Additional IVF Cycle Information

Additional IVF Cycle Information

Additional Information about the Procedures and Expectations for Each Day of an IVF Cycle

  1. Day 0: The day of the egg retrieval. We remove the cumulus cells from the eggs to assess the maturity of each egg. We can only perform ICSI (injection of a single sperm into the egg) on mature eggs. On average, we expect 70 to 80% of the eggs we retrieve to be mature. On Day 1, we will report the number of eggs that we perform ICSI on to you.
  2. Day 1: The day after the egg retrieval or egg thaw, we look for signs of normal fertilization. Occasionally, we do not observe the signs of fertilization in some eggs. This could either be because the window of time to observe fertilization is short, and some embryos may be moving along faster than others, or because the egg may truly be unfertilized. The embryos are each one-cell embryos today. We will continue to observe all eggs until day 3. Any embryos that are dividing by day 3 will remain in culture; if not, they will be discarded. Occasionally, we may keep immature eggs overnight, then assess if they are eligible for ICSI (this process is called Rescue ICSI). Although we are able to perform rescue ICSI, in general, these embryos tend not to do as well because the eggs matured late. Therefore, we only perform this procedure under extenuating circumstances. We will update you on the status of rescue ICSI embryos on day 3.
  3. Day 3: Today is when we would like to see division in all of your embryos. We expect them to be between 4 and 8 cells each, and of good to fair quality. Ideally, we want the embryos to be 6 cells or greater. We check the eggs that did not show signs of fertilization one last time today. Occasionally, these embryos start to develop. If they are dividing, we will continue to observe them with the other embryos. Eggs that have not started dividing will be discarded today. We don’t expect all embryos to develop to the blastocyst stage, and the number of embryos that continue to develop varies from patient to patient. If you are having PGT testing we will perform a procedure called “assisted hatching” today. Assisted hatching allows several of the embryo’s outer (trophectoderm) cells to hatch out of the shell surrounding the embryo, and these cells will be taken for the biopsy. If you are having a fresh transfer scheduled for Day 5 or 6, we will call you with the time for your transfer on Day 3 or Day 4.
  4. Day 5: Today we would like to see blastocyst development. We grade blastocysts on their expansion: Early Blastocyst, Expanding, Expanded, Fully Expanded, Hatching Blastocyst, or Hatched Blastocyst. Next, we give two grades for a blastocyst. First, we grade the inner cell mass (the cells that lead to fetal tissue) on a good-fair-poor scale. Second, we grade the outer cells (the cells that form the placenta) on a good-fair-poor scale. We only give early blastocysts one overall grade because they are just beginning to differentiate their cells. Morula is the stage (compact ball of 8-16 cells stage right before blastocyst and compacting embryos are beginning to form a morula. Multicell embryos are embryos that have not started compacting yet, and have multiple individually visible cells. If you are having PGT testing for chromosomal abnormalities and gender, embryos that make it to the blastocyst stage that are of good to fair quality will be biopsied today. Blastocysts and embryos that do not meet the freeze criteria today will be given one more day to develop so they can gain the maximum number of cells before they are biopsied and/ or frozen. This will help their survival during the thaw. Please note that you may receive your Day 5 and Day 6 updates later in the day than you received your Day 1 or Day 3 updates. This is usually because we are performing the biopsy and freezing procedures, and these procedures may not be completed until later in the day.
  5. Day 6: For day 6 embryos to be candidates for freezing, the embryos must be at least expanding blastocysts and good to fair quality. The embryos that do not meet our criteria for freezing will be discarded within 24 hours.
  6. Day 7: Some embryos grow very slowly, and although they did not meet the biopsy and/or freeze criteria on Day 5 and Day 6, they may look exceptional on Day 7. We always take one last look at the embryos before discarding. If we observe exceptional blastocysts that have advanced overnight we will freeze them on Day 7. A reply from you is requested on Day 7, to confirm that you understand the total number of embryos frozen and that the remaining embryos will be discarded within 24 hours.
  7. PGT – Genetic Testing: If you are planning to have PGT genetic testing performed on your embryos, we recommend testing all eligible embryos to give you the greatest chance of achieving your family goals. It is impossible to know how many embryos will be normal, as well as the gender of the normal embryos, so the best way to have a normal embryo to transfer, (particularly if you have a gender preference,) is to test all of the embryos. Also, there is no guarantee that transferring a normal embryo will result in a pregnancy. Therefore, it would be best to have a few embryos frozen for future embryo transfers. If you choose not to test all eligible embryos now, any embryos that make it to the blastocyst stage and are at least fair quality will be frozen for future use. While you can test these embryos at a future date, we don't recommend this process as it requires thawing, biopsying and re-freezing the embryos, and can be extremely risky for them. Also, please note that if you elect to only test 8 embryos at this point in time, your PGT financial package will be complete with the genetic testing lab. Should you choose to thaw and test the previously untested embryos in the future, you are no longer eligible to pay $250 per embryo, but will be financially responsible for the total PGT fee.
  8. When PGT Test Results Are Received, we will e-mail you the results, and attach the PGT report. Please do not open the attachment if you do not wish to know the gender of your embryos, as it is clearly indicated on the report. Any embryos that are abnormal by PGT testing will be discarded in 24 hours, unless we hear from you directing us to keep the abnormal embryos frozen. Please confirm with us when you receive this email that you understand that the abnormal embryos will be discarded or direct us to do otherwise.