Wednesday, March 17, 2021

Why do embryos fragment in the IVF lab ? What patients need to know about embryo grading


Patients know that their chances of getting pregnant depend on the quality of their embryos, which is why they get excited when they have top quality blastocysts.

However, when their embryos start fragmenting, and are graded as being poor quality by the embryologist, based on their morphology ( cell fragmentation occurs because the cells of the embryo ( called blastomeres) don't remain viable) ,they often go to pieces .

You need to understand how doctors grade embryos in the laboratory , and you need to make sure that your doctor provides you with photographs of your embryos, so that other IVF experts can judge the embryo quality for themselves, rather than have to depend upon a  printed report given by an embryologist ,which is impossible to verify because he can call every embryo a Grade A embryo !

Embryo quality could be poor because of poor quality eggs, or a poor quality lab, and it makes a world of a difference what the reason is !

Thus, if you are an older woman with poor ovarian reserve ( a low AMH level and a low antral follicle count), then this could be the reason for poor embryo quality, because poor quality eggs which have aged have dysfunctional mitochondria, which results in impaired cell cleavage.

However, if the reason for the poor egg is iatrogenic – for example, when the doctor does not use the right superovulation protocol to help you grow more eggs, then changing your doctor can improve your chances dramatically.

This is also true for young women with PCOD. Doctors are so scared of OHSS ( ovarian hyperstimuation syndrome) that they end up using a very low dose of FSH ( Gonal-F ) for the superovulation, and they mistimed  the HCG injection, as a result of which they get few eggs and poor quality embryos.

The other common reason for poor quality embryos is a poor quality IVF lab, where the embryologist is not full-time, or is not experienced and does not have enough expertise.

The key take-away message is that the reason for poor quality embryos may not be a problem with you – it maybe a problem either with the clinician , or with the laboratory .

This is why , if you end up with a failed IVF cycle because of poor quality embryos , rather than change your eggs ( as your doctor may suggest ), you may actually be better off changing the clinic .

Find a better clinic who can grow your eggs , and transfer top quality blastocysts for you

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