Welcome back for part 4 in my Behind the Laboratory Door series where I detail what happens in an embryology lab during an IVF cycle. If you are just joining us you can get caught up with part 1, part 2, or part 3. The last time I left you the embryos were all safe and secure in their nice warm incubator.
OK, so you have been coming into the office all the time for scans and blood draws – sometimes on a daily basis, and have got to know most of us pretty well by now. So then you have the egg retrieval and you are left to your own devices for a few days with just a couple of phone calls. Don’t worry about it though – we have not forgotten about you or your embryos at all.
They have been kept nice and warm in the incubators, and given fresh media when they needed it. We have checked them and noted things about their developmental status at different times as well. They may even have heard some singing – we like to keep the music playing in the laboratory most of the time!
The next time after the egg retrieval that you will be asked to come back to the clinic will be for a discussion about the development of the embryos on day 3. At this point we generally expect that the embryos will have about 6-8 cells inside them as they start on their journey to being ready for implantation.
This is an exciting day – and you will have to be getting ready to make a big decision. Once again you will probably be very nervous waiting to hear what we have to say, but we will try to give you all of the information that you need to hear in order to be able to make that decision as easy as possible.
We like to make each of our treatment cycles as appropriate to the patient as possible, and with us being a small team we are able to make decisions and change tactics quickly if needed. Some clinics might determine that all patients will either have a day 5 or a day 3 transfer. Some others may decide what day a patient is going to be having their transfer at some early stage during the cycle. While it is sometimes possible to guess what day a patient will be having their transfer, unless you are doing PGD we will not make that final decision until we have all the information about your embryos on day 3.
So, what are we going to be telling you at this visit? We will go over the whole cycle up to this point as far as the laboratory is concerned, such as how many eggs were retrieved, how many fertilized and then what their development looks like. To be considered a good quality embryo on day 3 they should have between 6-8 cells with very little fragmentation, which is small parts of the cell that break apart each time to embryo divides.
Although there are a whole series of different algorithms that we use to determine who should have a transfer on day 3 and who should go to day 5, the decision isn’t always an easy one. There are risks and benefits to both options, and at the end of the day all we can help you do is try and balance them out.
This decision is a very personal one and depends on your individual history, the number and quality of the embryos, your age and the degree of risk, and tolerance for the possibility of a high order multiple pregnancy. Although we generally get a higher pregnancy rate after carrying out a blastocyst (or day 5) transfer, it does not always mean that it is the right answer for you. There is obviously going to be an end point by which you will need to have made a decision, but we will try to give as much time as you need, within reason, to make this decision. It is always good to try to discuss before hand what your ‘ideal’ number of embryos to transfer might be – but you do need to be able to flexible depending on the information that we give you at your day 3 appointment.
Next time, in the final installment of my series, I will talk about the embryo transfer process. Thanks for reading, if you have enjoyed this series please share using one of the buttons below. You can also follow us on Facebook, Twitter, or sign up for our RSS feed. Cheers!