Day 6 Fertilization Report

We just heard from the lab and the news isn't great but we're not out of the running yet. I just wish we were dealing with larger numbers since we were doing such a good job of defying the odds - I had hoped that trend would continue.

We're down to two blasts that are pretty good quality and two that are really poor quality. Normally, they wouldn't have even biopsied the two poor quality blasts but they only did so at our request. The embryologist said that they haven't seen the poor quality ones turning into babies and that they usually don't freeze or thaw well. However, we still wanted them biopsied and again, you must be your own advocate as I have told everyone and anyone over and over again that no matter what, we want everything and anything biopsied, arrested or not. We just want answers and I want as much information that I can lay my hands on because this is it for us.

Of the three early blasts from yesterday, one was graded a 5BB and the other one was graded 2/3. To understand what this means, I am quoting from Linda's Day 5 post from November since she explained it so well:

"The blast development status (expansion - hatching stage) is indicated by the number in the front. The number ranges from 1 to 6, with 1 being the lowest and 6 being the highest quality.

1 = Blastocoel cavity less than half the volume of the embryo.
2 = Blastocoel cavity greater than than half the volume of the embryo.
3 = Full blast, cavity completely filling the embryo.
4 = Expanded blast, cavity larger than the embryo with thinning of the shell.
5 = Hatching out of the shell.
6 = Hatched out of the shell.

The first letter is the grade of the inner cell mass (the cells that will become the fetus). The letters range from A to C, with A being the highest and C being the lowest quality.

A = Many cells, tightly packed.
B = Several cells, loosely grouped.
C = Very few cells.

The second letter is the grade of the trophectoderm (future placenta cells). Again, the letters range from A to C, highest to lowest quality.

A = Many cells, forming a cohesive layer.
B = Few cells, forming a loose epithelium.
C = Very few large cells. "

Thank you Linda!

Really, you're looking for embryos that are graded 5AA so a 5BB is a pretty good quality embryo but not the best. The one graded 2/3 is the earliest blastocyst stage and they can't grade the inner cell mass or the trophectoderm cells (hence no letters after that grade) at this point. They biopsied it anyway because they felt that if they waited any longer, it may have hatched out of its shell. They don't like to perform biopsies on hatched embryos but she did say that the cells of the 2/3 looked good and healthy so we're hoping that this one will be okay.

Of the three early blasts from yesterday, two are the ones I just talked about and the third one has turned into a poor blast. The grade she gave it was a 4CB...ouch. The final blast biopsied was one of the morulas from yesterday and I believe that the grade given to that one was a 2/3 again but she said that this one didn't look very good. Everything else has arrested but she said that they would continue to culture them for one more day just in case the improbable happened but that it was unlikely that anything else would come along at this point.

In total, 4 blasts were biopsied, two being pretty good quality and two being very poor quality. I always knew that the attrition rates were high and we went from 8 fertilized in total down to 2 real contenders but it is pretty stark when you look at it. My mind is telling me that we only need one and if the probabilities hold true, one of the two of those will be normal so there is our singleton...but my heart is demanding retribution for the long, long road we have travelled to get to this point. Shouldn't IVF results be positively correlated with the length of the journey and the suffering that ensued along the way?

I think the embryologist I spoke with told me that they would call us one more time tomorrow with the final count but I don't think that anything will change between today and tomorrow.

I'm not sure how to feel...excited to have the two or sad for the others that were lost along the way. I don't mean to sound ungrateful for the two that we do have...I just feel conflicted at the moment. I think that I need some time to digest this information. I have maintained that I didn't want to do a transfer for the sake of doing a transfer and I would rather know than go through the pain of another m/c...but part of me, naive me, still managed to plant the seeds of belief and hope, secretly thinking that the statistics were wrong somehow.

If both of the two embies come back normal, we have an 85% chance of success if we transfer both. If one of the two embies come back normal, the success rate drops to 65% because we would only be transferring one. Still, these odds are better than what we would have had given a fresh transfer so I need to hang onto that. So I guess we settle in now for the 6 week wait for microarray results.