Day 3 Update

Day 3 Update - June 23rd:

Life as in IVF patient means you pretty much live in a state of constant suspense.  Things are always moving and fluctuating and there is rarely, if ever, a flat-even road.  You are continually asking yourself; How well am I responding to the drugs?  Is the dosages high enough?  Is it too high?  Would I have responded better to a different protocol?  How many follicles are there?  Will I have EFS (empty follicle syndrome)?  How many eggs will/did they retrieve?  Will I have enough mature eggs?  How many will fertilize?  Then once you get past the ER, and after you get your Fert Report, then you start a new roller coaster of worrying about the embryos and add in even more questions/worry.  How good are my embryos?  How are they growing/dividing at a health rate? Is the quality going to be good enough?  What if they arrest?  Should I do a Day 3 or Day 5 transfer?  Assisted Hatching?  PGD? CGH?  On and on and on.  

Thankfully most clinics will call you with updates about every other day, and it helps put your mind a ease, at least for about 10 mins, then the worrying and wondering starts back up until you get the next update phone call. 

After retrieval you will get 3 – 4 calls with updates telling you how the embryos are doing.  1^st update is with the Fert Report, which happens on Day 1 (the day following retrieval), the 2nd update is on Day 3, and the last update (unless you are doing genetic testing) is on Day 5, which is typically transfer day.  If you are doing genetic testing you will also get a call on Day 6 or 7 with the results on the biopsy and how many embryos were able to be cryopreserved (freezing (in liquid nitrogen) and storing embryos for future use), if any.

Day 3 embryos, are graded on 3 criterias, the 1^st being the rate of cell division.  On Day 3 most healthy embryos will be between 6-9 cells (with an ideal embryos being 8 cells), some healthy embryos can be lagging behind 4-5 cells, or growing a bit faster 10 cells, but typically if they are slow/fast growers it’s a sign of an abnormal embryo!  Embryos that’s are growing too slow, or fast, by Day 3 have about 10-15% chance (half that of a 6-9 cell embryo), of implantation success. 

The next thing that embryos are checked for in the grading process is Fragmentation.  Fragmentation is when parts of an individual cell in the embryo break apart, or ‘fragment’.  Most embryos will have a slight degree of fragmentation but typically you want no-to-little fragmentation, it has been found that 25% or more fragmentation leads to poor implantation rates.

 And the last of the grading criteria is wither the cells are symmetrical in size and shape.  Not only does cell number and fragmentation matter, but so do symmetry.  Symmetry is assessing the cell in the embryo to see if they are all the same size, it is not as significant as cell numbers and fragmentation but helps determine the grade of the embryo and which ones would be better suited for transfer.  An embryo with same size cells is graded G (good), if a few of the cells are different sizes its scored F (fair), and embryos with all different size cells P (poor) and those graded poor will typically arrest if watched/cultured for another 1-2 days.

So in a nut shell, a text book “perfect” Day 3 embryo would be a 8-cell, no fragmentation, and all the cells of equal and symmetrical size.  But as we know embryos are so variable, and a healthy baby can come from an any cell number, size or fragmented embryos.  Sometimes those “perfect” looking embryos are far from good, and actually have additional or deleted chromosomes.  We know this by experience. Our 2 textbook perfect embryos which we transferred back in August 2011 ended up being our daughter who had Trisomy 21 (Down Syndrome).  So really in the end, you can never truly know … unless genetic testing is done, and even then that has its margin of error.  God can do anything despite the poorest, of poor looking embryo - so "perfect" embryo or "poorest" its nothing that is in our hands.

So after explaining a little about Day 3 embryos, here was our Day 3 update yesterday:

18 total embryos, 16 which are growing “beautifully” all 18 with minimal fragmentation.

(1) – 4 cell (slow grower)

(1) – 5 cell (slow grower)

(3) – 7 cell 

(8) – 8 cell (ideal)

(2) – 9 cell

(3) – 10 cell (fast grower)

So we currently have 13 embryos that are in healthy 3 day range, with 8 of them being ideal.  This is amazing new, but with that being said we are cautiously exciting and very guarded.

This has been a typically IVF for us, granted we have about 3-6 more embryos that we have in the past, but we have always had an amazing fertilization report, and amazing Day 3 update, its after Day 3 when things start to get a little hairy, and go downhill.  By Day 5 we get the call that most of our embryos pretty much stopped growing at a steady rate and by the Day 6 call, we find out the left over ones (that were not transferred) are starting to arrest. 

In the past, by Day 5 we have 2-7 embryos left out of the entire batch - and with the the last cycle we only had 4 left and after the results of the biopsy we had even less.

Tomorrow will be big day and we are very nervous about it.  We would love any and all prayers that the Lord would continue to breath life into our little ones, but in the end we know its in His hands.  All we really need is 1 healthy embryo to transfer, of course would like 2 but we will take what we are given.  If by some miracle we are able to have any left over, health embryos to freeze, we would be on cloud nine!!  If I could have it my way, I would like 6 'normal' embryos after its all said and done, but I know that is asking for A LOT and my exceptions are super duper high, so trying to reel that in and hope for 4, but at this point all we can do is wait and see what the Lord has planned for this cycle. 

Next update, tomorrow, Day 5.