Additional IVF Cycle Information

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

Day 0: The day of the egg retrieval. We remove the cumulus cells from the eggs to assess the maturity of each egg. We 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, and most eggs are rated fair. On Day 1, we will report maturity, quality, and the number of eggs that we performed ICSI on to you.

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 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. Under extenuating circumstances, such as very low fertilization rate (less than three), or very poor egg quality or maturity, we may perform rescue ICSI on Day 1 on any eggs that matured overnight. In general, these embryos tend to not develop very well because the eggs were not mature on time. We will update you on the status of rescue ICSI embryos on day 2.

Day 3: Today is when we would like to see cell division in all of your embryos. We expect them each to be 4 cells or greater, and of good to fair quality. It is possible to have more embryos dividing on Day 3 than we initially observed fertilization in. Please see the tables below for details on number of embryos dividing, cell number ranges, and quality indicators. We don’t expect all of your embryos to develop to the blastocyst stage. On average, 40-50% of good quality embryos that are dividing on Day 3 will meet our freeze criteria. The number of embryos that continue to develop varies from patient to patient. Embryos that have not begun to divide today will be discarded.

Day 5: Today is the first of three days (Day 5, 6, and 7) where we look to see if embryos meet our biopsy (if you are having PGT) and freeze criteria. We biopsy and freeze embryos that are expanding to fully hatched blastocysts of fair or good quality. Blastocysts are embryos that have two clearly-visible cell types. These are called the inner cell mass and the trophectoderm. We grade each of these cell types on a good-fair-poor scale. The majority of embryos we see in the lab are rated “fair.” The grade of “good” is given when exceptional appearance, quality, and cell numbers are observed. We also rate blastocysts on their size (expanding -> expanded -> fully expanded -> hatching -> hatched). The smallest blastocysts are called “early” and they are not typically given a grade because they are just beginning to differentiate their cells and the two cell types may not be clearly visible. Embryos that have not yet reached the blastocyst stage are called either “morula” or “compacting.” Early blastocysts, morula, and compacting embryos do not meet our biopsy and/or freeze criteria. Multicell embryos have slowed down in development and are not likely to make it to the blastocyst stage. Blastocysts and embryos that do not meet the freeze criteria today will be given one more full 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 because we are performing the biopsy and freezing procedures, and these procedures may not be completed until later in the day.

Day 6: This is the last full day that embryos will be kept in culture. For day 6 embryos to be candidates for biopsy and / or 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 on Day 7.

Day 7: Some embryos grow very slowly, and although they did not meet the biopsy and/or freeze criteria on Day 5 or 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, although Day 7 embryos may have a lower implantation and development rate. A reply from you is requested on Day 7, to confirm that you understand the total number of embryos frozen and that the remaining non-viable embryos will be discarded by the end of the day.

7. Preimplantation Genetic Testing (PGT): If you are planning to have PGT 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 rather are financially responsible for a total fee of $6,450 (for 8 embryos) plus and additional fee of $250 per embryo over 8.

8. When PGT 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. SDFC has revised our policy regarding embryos that have tested “abnormal” according to PGT-A (preimplantation genetic testing for aneuploidy, previously known as PGS) based on recent evidence regarding pregnancies conceived using such embryos. Healthy births have been reported from transfer of embryos reported as “abnormal” or “mosaic” (embryos containing more than one genetic cell type), though at a significantly lower rate than transfer of embryos reported to be “normal” by PGT-A analysis. For this reason, it is our recommendation that all frozen embryos, regardless of genetic testing result, be maintained in storage until you have had an opportunity to thoroughly discuss your individual situation with your physician and/or a genetic counselor. Should you wish to discard any frozen embryos, we will provide you with a Consent to Discard form. We recommend that you contact Ovation Fertility, Email: [email protected], Phone: (702) 701-8239 or Igenomix, Email: [email protected], Phone: (305) 501-4948 to speak with a genetic counselor regarding abnormal or mosaic results, ideally prior to your next follow-up appointment with your physician.