How do you know an egg has been fertilised?
It is normal that not every egg retrieved at egg collection will be mature, or be able to fertilise normally. After the eggs have been inseminated with sperm via In Vitro Fertilisation (IVF), or Intracytoplasmic Sperm Injection (ICSI), they are left uninterrupted and assessed the next day for signs of fertilisation.The embryologist will observe each egg and look to identify the presence of pronuclei (PN). Pronuclei represent the presence of the genetic material (DNA) within the fertilised egg (zygote). A successfully fertilised egg will have two pronuclei (2PN), one from the egg, and one from the sperm. Some eggs may present with an abnormal number of pronuclei, containing too little (1PN), or too much (3PN+) DNA. Embryos resulting from abnormally fertilised eggs may have reduced pregnancy potential, or an increased risk of leading to miscarriage.All normally fertilised eggs (2PN) will be kept and grown in the lab, while abnormally fertilised eggs will be discarded or monitored in the lab depending on the type of abnormality present.The 2PN stage is an important milestone in embryonic development, as it signifies successful fertilisation and the potential for further embryonic development.
How is a sperm selected for Intracytoplasmic Sperm Injection (ICSI)?
When performing intracytoplasmic sperm injection (ICSI), the embryologist seeks to select the best quality sperm for injection into each mature egg. Selecting the best quality sperm increases the chances of successful fertilisation and embryo development, leading to a higher likelihood of a successful pregnancyFirst, the sperm is prepared in the lab by removing the seminal fluid and other debris to concentrate the sperm. The sperm is then observed under high powered magnification to assess the morphology (shape, size and structure) and the motility (ability to swim). Some labs may also place the sperm in a specialised solution to assist in the selection of sperm harbouring the least amout of DNA fragmentation. High levels of DNA fragmentation have been associated with reduced fertility and poor pregnancy outcomes.
How are embryos graded?
Embryo grading is an important part of the In Vitro Fertilization (IVF) process. The purpose of grading embryos is to determine the pregnancy potential of each embryo and determine whether they are suitale to be transferred back into the uterus, or frozen. Grading involves assessing the number of cells within each embryo, as well as the quality of these cells. It also takes into consideration each embryos ability to meet particular developmental milestones throughout its growth in the lab. Embryo grading is performed by a skilled embryologist using a grading system that assigns a grade or score to the embryos based on their physical characteristics.There are a number of grading systems used to assess the quality of embryos in IVF, and the way in which the grade is communicated may vary depending on the clinic or laboratory. The most widely understood system is the Gardner grading system, which was developed by David Gardner and colleagues in the early 2000s.The Gardner grading system assigns a grade to the embryos based on their appearance and development on days two, three, and five after fertilization. Here is a breakdown of the grading system:
Day 2:
Grade 1: Four cells of equal sizeGrade 2: Four cells of slightly uneven sizeGrade 3: Four cells of significantly uneven sizeDay 3:Grade 1: Eight cells of equal sizeGrade 2: Eight cells of slightly uneven sizeGrade 3: Eight cells of significantly uneven sizeDay 5:Grade 1: Blastocyst with an expanded cavity and a well-defined inner cell mass and trophectodermGrade 2: Blastocyst with a less expanded cavity and less defined inner cell mass and trophectodermGrade 3: Blastocyst with a small cavity and poor inner cell mass and trophectodermThe grade assigned to the embryo is based on the best score it receives on each day of assessment. For example, an embryo that receives a grade 1 on day two, a grade 2 on day three, and a grade 2 on day five would be assigned a final grade of 2.The grading system is used to help embryologists select the best quality embryos for transfer back to the patient’s uterus. In general, embryos with higher grades have a better chance of implantation and a successful pregnancy. However, it is important to note that embryo grading is just one factor that is considered when selecting embryos for transfer, and other factors such as the patient’s age, medical history, and previous IVF outcomes are also taken into account.
Can I proceed with embryo transfer if my embryo forms a good quality blastocyst on day 6?
If your embryo develops into a high-quality blastocyst on day 6, we will not perform an immediate embryo transfer. Instead, we will freeze the blastocyst because we want to place it back into the uterus on day 5 to account for its slower development. This gives the embryo the best chance for successful implantation.
Is it possible to perform rescue ICSI on the IVF eggs today?
No, it is not possible to perform rescue ICSI on the IVF eggs as we cannot confirm if a sperm has already entered the egg. Adding another sperm at this point could result in an abnormal embryo.
Why were some of my eggs not mature?
During your cycle, we monitored the growth of your follicles using ultrasound. Follicles over a certain size should contain mature eggs, and we collected the eggs when the follicles were deemed ready. Unfortunately, not all large follicles contain mature eggs. You can discuss this further with your specialist during a review appointment.
Can you inject immature eggs?
No, we cannot inject immature eggs as they do not have the potential to fertilise normally. A mature egg has undergone a maturation process where it removes half of its genetic material to make space for the DNA from the sperm. If an egg has not undergone this process, it will have too many chromosomes and will not result in a viable pregnancy.
Why did my embryo not survive the thaw?
It is difficult to determine why an embryo did not survive. When grading embryos for freezing, we assess them based on their development stage and the quality of the cells visible at the time of freezing. Although a good quality embryo should typically survive the freeze, this outcome could indicate that the embryo had abnormalities. However, each embryo can respond differently to the freezing/thawing process, so it does not necessarily mean that your other embryos will have the same outcome.
What is the difference between day 3 and day 5 embryo transfer?
Day 3 and Day 5 embryos refer to the age of the embryo in vitro, meaning the number of days since fertilisation of the egg in a laboratory setting.A Day 3 embryo, also referred to as a cleavage stage embryo, is typically a 6-12 cell structure.By Day 5, an embryo will hopefully have undergone many cell divisions, having hundreds of cells, and now be referred to as a blastocyst. Blastocysts have an identifying fluid-filled cavity surrounded by a layer of cells. At this stage, the inner cell mass has formed and will eventually develop into the embryo, while the outer layer of cells will eventually form the placenta.Not every embryo will reach the blastocyst stage, this is a normal and expected outcome of extended embryo culture. Some embryos will arrest in development which will help deselect against the poorer quality embryos lacking the potential for pregnancy.In summary, the main difference between a Day 3 and Day 5 embryo is the degree of development and differentiation of the cells.
Why were the other embryos not suitable to freeze?
In order to be suitable to freeze, an embryo must meet standardised criteria which has been set to ensure only embryos with the potential for pregnancy are stored for future use.
Embryos need to have reached set developmental milestones, as well have a suitable embryo grade. Poor quality embryos, such as those that have poor cell division, do not have the potential to lead to a viable pregnancy. They are also less likely to survive the freezing and thawing process and are therefore not suitable for storage.It is important to note that not all embryos are suitable for freezing and that the quality of the embryo at freezing may affect how well the embryo survives the thawing process. Typically, it is expected that 90-95% of frozen blastocysts will survive the process.
What is the difference between IVF and ICSI?
IVF (In Vitro Fertilisation) and ICSI (Intracytoplasmic Sperm Injection) are two assisted reproductive technologies (ARTs) used to treat infertility. The only differences between the two, is the method of insemination used.IVF is a process where the retrieved eggs are added to a prepared sperm sample in a laboratory dish. The sperm and eggs are then left together whereby the sperm is required to find and fertilise each egg naturally.ICSI on the other hand, is a more invasive procedure where a single sperm is injected directly into each mature egg. ICSI is typically used in cases of male infertility, where the sperm has difficulty reaching and fertilising the egg on its own, or in cases of previous failed fertilisation using IVF.
What is an IVF cycle with MIRI?
IVF with MIRI is a type of assisted reproductive technology (ART) where the fertilised eggs are monitored in a specialised incubator (MIRI) that provides constant time-lapse imaging. This allows embryologists to closely observe the development of embryos in real-time, increasing the chances of successful implantation and pregnancy.
What is UTM?
UTM is a substance used in some IVF cycles to help the embryo attach to the uterine wall more effectively. It is a type of growth factor and is applied to the embryos before they are transferred to the uterus.
Does your clinic offer PGD/PGT-A testing?
Yes, our clinic currently offers PGD/PGT-A testing.
Why are my embryos abnormal if I’m under age 40?
All women of reproductive age have some abnormal eggs, which increase with age.
What is infertility?
Infertility is defined as the inability of a couple to conceive a child after one year of regular, unprotected intercourse. Infertility can be caused by various factors, including problems with ovulation, sperm quality, hormonal imbalances, and other medical conditions.
How is infertility diagnosed?
Infertility can be diagnosed through a series of tests and exams. For women, the tests may include pelvic exams, blood tests to check hormone levels, and imaging tests like ultrasound. For men, fertility tests may include semen analysis, genetic testing, and hormonal tests.What does a fertility assessment include?
A fertility assessment includes a series of tests and exams to determine a patient’s suitability for fertility treatments. The tests may include ovulation testing, pelvic ultrasound, ovarian reserve testing, hormone testing, viral screening tests, and others. For men, the tests may include a general physical examination, semen analysis, hormonal testing, and viral screening tests.
What lifestyle changes can help improve fertility health?Lifestyle changes that can help improve fertility health include maintaining a healthy diet and BMI, taking folic acid, and avoiding alcohol and tobacco.
All of my initial testing came back normal, why am I not getting pregnant?
Approximately 20-25% of patients with infertility have normal initial testing results, which is referred to as “unexplained infertility.” This may be due to an age-related decline in fertility. Further monitoring may help determine the underlying cause and treatment may be recommended.
What are the most common causes of infertility in women?
The most common causes of infertility in women include problems with ovulation, hormonal imbalances, endometriosis, and polycystic ovary syndrome (PCOS).
Does a woman’s weight affect fertility?
Yes, a woman’s weight and body mass index (BMI) can affect her fertility. Being underweight or overweight can disrupt the normal ovulation process and affect fertility. Women with a BMI over 35 are considered to be at a higher risk of infertility.
What is the age limit for fertility treatments?There is no absolute age limit for fertility treatments, but success rates tend to decrease with age. Most fertility clinics do not offer treatments to women over the age of 45, as the chances of a successful pregnancy are low.
When can I expect my period after taking Provera?
Typically within 7 to 10 days. If there is no period, contact the Oasis Fertility nurse.
When can I expect my period after taking birth control pills?
Usually within 2-5 days after the last pill. If there is no period, please contact the Oasis Fertility nurse.
What should I do if I experience a rash/reaction after injecting Cetrotide/Ganirelix?
Cetrotide and Ganirelix can cause redness and irritation at the injection site, which is common. Using ice can help with discomfort and redness. If you experience breathing changes or other severe symptoms, call 000 or go to the nearest emergency room immediately.
Is there a difference in effectiveness between Crinone and Utrogestan?
No, they are interchangeable vaginal progesterone preparations (with the exception of different dosing).
Can I take my stimulation meds (Gonal-F/Menopur) a few hours late due to a concert?
Yes, but the trigger shot prior to egg retrieval is time-sensitive. If you take it at a different time than advised, please contact your team nurse or the nurse on call.
What should I do if I missed a dose of birth control, Estradiol, Crinone, Clomid, or Letrozole?
Contact the Oasis Fertility nurse for specific instructions.
Why do I need to take progesterone and oestrogen after my embryo transfer?
For frozen embryo transfers, the uterus lining may be prepared with estrogen followed by progesterone. For fresh IVF cycles, progesterone alone is usually sufficient.
Can I eat fish/sushi/un-pasteurized cheese during treatment?
Stick with cooked/pasteurized foods and low mercury fish during pregnancy.
Can I use a heatpad during treatment after IUI/ET?
Yes, if set to a low setting.
Can I fly during IVF stimulation?
Yes, there are no restrictions to flying during IVF stimulation.
Can I fly/travel after embryo transfer during the 2-week wait before my first pregnancy test?
Travel is not recommended after a positive pregnancy test until an ultrasound can assess the pregnancy’s location and viability, usually 2-3 weeks after a positive result. Prolonged travel and sitting increase the risk of blood clots, which can be serious if they occur.
Is it okay if I exercise/run after IUI?
Continuing routine exercise after IUI is generally okay. High-impact activities, such as running, should be avoided after an IVF stimulation cycle and egg retrieval. Walking is recommended.
Is it okay to lift my toddler while on stimulation medication and after the egg retrieval or embryo transfer?
Yes
Can I have intercourse during IVF?
Abstaining from intercourse or using condoms during an IVF/embryo transfer cycle is recommended to avoid a high-risk multiple gestation pregnancy. For an IUI cycle, intercourse is allowed the day of IUI and after.
Is acupuncture helpful for fertility treatment?
Studies show mixed results, but some patients may benefit and it is recommended if you’d like to try it.
Can I drink alcohol during fertility treatment?
We suggest limiting it to an occasional drink during treatment and avoiding alcohol once you are pregnant.
Can I take ibuprofen after my egg retrieval for pain?
Yes, starting 6 hours after retrieval and discontinuing the day before your embryo transfer.
Is it okay to get my hair coloured?
It is recommended to wait until the second trimester (or after pregnancy) to colour your hair or check with your Obstetrician once pregnant.
Is it okay to get a manicure and pedicure?
There are no clear restrictions on getting a manicure and pedicure.
Is it okay to get a body massage?
Yes, but inform the therapist that you are in treatment or pregnant beforehand.
Can I take herbal supplements during fertility treatment?
While herbal supplements are not controlled, it’s important to inform your doctor of everything you are taking prior to testing or treatment. If you are taking a biotin supplement, please discontinue this at least 3 days (preferably 1 week) prior to blood tests, as this can interfere with results.
Can I drink coffee during treatment or other caffeinated beverages?
It is recommended to limit caffeinated beverages to two 8 oz drinks (with less than 150-200mg of caffeine) during treatment and when pregnant.
Can I swim during treatment (in a pool, ocean, or lake)?
Yes, there are no restrictions on swimming.
Can I use my hot tub or sauna during treatment?
It is recommended to avoid using hot tubs or saunas during treatment and when pregnant.
Why do I need to take low dose aspirin?
Your physician may recommend taking baby aspirin during treatment for a number of reasons. Discuss directly with them and only take aspirin if advised to do so.
What is the use of Prednisolone in IVF cycle?
Prednisolone is a steroid medication that is sometimes used in IVF cycles to reduce inflammation and improve implantation rates. It is commonly prescribed to women with autoimmune disorders or other conditions that may affect the success of IVF.
What is the use of Clexane in IVF cycle?
There is limited evidence to support the use of Clexane in IVF cycles specifically to improve implantation rates. While some studies have shown a reduction in the risk of blood clots during an IVF cycle with the use of Clexane, there is not enough evidence to suggest that it directly improves implantation rates.Implantation success in an IVF cycle depends on many factors, including the quality of the embryos, the thickness and receptiveness of the endometrial lining, and the overall health of the patient. While anticoagulant medications such as Clexane may help reduce the risk of blood clots, it is not considered a direct treatment for improving implantation rates.It is always important to discuss your individual situation with your doctor and make decisions about your IVF cycle based on the best available evidence and your unique medical history and circumstances.
What is Myoinositol used for in IVF?
Myoinositol is a dietary supplement that is sometimes used in IVF to improve egg quality and increase the chances of successful pregnancy. It is believed to improve insulin sensitivity and reduce oxidative stress, both of which can negatively impact fertility.
What is Melatonin used for in IVF?
Melatonin is a hormone produced by the body that helps regulate sleep. It is sometimes used in IVF to improve the quality of the embryo and assist reproductive health.
What is DHEA used for in IVF?
DHEA (Dehydroepiandrosterone) is a hormone produced by the adrenal glands. It is sometimes used in IVF to improve egg quality and increase the chances of successful pregnancy in women with diminished ovarian reserve.
Is spotting okay during pregnancy?
Pink/red/brown spotting, which can be blood mixed with vaginal discharge, is common after an egg retrieval/embryo transfer/IUI and is typically not concerning. Heavy bright red bleeding should be reported to your team nurse.
How many blood tests do I need to monitor HCG level?
Following a treatment cycle, we will draw one HCG level 10 days after embryo transfer (or 14 days after IUI). If it is positive, we will get one more 48 hours later. If there is an appropriate interval rise, the next step is an early OB ultrasound at 6-7 weeks gestation (which is actually just a couple weeks after your blood tests).If a reassuring level is seen on the second HCG test, the further HCG levels are not needed and the prenatal ultrasound can be scheduled. If the HCG level is not rising appropriately, your team will follow serial levels to help determine if this is a viable pregnancy.
Why is my HCG rising abnormally?
With any pregnancy there is a risk of an abnormal pregnancy/early pregnancy loss or an ectopic pregnancy (a pregnancy outside of the uterus). These scenarios can present with abnormally rising HCG levels and are followed closely by your team.
My HCG is normal, why am I bleeding?
There can be several reasons for bleeding in early pregnancy and this would warrant a call to your team nurse, especially if bright red and heavy like a period. As above, light spotting in early pregnancy is very common and often not concerning.
Why am I pregnant with twins after having one embryo transferred?
An IVF-derived embryo can split after transfer and result in an identical twin pregnancy, or a concurrent natural conception can occur if unprotected sex was had around the time of the transfer.
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