QuestionHi Dr. Ramirez,
I am writing from Israel. I am 27 with unexplained infertility and recently completed my first IVF cycle after 6 IUIs and 1 loss at 7.5 weeks. My fresh IVF failed after transferring 2 3-day 8-cell B grade embryos. Five embryos were frozen on day 3 (8B x2, 9B x2, and a 5BC). My doctor was resistant to the idea of trying to culture everything to blast as a selection device (my preference) and instead recommended that we do 2 FETs with the day 3 embryos to give each one a chance.
My ET for the first FET was this past week and we thawed 2x 9B embryos and 1x 8B embryo. One 9B became a 5B after thaw, one 9B became a 7B, and the 8B became a 6B. We transferred all 3. My question is this - does an 8B embryo, for example, with only 6 cells remaining post-thaw retain the same genetic potential that it had originally or is it now essentially the same as an embryo that was frozen as 6B and survived thaw as a 6B?
The fact that my doctor had no hesitation in transferring 3 suggests to me that none of these embryos have a great chance based on how they survived thaw but he wasn't really willing to tell me how I should adjust my expectations other than that I should always stay optimistic.
Also, if this cycle doesn't work, would you recommend a 2nd FET with the remaining 8B and 5BC or is it time to move on to another fresh cycle? Thank you very much for your time!
AnswerHello Alyssa from Israel,
There is no technology today that allows us to know exactly what the quality of an embryo is internally. The grading classification is mainly based on how the embryos looks. It is NOT measure of quality. It is also not a good measure of the ability of the embryo to achieve a pregnancy. I presume that your doctor's clinic is using an A-B-C classification (I use a Grade 1-2-3 classification). Studies have shown that there is no difference in pregnancy rates with grades 1 and 2 (A & B), but there is a decrease with grade C's. The more important aspect to look at is how the embryos progressed in their formation and divisions. Certainly, anything between 6-8 cells are good embryos and dividing well, and therefore have a good chance to implant. Even a 4 or 5 cell embryo can do this, although the chances are less.
I think I would agree with your doctor and not culture these embryos out to blastocyst for three reasons: (1) I think the uterus is a better culture media and environment that the lab, (2) we usually prefer to have a lot of embryos at the start because there will be an inherent reduction of the number that reach blastocyst, that is not all the embryos will make it due to lab, culture and other reasons. That does not necessarily mean they are bad embryos. I think it may just mean that we have not perfected the culture media and environment, (3) culturing to blastocyst does not necessarily increase your chances of a pregnancy, but definitely increases the chances that you won't have anything to put back.
In terms of how they thawed, they certainly did not do as well as would be expected, but that is a laboratory specific issue (which depends on the freezing and thawing technique). However, in answer to your question, the reduced number of cells does not affect the overall ability of the embryo to implant, cause a pregnancy or end in a normal child. We do PGS testing by removing a cell on D#3 embryos and they do just fine. So that is not something you need to worry about.;
I would also agree that you try both frozen transfer cycles because there is a chance that it might work. For instance, I just had a patient, and this is only one example, where we transferred two beautiful 8 cell grade 1 embryos in a fresh cycle and they failed. Not even a chemical pregnancy. They then just underwent a frozen transfer cycle with one embryo (the only one they had frozen) and they are pregnant. The point being that every FET cycle has a chance to be successful and it is a lot easier and less expensive than a fresh cycle.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
