transfer.

Thanks for posting about the number of genetically abnormal embryos you had. It is important for the members of the Shared Journey Community to understand that by the time you're in your early 40's, this is a pretty typical outcome. How come no one tells you this when you're 35? Good question.

Best of luck.

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Dr. Smith,

I'm 35 and had 4 embryos transferred back yesterday;

2 A grade 8 cells (both from ICSI)
1 B grade 8 cells (fertilized conventionally)
1 C grade (fertilized conventionally)

At retreival, I had 22 eggs, over 1/2 immature. 6 were ICSI'd from which 2 fertilized. And 3 fertilized conventionally for a total of 5. We lost the 5th as it did not cleave. Since the C grade would not be expected to make it to freezing, we decided to put it back (use it or lose it). My highest day 3 was E2 66 and FSH 7.9, 6 failed IUI's, responded well to stims each time.

Would you expect my problem to be poor quality eggs overall with these results and do you feel the chance of these to be successful based on actually 3 appearing viable? My quality concern is that since most did not make it, does it reduce the chances of these even though 2 were 8 cell grade A on day 3? (proportionate assumption)

I'm on inj. progesterone and Lovenox post transfer.

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Also, addition to the email above;
Assisted hatching was performed on one of the A grade 8 cells, and the B grade.

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I'll answer your second question first. No, the fate of the other eggs/embryos does not reflect directly on the quality of the embryos that were transferred. The three 8-cells embryos that were transferred were of sufficienct quality to result in a pregnancy.

However, with respect to the other eggs/embryos, there does appear to be an "egg problem". I'm concerned that so many of the eggs retrieved were immature. I would have expected about 20% (say 4-5 out of 22) to be immature. The high number of immature eggs suggests dysynchrony in folliclular growth (i.e. half of the follicles were too small to contain a mature egg). Of the "mature" eggs (i.e. fertilizable), the low fertilization rate (even with ICSI) suggests inadequate cytoplasmic maturation. In other words, a sperm got inside the egg, but the egg failed to initiate development because the egg cytoplasm had not matured sufficiently while it was still in the follicle. The process of cytoplasmic maturation is not well understood and often overlooked when evaluating what might have gone wrong with a particular cycle. The observed "egg problems" point back to the management of the stimulation. If the stimulation was too short (i.e. <9 days) or if there was a disporportionate number of small follicles, it can cause these kind of problems. I suspect there is nothing inherently wrong with your eggs and, if this cycle is a bust, you might do better on another cycle with better control over folliclular growth.

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Dr. Smith,

Thank you so much. After 6 IUI cycles (3 on bcp, lupron & follistim), based on our past responses to stims, we expected that we should have gone one more day before retrieval in order to obtain more mature eggs. You are correct about our length of stimulation, it was 8 days of follistim, (Ovidrel the following day, ER 36 hrs later). We also had different RE managing our IVF cycle than the one that managed all 6 IUI's. We are very familiar with our response to stims and were surprised we did not go another day in order to mature the smaller follicles as they were all close in size and expected to be mature very soon. My E2 was 2850 48 hrs before ER, perhaps she was concerned with hyper stimulation. Thank you again.

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Hello Dr smith,

I am 37 & I have just had ET on my 3rd icsi..
I had 10 follicles.. 6 eggs.. 2 were empty.. 2 were very immature & 2 were suitable for icsi.. Only 1 fertilised, I had it put back on day 2 at 2.30..
My clinic graded it a grade 2 ( grade 1 being best) but it was only a 2 cell ( it was 2 cell in the morning also) I have been told to be cautiously optimistic but did get the impression from my embryologist that it may well have stopped dividing.
I just wondered what you thought , Do I have any hope do you think ??

Thank you Katy. x

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I have to say that it doesn't sound very promising. By the afternoon of Day 2, the embryo should have reached the 4-cell stage. It is likely that the embryo has stopped dividing. From your description of the current cycle, and the fact that this is your third IVF cycle, their appears to be a serious problem with egg quality here. If this cycle doesn't work, I think you should consider utilizing donated eggs (if this is acceptable to you and your partner). Of course, this is not what you want to hear, but I'm being completely candid here.

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Hi Dr Smith,

I appreshiate your honesty. I know it is a long shot for it to work & I thought I should ask you what you thought. I actually made an app with my consultant on my way out of ET & we will discuss my options. Both my other cycles I got 4 eggs all 4 were good enough for icsi & 2 fertilised both times & had divided well for 2 day ET. This was my worse go yet !! I am thinking maybe I will try Menopur next time ( I have been on 450 Puregon) again do short protocol & if I do just as badly next time I really will have to consider Egg Donation & for that we would go to Spain as here in England there is a long wait & we would have to inform the child when it was 18. Going to spain & everything is a big deal it would be so much easier if we could do it here so one more go at icsi with my own eggs seems easier. I have children already & only had to look & I was pregnant so all this has come as a real shock.
Thank you for your response.
Katy.

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With regards to Menopur, the best results seem to be obtained with a mixed protocol (i.e. a purified FSH product plus Menopur).

I read that Sir Richard Branson (of Virgin everything fame) has set up a "pirate" IVF center on a ship off the coast of England to circumvent the rather strict regulations around using donor sperm and eggs in the U.K. The center is called (what else?) "Virgin Conception"

http://deadbrain.co.u
k/news/article_2005_09_17_0830.php

Hav
e
you heard anything more about it?

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Hi Dr Smith,

I hadnt heard anything about Sir Richard Bransons... 'virgin conception' !!... Very interseting , thank you.

What kind of purified FSH product would you recommend ?? To go with the menopur ??

With the Puregon I was having ganirelix ( Orgalutran ) from day 7 is that what you mean ? Sorry if I sound dence but I would like to go in there on Feb 22nd sounding like I know something & to have questions & suggestions ready.. ( If this cycle fails !!! )

Thank you for all your help,

Katy.

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Any of the purified FSH products will do. There are equivalent. Some doc prefer one over another, but they are all pretty much the same.

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Hi Dr Smith,

Last question I promise !!!!!

So I could suggest Bravelle and Menopur ??
As I dont down reg .. Do you have these together or one first & the other once follicles are growing nicely ?? I am not sure what the FSH products will do ??

Thank you Katy. x

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