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Hi Dr. Smith-
I email you all the time concerning different issues but I am sure you cannot keep track so in order to set up my questions, here is my background:
48 eggs retrieved, 35 mature, 31 fertilized (ICSI)
I did not develop OHSS but my estrogen levels went above 7000 so we had to coast for 24 hours prior to retrieval.
Fresh IVF cycle:
Transfered 3, 3day embryos Level 2, 8celled.
BFN
16 3 day embryos in cryo
FET cycle:
thawed 6 embryos
All arrested on or before day 5 except for 1.
1 embryo made it to blast on day 6 and transfered.
BFP
Blighted Ovum, D&C
Questions:
1. I have 10 frozen embryos, what are the chances that any of these can/will develop into a healthy fetus considering that the other 5 arrested on day 5?
2. On my 1st FET, the RE told me "the Blast looked pretty good"...well it wasn't. Can the Embryologist tell whether a Blast is capable of full development prior to transfer to avoid a miscarriage?
3. I am considering starting over with a fresh cycle because I do not want to go through 6 weeks of pregnancy (symptoms and all) to end up with a D&C again. In your opinion, should I start fresh or go for the FET?
Thank you very much for taking your time to help all of us the way you do.
Jenn
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A1. I cannot predict the outcome of another FET. However, keep in mind that every sperm-egg combination is genetically unique. So, the developmental potential of some embryos does not necessarily reflect the developmental potential of other embryos in the same cohort. I do have to say that when so many eggs (48!) are retieved, the developmental potential of the embryos is lower than optimal. In the case of eggs, more is not necessarily better. The ideal number of eggs from a stimulated cycle is 15-20. To few, and there is a risk that there will not be enough embryos to make it to blastocyst. Too many, and the developmental potential is decreased - follicular overcrowding? exceptionally high E2? - no one knows why. For this reason, I would not be too alarmed that one out five made it to the blastocyst stage. This is somewhat predictable based on the number of eggs retrieved.
A2. The embryologist can, to some degree, evaluate the developmental potential of the blastocyst by looking at the number of stem cells present. Blastocysts with too few stem cells can, and do, result in "chemical" pregnancies or empty gestational sacs. "Pretty good" is hardly a quantitave statement and does not refer to the grade (i.e. # of stem cells) of the blastocyst that was transferred. I would seek the embryologist's grade of the blastocyst.
A3. I would still proceed with another FET. However, make it clear that you do not want any "substandard" embryos transfered (i.e. embryos with too few stem cells).
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What do you consider "too few stem cells" in a Blastocyst?
Thank you again.
Jenn
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The grading system for number of stem cells in the blastocyst is not entirely quantitative and is based, in part, on the subjective evalaution of the embryologist. In my experience, there should be about 6-12 stem cells in the inner cell mass (the "lump" of stem cells inside the blastocoel cavity) to be transferrable or freezable. However, it is not always possible to actually count the number of stems cells (now we get to the subjective part), so the embryologist will look at the size of the inner cell mass as an indirect measure of the number of stem cells present. The inner cell mass then receives a grade of A, B, or C. A's and B's are O.K., C's are not.
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