Why are my embryos of such poor quality ?

Grading human preimplantation embryos. Courtesy : nature.com

Your embryos are graded according to their microscopic appearance and are given a rank (like grade A, grade B, grade C and so on).  A day 3 embryo which gets the topmost grade will have 8 cells which are equal in size, with all cells having single nucleus , without any fragments. If you have 10 embryos, not all of them will be of top grade on day 3. Some will have a fewer number of cells, some might have uneven cells, while others may have lots of fragments. The doctor will select the best embryos from amongst these (the top grade embryos) , and transfer these to the uterus . The remaining embryos can be frozen, if they are of good quality. But what happens if all your embryos are of poor quality? Why does this happen ? There are 2 possibilities :

• The embryology lab had some technical problems,  and failed to create good embryos
• The quality of your egg is not good , which is why the cells did not divide properly, and hence the embryos appear poor morphologically

To rule out the first possibility , insist that your embryologist show you photos of the embryos of other patients who were treated on the same day . If these are good quality, this means the chances of their being a lab problem are small.

If this has been ruled out, then remember that the commonest reason for poor quality embryos is poor quality eggs. It’s the mitochondria in the cytoplasm of the egg which provide the energy for cell division. If the eggs are of poor quality , their mitochondria cannot provide enough power to drive normal  cell cleavage, which is why the embryo may arrest; or the cells may have lots of fragments. Unfortunately, there is no method to test egg mitochondrial quality as yet.

However, do remember that grading is a very crude tool and that the appearance of your embryo cannot predict its ability to give rise to a baby accurately. Poor grade embryos do give rise to a healthy baby , while many good looking embryos fail to do so !

Read more at : http://blog.drmalpani.com/2011/06/why-were-my-embryos-of-such-poor.html

When should I test for pregnancy after embryo transfer?

The two week wait ( 2ww) is one of the most exciting as well as one of the most emotionally draining phases of an IVF cycle.  You are eagerly waiting to know what has happened to your embryos – did they implant or not ? The doctor’s done his best – now  it’s all upto you ! How well will your body
perform ? Most  IVF clinics want you to wait 14 days after the egg collection before doing a pregnancy test (a test which detects the HCG hormone produced by the cells of the developing embryo !)  But you can do a pregnancy test much earlier too. A blood test might tell you whether your embryo implanted or not as early as 7 days after the embryo transfer.  Very sensitive home pregnancy tests ( which detect the HCG hormone in urine ) are also available. They detect HCG even at very low levels – as little as 25 mIU/ml. Such tests appear to be a boon for women who cannot wait to know their result – those who cannot bear the suspense. But such tests are a bane as well ! Sometimes , even if you get a positive pregnancy test at home , or if you detect the HCG hormone in your blood earlier than 14 days past transfer, when you go in for the definitive test (14 days after egg collection) you might end up with a negative result. This can be heart-breaking , because all the dreams you built because of a positive pregnancy test will be shattered.  A positive pregnancy test which later become negative can happen because of two reasons :

• Chemical pregnancy – your embryo tried to implant , but failed to successfully embed into the lining
• The HCG shot which you took for triggering ovulation was still in your body and the pregnancy test detected this HCG , which is why you got a false positive result !

Such false positive tests or short-lived positive pregnancy tests can cause enormous frustration ! 

You can also get a false negative if you test too early. As a result of this, you might spend the second half of your 2ww in tears, anger and disbelief – none of which will help your emotional well-being. Of course you will feel happy when you get a positive result 14 days after egg collection, but all the stress and negative emotions you go through because of the first negative pregnancy test result can make your 2ww  very unpleasant.

This is why it is wise to wait patiently for 14 days after egg collection before you can do a pregnancy test. 

Read more at : http://blog.drmalpani.com/2011/01/testing-for-pregnancy-after-embryo.html

What happens to my embryos if they do not implant ?



Scanning electron microscopy (SEM) of a human blastocyst that adhered to the endometrium (during cell culture). The blastocyst is oblong and flattened, presenting many short microvilli at the apical surface. Many trophoblastic cells have bulging surfaces, thereby illustrating cell borders. The blastocyst adhered to a pinopode presenting area on the endometrial cells. Flattened endometrial cells dominate the surrounding area with microvilli at the apical surface. Single ciliated cells are interspersed (scale bar = 130 μm).   © European Society of Human Reproduction and Embryology

 

If my embryos do not implant , what happens to them ?

The embryo(s) which are transferred to your uterus are just microscopic ball of cells. You cannot see your embryo with your naked eye; you need a microscope , which would enlarge it several hundred times , before you can view it. When your embryos fail to implant and give rise to a pregnancy, they die and disintegrate. Cells die in the human body all the time, and these dead cells are removed by your body’s scavenging machinery. When you get periods after a failed cycle, only the endometrium which is formed during that particular IVF cycle is sloughed off. Since you took lots of hormones , your endometrial lining might be thicker than usual and you might experience heavier menstrual bleeding or you might have more clots (which appears like a tissue) than you normally do. This doesn’t mean you are having a miscarriage or that the transferred embryo was expelled.

If one of my embryos implant, what happens to the other embryo(s) which was transferred along with it?

The embryos which did not implant die and disintegrate. They are removed by your bodies cleaning machinery. You do not need a menstrual period to remove them from your uterus and neither do they harm your developing baby, so do not panic !

Some FAQs about embryo trasnfer

What if I bleed after the embryo transfer ?

Most embryo transfers are very smooth, and do not create any trauma to your cervix or endometrium, which is why you should not experience bleeding or spotting after an embryo transfer. However, some patients have cervical stenosis (a narrow cervical opening), and if their embryo transfer is technically difficult, there may be bleeding after the transfer. Please do not panic. The blood is not coming from your uterus and your embryos are not affected in any way. The tiny drop of blood is not your embryo. So keep calm and carry on with your everyday activity. If you experience severe bleeding after the transfer please contact your clinic (but this is very unlikely to happen !)

Why did I feel a wet discharge after the embryo tarnsfer ?

During embryo transfer , the doctor cleans your vaginal canal and the cervix with a sterile fluid. When you get up after the embryo transfer you might experience a wet feeling, because this fluid leaks out. Do not panic – this doesn’t mean that your embryos are being washed out ! The fluid that comes out is not from your uterus. Your embryos are transferred inside your uterus in a tiny droplet of culture medium , which cannot flow out – your embryo are safe in your uterus !

Do I need to take any special precautions after the embryo transfer ?

Once your embryos are transferred to your uterus they are safe inside. If they are genetically competent and if your uterus is conducive for implantation, the embryos will implant , no matter what you do ! Stress, food habits, coughing, sneezing, climbing stairs or not taking bed rest will not stop you from conceiving. In short, anything you do during 2ww will not stop you from conceiving . Conversely, nothing you do during the 2ww (like changing food habits, bed rest etc) will help you in conceiving. Do not do something which will cause regrets,  if the cycle does not succeed (for example, if you are going to think - I had a glass of wine , and that is why my IVF cycle failed, then please do not have a glass of wine ! )  Try to have a healthy diet, take your folic acid, continue with your normal, daily activities ; take your prescribed medicines.

Nothing you do can harm your embryos. Please do not let your mind play games with you. Read more at http://drmalpani.com/care-after-embryo-transfer.htm

Can I fly home straight after embryo transfer ?

Yes, you can travel immediately after embryo transfer. Air travel or any other mode of transport has not been shown to affect embryo implantation , and it will not affect your chances of achieving a pregnancy. Take measures to make yourself comfortable during air travel – keep yourself well-hydrated and move frequently to enable proper blood circulation.

How do my embryos look?

 

Source: The Virtual Human Embryo.

Your embryos are very minute; it is impossible to see these tiny balls of cells using your naked eye. You need a microscope to view them. Your embryo divides at regular intervals after fertilization and will have a different appearance under the microscope each passing day. There is a set of rules which tell you how your embryos should look for their age ( for example, a day 4 embryo looks entirely different from a day 2 embryo because of the rapid cell division they are undergoing). Knowledge about how they look during the different development stages will help you to know how competent your clinics IVF lab is. If you want to see how embryos look , check out: http://www.drmalpani.com/embryos2.htm and http://www.drmalpani.com/embryos.htm

Dr.Malpani's Blog: Video Guide to PCOS ( Polycystic Ovarian Syndrome)

Dr.Malpani's Blog: Video Guide to PCOS ( Polycystic Ovarian Syndrome)

Happy Mother's Day !

Many women who are struggling to have a baby might view this day as an occasion, which reminds them of their inability to become a mother.  While the rest of the world celebrates motherhood, they suffer from Mother's day blues. See the above picture - did the lady in that picture carry a baby in her womb ? No - but she will always be fondly remembered as "Mother" Teresa. When we think of Mother Teresa, we remember her caring ways; the selfless service she rendered to the poor and needy; the love and compassion she showered on suffering souls; the dedication she showed in the work she did; the sacrifices she did to make this world a better place. It's these qualities which prompted people to call her affectionately as "MOTHER" and not the fact that she had undergone the biological process of giving birth ! Mother's day is a celebration of all the admirable qualities that exist in a living being - LOVE, AFFECTION, DEDICATION, SACRIFICE, COMPASSION, EMPATHY and so on. Actually, going through infertility brings out these sterling qualities which are lying within us. Can you show me an infertile women who doesn't love children, who doesn't care for others suffering, who doesn't reach out to a soul in pain ? Being infertile teaches you empathy – and all of us learn a lot from adversity. Infertile women are usually much more caring – and can reach out to a fellow soul in pain because they are suffering themselves.  The truth is that carrying a baby for 9 months doesn't make anyone a mother - caring does ! Is there anyone else who knows the value of motherhood than we do :) So, my dear friends, have a very Happy Mother's Day ! Every one of us deserves as many Mother's day wishes as any other women ! I will be very happy too if the readers of this blog could reach out to me with their Mother's day greeting.

I love my mother so much - she carried me in her womb, and cares for me until this moment. She is my greatest moral support; she helps me to tackle infertility bravely. She remembers the jokes she reads, and shares them with me whenever we talk over phone. She makes sure to make me happy; hear me laugh; and finds happiness in that.  During childhood, whenever I suffered from fever, she used to wake up several times during night and feel my forehead  to make sure that I am not running high temperature. I still remember the warmth and love I felt in those gentle touches. Other than her daughters, there are many people who call her mother too ! She never failed to reach out to people who are in need; she could easily put herself in their shoes. I learned all the motherly qualities from her, and I am blessed to have her in my life. I love you mom, you are the best !