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Although most of the genetic "weeding out" occurs prior to reaching the blastocyst stage, a small fraction of blastocyst stage embryos are genetically abnormal. It is these genetic abnormalities that often cause chemical pregnancies and 1st trimester losses.

Each sperm and egg combination is genetically unique, just like you are genetically unique from, say, your sister or brother. Every embryo's DNA is unique in some way. Therefore, just because all the embryos on a given cycle are genetically abnormal, it doesn't mean that the all the embryos on a subsequent cycle would also be genetically abnormal. However, and this is a big however, the [i]probability[/i] is higher than say someone that had only a few genetically abnormal embryos on the first cycle. That's because the genetic abnormalities were likely caused by a problem with the eggs that was, in turn, caused by age. In other words, having a really crappy cycle predicts a higher probability of having another really crappy cycle, but it does not absolutely predict another crappy cycle.

I believe there are various stages of blasts. What is the success rate with early blasts (1st stage) compared to advanced blast on Day 5.

Continuation from above.....

I'm 29. We did ICSI due to MF. I had 6 embryos on Day 3. Out of 6, 3 were 9 cell, 2 were 7 cell and 1 4 cell. RE suggested a Day 5 transfer. On day 5, we had 3 blasts (the 9 celled ones from day 3). Out of 3, 1 was a stage 3 blast and looked grainy and the other 2 were early (stage 1) blasts. We transferred all 3. What do you think my success rates are compared to a Day 3.

I think your chances are good - about a 60% chance.

Thanks for your reply. Would you have suggested to transfer 3 early stage blasts ? I believe the advange of going to blastocyst stage is to be able to pick good quality embryos and thus transfer fewer embryos. I was going to transfer 3 embryos on day 3 (the same ones that I transferred on Day 5), so how is day 5 more advantageous in my case. I'm still scared to death about ending up with triplets.

Although triplets are possible, they are unlikely in your case. However, should you become pregnant, the chances of twins is significant. Although that doesn't sound so bad, there can be significant developmental problems even with twins. They are almost always born prematurely and usually spend some time in the hospital before coming home. In our practice, we don't consider twins as such a great outcome. We believe that you should have as many babies as you like - one at a time. So, I share your concern for the possibility of multiple gestation. If you want my opinion, I think it was a bit irresponsible to transfer 3 blastocyst stage embryos on a 29 year old patient. We would not have exceeded 2 at our prgram - even though the two stage 1 blastocysts weren't as far along as we like to see them. Once embryos reach the blastocyst stage, even stage 1, they usually continue to develop rapidly (within a few hours) to stage 3-5. So, the good news is that you have a good chance of becoming pregnant, the bad news is that you are now at risk (albeit small) of triplets. A two embryo transfer would have reduced your chances of triplets to zero (monozygotic twinning aside). The extra embryo, if good of good developmental potential, could have been cryopreserved for later use. Of course, hindsight is 20/20. Best of luck.

Dr. Smith,

Thanks for giving your frank opinion. I'll keep my fingers crossed next few days. I'll let you know the outcome.

Dr. Smith,

I just wanted to let you know that I got a positive beta of 132 @ 14dpo and 292 @ 16 dpo. What do you think? Could this be twins? or more ?

Thanks for letting us know what's going on. The values are very good for a singleton and possibly twins. Thankfully, it appears that triplets are not a concern. Congratulations. The ultrasound examination in a couple of weeks will be conclusive as they will be able to count sacs. Until then, hang in there.

Dr Smith,

I wish I had found this website before , your answers are so honest and make such scientific sense to me, unlike some others I have read.

I have just undergone ICSI, and had a day 5 transfer yesterday, we had 10 embryo's, only 6 made it to day 5, all grade 2. But they did not make it to the blastocyst stage by day 5. The doctor did not seem worried , however I just received a call from the clinic that the remaining 4 did not make it to Blast by today either, so they do not recommend us freezing them (which is fine). Does this mean the 2 that have been transferred will more than likely not make it either? What percentage of success do you think I have.

I am remaining positive until scientifically I know otherwise, i really look forward to your response,

Thank you so much
Hugs4free

Your situation is a bit unusual. Please provide some additional information: your age and the reason for performing ICSI on the eggs. Thanks. I'll be in a better position to understand whats going on.

Hi , thank you

Following on from above. I am 31 and my husband is 31. My husband has a blockage, location unknown, so sperm was retrieved using a PESA procedure, taken from the epdidimis so that is why ICSI was performed. I have endometriosis.

19 eggs were retrieved on 2/11, 11 made it to fertilization.
Embryo transfer occurred on 2/16

On day 3 there were 10 embryos’ left, 2 grade 1 embryos, 6 grade 2’s, and 2 grade 3’s. By day 5, we had 7 left. 1 embryo was a grade 2, only 6 cell so it was discarded, the remaining 6 were grade 2 , one did grow to an early blast but the others didn't, the doctor said he thought they were developing a little slowly (due to the sperm)but he felt sure the others would make it to blast in the next 6-8 hrs that we could freeze, but by 2/17 they were not at a blast stage yet, so they have also been discarded. They transferred the blast stage 1 embryo and one other on day 5.(the doctor recommended only transferring two to avoid a multiple pregnancy)

I know you mentioned "each sperm and egg combination is genetically unique, just like you are genetically unique from, say, your sister or brother.' so I am still hoping that one of our little embryo's will make it.

Thank you so much

The explanation for the higher than usual percentage of embryos arresting development prior to reaching the blastocyst stage is the sperm. While fertilization rates with epididymal sperm are reasonable (usually around 60%), embryo development can slow or stop on Days 3-6. These embryos often stop growing at the stage immediately preceeding the blastocyst stage, a stage callled the compacted morula (around 16-32 cells). This underscores the value of culturing the embryos until they reach the blastocyst stage prior to transfer. This is the only way to identify embryos with the capacity to initiate implantation. In your case, only one of the eleven embryos made it to the blastocyst stage - but there was one. Early blastocyst stage is acceptable development for Day5, so you have reason to remain hopeful. It is unfortunate that you were not adequately prepared for the high embryonic attrition that is common to testicular and epididymal sperm IVF cases. It came a shock and stressed you out. I think your doctor could have done a better job of preparing you and your husband for this somewhat predictable outcome. Anyway, best of luck and hang in there.

Dr. Smith,

Thank you very much for your honest insight. If we ever decide to try ICSI again at least now we are better informed, and will be more prepared.

It is such a pity more doctors cannot be as honest and explain things to those of us undergoing fertility as you do.

I will let you know the outcome of our bHCG test on 2/25.
I shall remain hopefull.

Dear Dr. Smith,
I had 2 embryos transfered on a 5 day blastocyst. We were told by the lab tech that the embryos looked perfect and did exactly what they wanted them to do for a day 5 transfer.
(I don't remember the # of cells - was a different language to me at that time)
We also used ICSI because of my husband's low sperm count and motility.
(16 eggs were fertilized, 2 eggs transfered, and 4 eggs were put away) The transfer was done with a full stomach (so much water!), and using a sonogram machine for placement in the Uterus.
My beta test is this Thursday.
What do you think our chances are?
Thank you for your honesty and help!
Sunnydays

Your chances are pretty good - around 50/50 for a term pregnancy. And you have the 4 frozen blastocysts to fall back on as well. Hang in there and try not to stress too much during your two week wait. Best of luck on Thursday.