This means that if there is a grade 3 embryo on day-2 of development, the chances to form a blastocyst are lower, but they also can manage to remove these fragments and still form this structure with the remaining cells.
During these days, we will classify the embryos with the number of cells they have and the number according to the fragmentation rate. We always say that:
It is possible to define 3 main parts:
On the presented graph, you can see that at the age of 35-36, the euploidy percentage dramatically decreases. With the genetic selection, we can choose chromosomally normal embryos to transfer and avoid transferring embryos that may not be euploid. By doing this, we reduce the number of transfers and prevent transferring embryos which will lead to a negative pregnancy or even a miscarriage. How is the biopsy done in the lab?
To perform the biopsy, we need to have an expanded blastocyst, big enough to take some cells out of the trophectoderm without harming the embryo. We do it with a laser that helps us to cut these cells and then this is sent to the genetic lab which will analyse them. Once we finish the biopsy, we will try to preserve them until we have the report from our genetic lab, which usually takes around 10 or 20 days. Then with this information, we can plan the following embryo transfer if the embryo results are normal.If all the embryos come out as abnormal, in some cases of previous miscarriage or implantation failure, we can presume that this could be the issue. This will give us a lot of information to plan a different treatment for the future and maybe move on to an egg donation program that will be more accurate in this situation. Considering all these main factors, Ana suggests that:
By doing day-5 embryo culture, having the optimal conditions in the lab with the help of the time-lapse incubator that allows doing morphogenetic analysis, and by doing PGT-A testing, we can help to make a better embryo selection. That way we can transfer the best embryos, and this will be directly related with the successful treatment.
We don’t use this kind of media at our clinic. Each clinic uses different protocols in its daily routine. In our clinic in Alicante, for example, and the one that we have here (Manchester), we always access every media that we use, and we validate them, but unfortunately, I don’t have any experience with the ones you’ve mentioned.
Yes, I do. PGT-A gives us relevant information on what kind of embryos we have, if we have aneuploid embryos, and we transfer them, we know that the result is going to be a failure in the pregnancy. If we have this information, we can just select the embryos that we know are going to have more chances to become a positive pregnancy. Every clinic is going to say that, and it’s really important. It also depends on the age, but we always recommend it.
If the fragmentation rate is high, the embryo is not going to develop to the blastocyst stage, so it’s not going to be a successful embryo, it’s not going to create this successful structure that we want. If the fragmentation rate is not as big, they can manage to form this structure anyway, and they can also result in a positive pregnancy. We have a lot of cases that it has already happened, but the fragmentation rate will affect the quality of the embryos.
We have almost the same success rates with frozen embryo transfer and fresh embryo transfer. I would say we have like a 99% of the viability of when we thaw the embryos, so they have almost the same quality. The success rates are quite similar, at least in our clinic.
Not better, as I said, it can be the same, but it isn’t better to do it on day-3. If we froze the embryos at day-5, this embryo at this stage has much more cells, they are formed by hundreds and hundreds of cells, whereas day-3 embryos have normally around 8 cells. If we miss one cell in this one cell is that in this process of cryopreservation, it will imply more damage in the day-3 embryo than it will do on day-5. I would always recommend going to day-5 and then freeze the embryos and then do the transfer.
We just freeze or transfer good quality embryos grade A or grade B, we always freeze them. If we don’t think an embryo has any possibilities of becoming a pregnancy, we will not freeze it.
If the egg quality is not the best, PICSI is not going to improve the outcome of the treatment. PICSI is going to help when the quality of the sperm is not so good, but if we have an oocyte problem, it’s not going to help. We can choose a better sperm and try our best, but it’s not going to change the quality of the oocyte.
The male factor starts to appear on day-3, it becomes part of the embryo on day-3. It’s true that at some point if we, for example, see that the embryo has good fertilization, good quality on day-2, good quality on day-3, but suddenly something stops on day-3, after day-3, therefore, we can suspect that this can be related to the male factor. This isn’t going to be the only option, but yes, it can be related to the male factor, when we see that all the embryos are stopping on day-3 or day-4 of development.
I have seen it, not just heard about it. I have seen that embryos that don’t look as they are of perfect quality, let’s say we have a 3 BC embryo, which is not the best, but still, they have the instructors that we need, and we have transferred them, and we have babies, and we have pregnancies. That’s why we don’t discard any embryos. The optimal embryo to have will always be a 5 AA, 4AA, but sometimes we also have 5,3 3, 3, 45 BC quality embryos, which led to a positive pregnancy and a healthy baby.
There are different criteria between labs in what to keep and want to discard when we assess the embryo, but we always try to get all the information that we get from the embryo and keep the ones that we think are viable, even if they are not of the best quality.
If we’re talking about the embryos to improve the implantation, I would recommend doing PGT-A testing, I don’t know if in your previous attempt you have already done it or not, but the implantation failure most of the time is related to abnormal embryos. If we know that the embryos are chromosomally healthy, we can just try to deal with this problem.
If we’re talking about endometrium and the capacity of the endometrium to the implant, there are a lot of tests that you can always do such as the ERMAP test. This is a more clinical part, and it’s better to get advice from the doctor, but there are some tests that you can do to improve the implantation potential.
When we talk about donor sperm, we cannot compare frozen sperm versus fresh sperm just like that because when we freeze the sperm, some sperm cells are going to die during this process, and if in the fresh sample we have 50 million, in the frozen one we will have 30 possibly. It doesn’t mean that the quality is worse, sometimes if we just check the numbers, it seems that I have this frozen donor sperm, and it says that it has 10 million, don’t worry because the majority of the banks had wonderful criteria to select the donors that they use, and they have to fulfil this, they have to have normal sperm and this is not going to be a problem to use frozen sperm.
If it comes from the partner’s sperm, it’s a little different. If the fresh sperm quantity or quality is limited, we will always recommend using fresh sperm because we cannot lose these in the cryopreservation procedure.
The euploidy and the morphology are not related. If we have a good quality embryo, a 5AA quality embryo, it doesn’t guarantee that it’s going to be euploid, we have nice embryos that after the PGT-A test results, we see are aneuploid, so this is not easy to relate. When we talk about health conditions, as I said, the only way to access that is by doing PGT-A testing, we cannot check it with the morphology.