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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 (http://www.sharedjourney.com/articles/Time.html). 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.

Hello Dr. Smith how are you? I just wanted to say thank you so much for your honest answer. I had wrote to you with regard to my very first ivf cycle (see above). Needless to say, as you had predicted, it failed. I had my consultation today and was completely ready to hear "you need to use donor eggs". However, I was encouraged not to give up on my own eggs quite yet as I can always use a donors eggs but mine will not always be available. In your last post to me you seemed to think that I might have a chance if I tried one more cycle before going to donor egss. I guess I am looking to see that I am being encouraged to go in the right direction. As you well know, this is a very emotional and trying time for couples. With elevated fsh and my age would you say that this is a reasonable request? I respond fairly well to the meds and all my numbers (i.e. estrodiol, progesterone etc) on my blood draws look good. We are just very nervous as this is a huge financial obligation and the disappoint is also difficult to deal with. Don't get me wrong, there is no price on family, but a person can only go so far.
Looking for a little advice. Thank you in advance. Tina

From a purely practical point of view, the most efficient way for you to become pregnant is through the use of donors eggs (success rates of around 60%). However, moving on to donor eggs should only occur when you have satisfied yourself that it won't work with your own eggs. Otherwise, you'll be left with the nagging doubt "Maybe I should have tried just one more time". I think you still have a chance with your own eggs. For what its worth, I think you should give it another shot.

Hello Dr. Smith,

It took a great deal of courage for me to write you this e-mail. I guess my fear of the truth held me back, but here it goes. I turned 40 years old this January and already have a 14 year old son (Alex- he's the joy of my life), this is my 3rd attempt with IVF. My husband is 49 years old and has low sperm count with poor morphology. I just had my egg retrievel on Tuesday morning which produced 22 eggs of my own. My husband and I received the call the next day, the embriologist confirmed that all but 1 had fertilized and 1 the next day. They decided to do the egg transfer the next day with 2 embryo's- 1 at 2-cell & 1 at 3cell. I know that it's very hard to make any predictions on an individuals basis, however I'm asking for your expertise and tell me what my husband and I should expect? We are a very caring and determined couple who really wants to know our options. Do you think that this 3rd attempt will work?

Stats:
1st IVF 2 embryo transfered on 3 day 4-6 cell stage
2nd IVF 3 embry transfered on 3 day 3-8 cell stage
3rd IVF 2 embryo transfered on 2 day 2-3 cell stage

Why are they transferring only 2-3 embryos? Do you live in the U.S.? Although, in general, Americans tend to transfer too many embryos, at forty, transferring only two embryos cuts your chances significantly.

At forty, a low percentage of your embryos (roughly 20%) will be genetically normal. Most of the genetically abnormal embryos fail to develop beyond the 8-cell stage (usually attained on Day 3). Unless you wait until at least Day 3 to determine which embryos have the capacity for development to at least the 8-cell stage, it is very difficult to predict outcome.

I hope they cryopreserved some embryos because, at forty, your chances of success with only two Day 2 embryos is very small.

Dr. Smith,

I am 34 and this is my first IVF cycle. I just had my 3 day transfer with assisted hatching on Friday. They transfered 3-8 cell grade 2 embryos. Do you think there will be a chance at least one will implant? How long after 3 day transfer does the embies implant? I have been having a slight cramping/pulling sensation on and off all day. Is that a good sign? Or am I just over-analyzing everything?

Thanks,
Darlene

Its very hard to predict outcome from Day 3 transfers because the embryos are not yet over the "hump" by having reached the blastocyst stage (which is necessary if the embryos are going to implant). Also, grading systems can vary from lab to lab. Soooo, all I can say is that it looks O.K. so far. Embryos attach to the endometrium on Day 5-6 of development (at the blastocyst stage), so about 2-3 days after a Day 3 transfer. Implantation is a process that takes about 10 days to complete. You will feel all kinds of things during the two week wait, but none of them mean anything. It is natural to over-analyze during the two week wait, but try to stop yourself from driving yourself crazy. Best of luck.

Hi,

I would just like to say I posted on here pn page 1 & 2.. I have since had another go at icsi ( 4th go )
I only produced 2 folicles big enough this time & only 3 in total.. 2 eggs were suitable for icsi only 1 fertilised & I got my first grade 1 embie .. 4 cell.. 2 day transfer.
I JUST GOT MY FIRST POSITIVE... YEAH.
12 days into my 2ww my levels were 149.. nice & above average.
My reason in writing this is to say.. dont give up with your won eggs until you are really sure.. I thought mine had reached the end of the road.. But NOPE !!!

good luck everyone.

I just had my second IVF cycle, the stimulation treatment results in retrieval of 10 eggs, all of them are matured, but only 5 were fertilized with ICSI.

At day 3, we transferred two embryos

10-cell framentation 2 symmetry 2
10-cell framentation 4 symmertry 5

I have very good uterus lining. Do you think the first embryo has a good chance of implanting? Is a higher number of cell cleavage the better?

Unfortunately, different labs use different grading systems, so it is difficult to interpret the grading of your particular embryos. In general, a higher number of cells is better, but if an embryo develops much beyond the 8-cell stage without undergoing the process of compaction, it is likely that it will stop growing prior to reaching the blastocyst stage and therefore be unable to attach to the uterine lining.

Hello Dr. Smith,

I am writing to you again. I had wrote to you previously about my first ivf cycle. A quick overview: I am 38, slightly elevated fsh, was on menopur, had 12 follicles with 6 eggs retrieved. All eggs mature, all eggs fertilized. However at day 5 I only had one morula and the rest were still at the 8 cell. No pregnancy, as you predicted. My estrodiol last time was only around 1800. I did try another round as you recommended. My estrodiol level was higher, 2400 and something, 10 follicles found, 10 eggs retrieved, 3 were immature and out of the seven six fertilized. On day 3 (same day as putback) the doctor said we had gorgeous embryos. We had one 8 cell and the rest 7 cell. He would only put 4 back and we left the other two to see if they would go to blast. We expect a call tommorrow the 27th or 28th to find out what happened. I am just curious to know your thoughts on what my odds are. We did have one egg that was a little oblong shaped. I read on line that it could be a cause of the "pull" during egg retrieval. Oh, and previously to my first ivf cycle I had a surgical septum removal.
You were right last time and I am looking for some more of your wonderful, honest advice. thanks tina

Although the transferred embryos were at the appropriate cell stage for Day 3 and were of good quality (I stay a away from superlatives like "excellent", since they build strong patient expectations), its difficult to predict your outcome. Based on what you provided, your chances seem reasonable, but if there was any scaring of the endometrium from the septum resection, that could lower your chances. Like I said, its difficult to predict because there are several factors involved.

Best of luck.

i am 33yrs old i have 3 children which i conceived naturaly. iwas sterilized 7yrs ago but then i met my new partner 4yrs ago. he has no children so we decided 2 have my sterilization reversed but unfortunatly my tubes were to damaged, so the only way would be ivf, anyway here we are i had my embryo tansfer 4 days ago they transfered 2 embryos but they were only 2 cell embrys, we are worried because we heard that 2 cell embryos had a very low chance of implanting is this true?

The 2-cell stage is appropriate for embryos on the morning of Day 2 (Day 0 is the day of egg retrieval). If the embryos were transferred on the morning of Day 2, then their stage of development is O.K. However, embryos must continue to develop to the blastocyst stage (roughly 50 cells) by Day 5-6 in order to be capable of implantation. For someone your age, approximately 60% of the embryos will stop growing before reaching the blastocyst stage (due to genetic abnormailites). Of the embryos that reach the blastocyst stage, each one has about a 25% chance of implanting AND developing to term. Accordingly, your chances of a term pregnancy following the transfer of two 2-cell embryos on the morning of Day 2 is approximately 20%. If the embryos were transferred later than the morning of Day 2, then your chances would be less because the embryos were developing slowly or they had already stopped growing.

I am 40, FSH of 5.4. We did 2 IVF/ICSI cycles with my husband's sperm and on the first cycle we retrived 7 eggs on low dose FSH (after 9 days of stims). On the second (IVF/ICSI) mix FSH and Menapor and retrived 10 egg, 9 suitable for ICSI and 7 Fert (after 10 days of stims). We later found out that my husband has a genetic disorder and decided to do donor sperm. We did another cycle (IVF) we used FSH and from day 6 Menapor however we only retrived 5 eggs (after 8 days of stims). Of these we had again 80% fert rate on day 2 we had 1 five cell grade1, 1 four cell grade 1 and 1 four cell grade 3. All put back again BFN. We moved clinics and the clinic chose the donor for us (we had no input in the matter and no information given to us). I produced 11 eggs with low dose FSH (250) and 10 days of stim. On my day 10 scan I was surprised to be told we were scheduled for ICSI due to the low motility of the sperm. Of the 11 eggs retrived, only 8 were mature and only 4 of these fert!! Which is only 50% with ICSI as apposed to 80% with previous attempts. At ET they said we have 2 embryos to put back (max. here by law!!). I asked about the remaining but the doctor said after ET she would answer our questions. She said they were both 4 cell. After ET she said that the other 2 embryos had ceased to cleave. And that the embryos put back were excellent quality. I asked about the donor and she said that his motility was 12% hence ICSI. She refused to provide any further information except he was a proven donor. And suggested that the reason for the poor fert rate was poor quality eggs as they were dark and grainy and that is consistant with my age.

I asked the previous clinics about the condition of my eggs and they said nothing was noted about their condition. Do you think I should give up on my eggs or should I try again. And if so what should I do different?

Kindest regards
Gigi

It is not unusual for the post thaw motility of donor sperm to be on the low side. Admittedly, 12% is lower than usual (around 30% is average). In this situation, ICSI was your best bet for fertilization. When eggs fail to activate following ICSI, it most likely a result of poor egg quality rather than "faulty" sperm. The "dark and grainy" kiss of death is also consistent with your age. It might have been observed in the other clinic, but not recorded on the embryology lab sheets because it is so common in cases of advanced maternal age.

It is dificult to say much about 4-cell embryos since they have a long way to go to reach the blastocyst stage and become capable of attachment and implantation. At 40, approximately 80% of your eggs are anueploid (abnormal chromosome number). Anueploid embryos rarely make it to the blastocyst stage. With two embryos transferred and an 80% chance that each one won't even develop to the point where they are capable of implantation, your chances are pretty slim (but not exactly zero). From a purely practical point of view, using donated eggs and donated sperm would give you the best chance of a term pregnancy (assuming there is no contributing uterine factors). Not what you wanted to hear, but thats what I would advise.