Question about my embryos
61 Replies
Katy stokes - January 28

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


Dr Smith - January 28

Bravelle and Menopur work fine together. The Bravelle is FSH, follicle stimulating hormone, and does just that - stimulates follicular growth. The Menopur is a combination of FSH and Luteinizing Hormone (LH). Most docs believe that both FSH and LH are needed for adequate folliclular growth and egg maturation. I believe this. They can given together from the begining (i.e. 3 Bravelle and 2 Menopur) or Bravelle (FSH) first and the adding the Menopur on top of the Bravelle (FSH+LH) after a few days of stimulation. Depends on the doc. Both ways work.


allison - January 28

Sorry to barge in, but I have a question about the pure FSH vs. FSH-LH combination. I am now on my 4th IVF.
I'm 34, baseline FSH 4.7, LH 2.9, everything normal, ovulate regularly. Sperm is ok too. Unexplained infertility.
My first 2 cycles I was on a long protocol with Lupron and Gonal-F. I did not stimulate very well, and even though some eggs were retieved, none fertilzed.
The 3rd cycle was a short one - statrting with Gonal-F (7 days) and then switching to Menopure and Cetrotide. I stimulated much much better, more eggs retrieved (and mature) and 2 fertilized, but reached only 4 cells on day 3. BFN.
Now I'm on my 4th. My RE decided that we'll go with only Menopure & cetrotide this time. I'm on day 7 of stims and so far doing much better than the previous cycles. We'll see what happens....
Do you think for some patients the pure FSH stims don't work well? My RE seems to think that I need a longer stim and that the pure FSH was problematic and eggs weren't mature.

thanks, allison.


Dr Smith - January 29

Yeah, pure FSH only stimulations seem to work O.K. in younger women (like egg donors), but most REs believe that some LH is necessary - particularly later in the stimulation - to facilitate follicular and egg maturation. Stimulations with Menopur alone have resulted in particularly long stimulations (our own experience and that of others), but if its working better for you - Great!


LOuise - January 31

I had egg collection on Thursday 26th Jan. They got 4 eggs of which all fertilsed ( with ISCI ) I had 2 2 cells 1 3 cell and 1 4 cell. On saturday I had the 3 and 4 cell embryos put back in me. Im 28 and this is my first go of IVF treatment. Reading this site Ive noticed that everyone seams to have at least double the amount of cells as I have . Do you think this is bad news? We werent told a grade. Also is it ok to have sex now? Ive been resting in bed and have the week off to take it easy.


Louise - January 31

Laugh! I just read what I wrote and it sounds terrible. Iam going to be resting HONESTLY ! It was obviously a question my hubby wanted to know.


Dr Smith - February 1

The embryos should reach the 4-cell stage by Day 2 (in your case Saturday 'cause the day of retrieval is counted as Day 0). The 3-cell wasn't that far behind, so its not a really bad sign.

If they continue to develop, the embryo(s) would reach the blastocyst stage Tuesday or Wednesday (today) and initiate attachment and implantation at that time. I'd hold off on intercourse until after the pregnancy test (just to be on the safe side), BUT that's not the only way to fool around (wink, wink). Now I sound like Dr. Ruth LOL Hey, what can I say, I took a healthy interest in sex and turned it into a career. Now you know what kind of guy I am...


Janet - February 18

Hi Dr. Smith,

I am 39 with my first IVF cycle and had my ET yesterday (2/16). Only (1) embryo made it (I produced 2, but the 2nd one did not divide correctly "too much genetic material"). The embryo they implanted is a 4-cell Grade 1 and was slow to divide (ET on Day 3). My Dr. said I have a 5% chance of pregnancy. What are your thoughts? Do I have egg problems? Thank you!

~ Janet


Dr Smith - February 18

Yes, there is a problem with both the quantity and the quality of the eggs you produced on this cycle. At 39, you need to produce at least 6-8 eggs to have a reasonable shot at pregnancy. If this present cycle is unsuccessful, and you want to try again, it would only be worthwhile if you had 8 or more growing follicles. If your ovaries do not produce the minimum number of growing follicles on a subsequent cycle, you should give serious consideration to the thought of using donated eggs. Sorry, not what you wanted to hear, but that's where your best chances lay.


tinak - February 26

Hi Dr. Smith,

Just a quick question. My first ivf cycle and I had 12 follicles, 6 eggs retrieved, 6 eggs were mature, and 6 eggs fertilized. At ET I weas told I had 1 Grade A 10 cell, 4 Grade B1 8 cell, and one Grade B1 8 cell with fragmentation. However, on day five none were at blast but ther were not arrested either. Why? The doc transferred all five. What are my odds?


tink - February 26

Just a little extra info. This was my very first ivf cycle. I am 38 years old, had one natural occurring pregnancy a year ago and miscarried. I have not been pregnant since. Two injectible Gonal F cycles with IUI. I have elevated fsh of 13. The fragmented egg was discarded, and the other five were putback. Besides being slow he said they looked normal. I am now 9dp5dt. I am on POI and estrace 2 mg 3 times daily. I do not have a beta test scheduled until Friday, March 3rd. Needless to say I am very nervous. Any feedback you could offer would be greatly appreciated. Thanks Tina


Dr Smith - February 27

What was the day of transfer - Day 3 or Day 5? The embryos you describe are appropriate for a Day 3 transfer. However, if the cell-stage embryos you described were transferred on Day 5, they had indeed arrested.

Sometimes embryos do not reach the blastocyst stage until Day 6 of development. Embryos that continue development to reach the blastocyst stage on Day 6 are at the compacted morula stage (roughly 16-32 cells) on Day 5. Embryos that fail to reach the compacted morula stage by Day 5 have arrested.


tinak - February 27

The embryos were transferred back on day five. If they indeed had arrested, why would they even go through the process of putting them back? Is this a question I should ask? I mean with all of the costs and all, and if there is no chance why contiue to go forward. Also, I noticed they are waiting to do a beta test 14 days from egg put back not 14 days from retrieval, why? So you think it is worth even trying another cycle or should I give up hope. Thanks for your honesty and help.


Dr Smith - February 27

This is a matter to discuss with your doctor. I suspect the doctor did not want to tell you that all the embryos had arrested for fear that you would blame him/her and the lab. His/her thinking was that it was better to put all the embryos back in you and take an out-of-sight-out-of-mind approach. Of course, it defeats the whole purpose of waiting until Day 5-6 to identify blastocyst stage embryos that are capable of implantation. Not to mention causing you more stress in the long run. Having all the embryos arrest development is horrible news, but having to wait two weeks for the same outcome is painful.

It is not unusual to perform the pregnancy test 14 days post transfer (Day 3 or Day 5). This eliminates false positives resulting from the residual hCG in your system that came from your hCG shot before the egg retrieval. Its a long wait, but at least the results are definitive.

If this attempt is unsuccessful (I put your chances near zero), I think you should give it another try. I predict that the doc will tell you that you should have a Day 3 embryo transfer next time "because the embryos will do better in you". Unless their lab sucks (and its probably just fine), that suggestion is BS. My advice is to go to blastocyst again. If there are no blastocysts the next time, then give up or move on to donor egg. However, based on your age, I think you'll probably have a blastocyst or two next time.

Best of luck.


Aramance - March 1


I am 34 and this is my first IVF cycle. I had my ET on Monday of this week. My physician implanted 3 blastocysts, 2 grade C and 1 grade D (but he also told me it was a young blastocyst). When my embryologist spoke with me, he recommended transferring all 3 stating, "You will probably only get one to implant. By implanting all 3, 2 of them will help the other implant." I don't understand that statement. How can the embryos help each other implant?

I was very upset by the news of grade C blastocysts. However, I was also told that they were "average" and that it was common to implant grade C (if C is average, I assume they use a 5 point scale) and that pregnancies do occur with this. Is my anxiety well founded or am I just being a paranoid Polly:) Thanks for helping me understand.


Dr Smith - March 1

First, a point of symantics. The embryos are transferred to the uterus, not implanted. Implantation is something the embryos do (hopefully) all by themselves. Implantation occurs approximately 12-24 hours after the transfer of blastocyst stage embryos.

The laboratory is using their own unique grading system, so I cannot comment on the blastocyst quality issue. There is a standardized grading system for blastocyst stage embryos explained here ( You can ask them how their grading system compares to the standard.

You are correct that transferring multiple embryos does not increase the chance of any single embryo implanting. They don't "help" each other. It was white lie to make you feel better about transferring 3 embryos that were of "average" quality.



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