What a pity that you can’t watch an embryologist at work. But I really want to, it’s so interesting. Let's try to see what happens in such a mysterious and inaccessible place as an embryological laboratory.

Mature oocyte (Metaphase II, or MII)

This is how beautiful a mature oocyte looks.

But not all oocytes obtained through follicle puncture are fully mature and ready for fertilization. About 5-10% of all oocytes are immature, 2-5% are degenerative forms, both of which are not suitable for fertilization.

16-18 hours after in vitro fertilization (IVF or ICSI), the prezygote stage can be observed - an oocyte with two pronuclei (male and female), the genetic material of which has not yet fused. Under in vivo conditions, fertilization occurs in the ampulla of the fallopian tube.

Sometimes, for one reason or another, fertilization does not occur...

...or hyperfertilization occurs - two or more sperm enter the oocyte. The embryos that develop in this case are not viable.

24-36 hours after fertilization, the first division of the zygote occurs and from this moment the fertilized oocyte becomes a 2-cell embryo. The embryonic cells at this stage are called blastomeres.

At this stage, the quality of the embryo can be assessed by the degree of deformation, vacuolization, fragmentation (the volume of the embryo occupied by nuclear-free fragments of the cytoplasm); the more of them, the lower the potential of this embryo for implantation and further development is considered.

In addition to these data, the shape and relative sizes of blastomeres are assessed. The most generally accepted classification of cleavage embryos by quality is a – ab – b, where a is the best, b is the worst.

On the 2nd day of development, the human embryo consists of 2, 3 or 4 blastomeres.

After another day, the embryo normally already consists of 6-8 blastomeres, but 4 blastomeres are allowed if on the 2nd day the embryo was 2-cell. Up to the 8-cell stage, all cells of the human embryo are totipotent, i.e. each of them can give rise to an entire organism.

On the 4th day of development, the human embryo usually consists of 8-16 cells, and the morula stage begins. It is at this stage in vivo that the embryo moves from the fallopian tube into the uterine cavity. Morulae also differ in the degree of compaction of blastomeres (C1 – C2 – C3 – C4).

By the end of the 4th day of development, a cavity gradually forms inside the morula - the process of cavitation begins.

From the moment the cavity inside the morula reaches 50% of its volume, the embryo is called a blastocyst.

The larger the cavity of the blastocyst and the better developed the internal cell mass and trophoblast, the greater its potential for implantation.

At this stage, it is also possible to assess the quality of the embryo by the degree of deformation, vacuolization, and fragmentation. In addition, the shape and relative sizes of blastomeres are assessed. The most generally accepted classification of cleavage embryos on the 5th day of development according to quality is A – B – C, where A is the best, C is the worst. A two-letter designation is used - one for trophoblast, the other for embryoblast.

Subsequently, the embryo begins to increase in size. At the same time, blastomeres continue to divide.

When the cavity of the blastocyst reaches a significant size, the zona pellucida, which has become thinner due to stretching, ruptures and the process of hatching the embryo from the zona pellucida begins.

Only after this process is completed is the blastocyst able to implant (attach) into the endometrium of the uterus.

Implantation usually occurs on days 6-7 of embryo development, considering fertilization day zero.

Sometimes it is impossible to establish sharp dividing lines between certain variants of embryo development. Therefore, the above classification is relative and approximate.

Exist transitional forms, which are difficult to attribute to one or another specific group. And sometimes the worst embryo according to classification may be one of the best in terms of survival and ability for further development.

There are a huge number of factors that are unknown to us and cannot be controlled, but it is thanks to them that in rare cases embryos with not the most best characteristics successfully implanted in the uterus, and subsequently children are born.

The quality of embryos during IVF depends on the quality of the eggs obtained during IVF and the quality of the sperm.

Among the factors influencing the quality of embryos during IVF, the following should be highlighted:

• the adverse effects of environmental factors significantly worsen their quality and thereby reduce the risk of pregnancy
• The effect of toxic substances from smoking, drinking alcohol, household chemicals, some medications, gasoline vapors and others also reduce the ability of the embryo to implant
• Hormone-dependent diseases of the female reproductive system can also significantly reduce the quality of embryos
• Poor immunity and weak immune response to damaging factors
• chronic stress and chronic fatigue syndrome
• Obesity also contributes to poor embryo quality by disrupting the body's hormonal balance.
• Poor nutrition and limited quality of food intake leads to amino acid deficiency, deficiency of vitamins and minerals, which also indicates their poor quality
• The effect of radiation on the body also leads to pathological development of embryos, because when exposed to it, the process of cell division is disrupted
• The impact of constant climate and time changes leads to stress not only of the whole organism, but also of actively dividing cells in it - for example, blastocysts.

Poor quality of eggs during IVF is most often observed if many oocytes are obtained after ovarian hyperstimulation, which is primarily due to the impact of the above factors on the body of a pregnant woman.

Poor quality of eggs during IVF - reasons

Among the reasons that cause this, it is customary to distinguish two groups: these are embryonic reasons and external reasons. Embryonic causes include:

• chromosomal pathology of the fetus. Almost half of all natural fertilizations go unnoticed by the woman, since due to the rapid death of such an embryo, there may not be a delay in menstruation. With IVF, this cause can be excluded by performing preimplantation diagnostics in order to identify the chromosomal pathology of the embryo at the blastocyst stage.
• This technique is not performed on all couples, but only on those who have previously had unsuccessful attempts. in vitro fertilization. In rare cases, embryo development may stop after genetic diagnosis, even though the embryos were considered good.
• For genetic intracellular abnormalities

Failure of its own genome in many cases occurs on the third day after fertilization in a “test tube”, since the reserves of the oocyte are excised, and the morula itself cannot produce them for the reasons described above, which ultimately leads to its death on the 4th day. If she survives the fourth day, then this significantly increases the chances of pregnancy and therefore it is best to carry out the transplantation on the 5th day.

Among the reasons from external factors, it is customary to highlight the following:

• availability of modern high-quality equipment in full at the reproductology center
• what media are used for blastocyst cultivation
• compliance temperature regime in a heat chamber
• constant operation of several incubators at once, which allows emergency situations use them alternately
• highly qualified workers in the field of reproductive medicine and collaboration of the entire team, aimed at maintaining pregnancy and increasing the likelihood of its occurrence.

Classification of embryos by IV quality

The quality of embryos during IVF is assessed using several indicators. Among them, the main ones are:

• the appearance of the embryo is of a corresponding regular shape, smooth and symmetrical, and its shell has no visible thickenings or deformations.
• depending on when the embryo is analyzed - on what day after fertilization the number of dividing cells is assessed and, depending on the number of cells, reproductologists judge whether the embryo is developing correctly or not
• degree of fragmentation of blastomeres. It is generally accepted that up to 25% fragmentation is the norm, since such small fragments can further participate in the maturation of the blastocyst, but if their number exceeds this percentage, then they are not thrown away, but cultivated for up to 6 days, since they still have a chance for the formation of a full-fledged embryo.
• The cell size must be of the correct shape and all cells must be equal in volume.
• The appearance of any inclusions in the cytoplasm indicates an unfavorable outcome of pregnancy
• division must take place at the same time and evenly, that is, if there was a short period of time between the appearance of the third and fourth cells, this indicates that the blastomeres at the level of the first two cells divided evenly.

The classification of embryos during IVF is divided into transfer of three-day and five-day embryos. According to the classification of three-day embryos, only embryos of excellent and good quality. There is a certain marking, consisting of a set of numbers and letters, where the letters indicate the percentage of fragmentation, and the numbers indicate the number of embryonic cells at a given stage of development. So, let's look at how embryos are assessed during IVF depending on the percentage of fragmentation. So:

• A. This group includes “excellent students,” the so-called embryos of excellent quality, since they have a high rate of cell division, the shape of the blastomeres is spherical, which contributes to the maximum chances of implantation of the embryo into the endometrium.
• B. “Good” is an embryo of good quality, while the shape of the blastomeres is uneven, fragmentation is insignificant, but implantation has a high probability of occurring.
• C. Quality C embryos are characterized by fragmentation from 20 to 53%, which significantly reduces the ability to implant.
• D. Embryos of poor quality are classified as group D, since the percentage of fragmentation is more than 52% and they are rejected, since the chances of implantation are almost zero.

If the couple still has embryos from group A or B, then it is possible to freeze them, since in the event of an unsuccessful IVF attempt, it will be possible to carry out another fertilization without ovarian hyperstimulation.

There is also a classification of blastocysts for IVF, when five-day embryos are used. Embryos are assessed based on the quality of the blastocyst and its intracellular contents, as well as the quality of the trophoectodermal layer.

The classes of embryos in IVF at the blastocyst stage of development are indicated by a set of numbers and letters. Let's try to figure them out.

So, depending on the size of the embryo at the blastocyst stage, the quality of the embryos is assessed, where 1 is the appearance of an early blastocyst, 2 is a medium blastocyst, 3 is a growing blastocyst, 4 is with the beginning of the destruction of the outer shell, 5 is a blastocyst in hatching and 6 is an emerging blastocyst. its blastocyst shell independently.

When evaluating embryos, the absence of visible defects and the density of the blastocyst shell are taken into account, where A is the highest quality embryo with a dense shell, and D is a defective embryo that is discarded.

There is another classification of embryos according to IV quality, which is based on the content of intracellular mass and trophoectoderm.

And the class is characterized in a tightly packed, without additional education and a well-defined intracellular mass and unilamellar multicellular trophoectoderm.

Class B is characterized by the presence of defects such as inclusions, poorly packed and poorly visualized contents inside the cell, and the trophoectoderm is uneven and contains several layers.

C class, unlike the previous ones, the intracellular mass is not visible or has strong defects in its structure, while the trophoectoderm contains many inclusions and vacuoles.

And finally, class D - it contains a degenerative mass inside the cell and the same trophoectoblast.

How to improve the quality of embryos during IVF

To improve the quality of eggs before IVF, the main factors leading to deterioration in their quality should be eliminated. These include:

• Genetic material inherited from both women and men
• Living in an area with an unfavorable environmental situation, which impairs the quality of both eggs and sperm
• The presence of bad habits in people who want to become parents. These primarily include nicotine addiction, alcoholism, drug addiction
• Overweight couple
• A poor diet with the exception of fats – vegetarianism – also reduces the quality of eggs and thereby reduces the likelihood of pregnancy.
• Constant exposure to emotional turmoil and stress
• Hormone therapy also kind of reduces the activity of eggs.

Depending on the class of embryos during IVF, there is no uniform method for determining the quality of the blastocyst. In most cases, the number of cells that divide, their order, the percentage of fragmentation, and the thickness of the blastocyst shell are taken into account. For the first time after puncture of oocytes and extraction of eggs, their quality is assessed after 48 hours, while the number of dividing cells is at least two, and after another day there should be at least 6 cells, which are arranged in an orderly manner and without areas of fragmentation. All these parameters are assessed only by a doctor - a laboratory assistant at a reproductive clinic, who indicates the likelihood of successful implantation and the timing of its implementation. It is generally accepted that greatest ability embryos with a high division rate, the blastomeres of which have a certain shape and no fragmentation is observed, are suitable for implantation.

According to the category of embryos during IVF, only embryos are transplanted, the ability of which is assessed by the doctor during cultivation. As a result, the likelihood of choosing the best and highest quality cells for replanting during fertilization increases, while the IVF laboratory assistant assesses the degree of maturity of the blastocyst, its intracellular contents and the thickness of the outer shell.

As a result, each embryo receives a score, and the higher it is, the greater the chances of implantation and the success of in vitro fertilization is more likely than with a low score. For a reproductive specialist, the numbers and letters assigned by the laboratory doctor to your blastocyst are very important. Every reproductive specialist knows what the numbers mean. If 1 – then the blastocyst is immature and its cavity is half the volume, 2 – the blastocyst corresponds to a crushing embryo, 3 – the size of the blastocyst is much larger than the embryo and has a large cavity, 4 – the entire blastocyst consists of a cavity and it begins to break through the dense shell, 5 – the shell continues to rupture and 6 – when the blastocyst no longer has a shell. The doctor will also give a letter that indicates the contents of the cell from which the child will be formed. If you have the letter A, then this indicates the quality of the cell contents; the embryo has many cells. B – indicates relatively high-quality cell contents and has slight deviations. C indicates the presence of serious changes and disturbances occurring in the cell. And the letter D indicates very poor quality of the cell, in which pregnancy is impossible. This can happen if IVF and ureaplasma are present in the body.

The results of in vitro fertilization depend on huge amount factors, however, it is the embryological stage of the procedure that has the most important significance, practically determining the result.

Manipulating microscopic human embryos is a complex area of ​​medicine. Therefore, in the process of work, doctors use complex terminology. In this article, Apryshko Valentina Petrovna, head of the embryology laboratory of one of the Moscow clinics, will talk about methods and criteria for assessing the quality of embryos.

Only embryologists can independently make decisions related to the choice of embryo or the date of its transfer to the uterus. However, after reading this material, you will begin to understand medical designations such as “8C”.

The first day

Immediately after fertilization, the doctor checks for signs that the ICSI, PIXI or IVF procedure is successful. To do this, he looks at what the pronuclei look like and evaluates them:

• Availability;
• quantity;
• internal structure;
• symmetry;
• appearance.

Pronuclei are the nuclei of germ cells (male and female) that have not yet merged. By studying their appearance, it is possible to assess the prospects, quality and vital activity of future embryos.

Standard criteria:

• there should be two pronuclei;
• they should be located nearby;
• their sizes must be the same;
• “nucleoli” (pronucleoli) should be visualized inside;
• “nucleoli” must have the correct location and number.

At this stage of embryo development, many pathologies can form that lead to their death. For example:

• the presence of one pronucleus instead of two (fertilization will not take place);
• the presence of three pronuclei (the embryo is not viable, since it will have a triple chromosome set).

Bad embryos are immediately discarded. There is no point in replanting them. Even if they do not die during the cultivation stage, the woman’s body itself rejects such embryos. As a result, if pregnancy occurs, it is terminated very quickly. This occurs already in the first weeks of gestation.

Gestation, the gestational age of a newborn (from the Latin gestatio carrying) is the number of complete weeks of pregnancy that have passed between the first day of the woman's last menstruation and the moment of cutting the umbilical cord during childbirth.

Second day

On the second day of cultivation, the cell divides into two. Blastomers are formed.

Blastomers are embryonic cells at the stage of fragmentation. The fertilized egg divides into two daughter cells called blastomeres. Each blastomere divides into two new daughter cells, which are also called blastomeres.

The criteria for the quality of an embryo at this stage are its:

• dimensions;
• form;
• degree of fragmentation (the volume that is occupied by nuclear-free elements of the cytoplasm inside the embryo);

The more blastomeres inside the embryo and the lower the degree of fragmentation, the higher quality it is considered. Such an embryo has great potential for further normal development.

Many embryologists use a classification that reflects the quality of embryos using four letters Latin alphabet. This is the classification:

• A - no nuclear-free fragments, high-quality embryo;
• B - fragmentation up to 20%, embryo of average quality;
• C - the content of nuclear-free elements of the cytoplasm is more than 20%, but does not reach 50%, the embryo is of satisfactory quality;
• D - the number of annuclear (nuclear-free) fragments of the cytoplasm exceeds 50%, such an embryo is considered to be of poor quality.

This classification also uses numbers that reflect the number of blastomeres. The more there are, the better the product of the fusion of male and female reproductive cells. For example, a "4B" embryo is rated higher than a "3C" embryo. After all, it has more blastomeres and less fragmentation.

Day three

A normal embryo on the third day of development has from 7 to 9 blastomeres. He is already beginning to carry out the genetic program embedded in him.

At this stage, many embryos stop developing. This occurs due to the presence of defects in the genetic material.

“Development block” is what embryologists call a phenomenon that ensures natural selection. The process of reproduction is very complex. Breakdowns often occur in DNA. “Broken” embryos stop developing.

Their quality is assessed in the same way as on the second day. A similar classification is used. Only there are more blastomeres. Therefore, they are described, for example, as 8A.

Day four

If the development of the embryo occurred under natural conditions, it would enter the uterine cavity on the fourth day after fertilization. Until this time, it remains in the fallopian tube.

On the fourth day, the embryo consists of 10-16 blastomeres. It becomes more compact - it occupies a small volume relative to the number of cells. Its surface looks smoother than on the third day.

Morula is the name given to the stage of embryo development at this stage. Translated, this means “mulberry.” Embryologists named it that way precisely because of its external resemblance to this berry.

This stage ends with cavitation. This is the name for the process of formation of a cavity inside the embryo.

Day five

On the fifth day of development, the embryo reaches a stage called blastocyst. This means that the cavity inside the embryo has already reached 50% of its total volume.

Unlike previous stages of development, the blastocyst consists of different cells:

• Trophoblast. Located outside. This part of the embryo is responsible for its introduction (implantation) into the uterine mucosa. From it the placenta and other extraembryonic membranes will develop.
• Embryoblast. Located inside. These cells will later form the organs and tissues of the fetus.

It is at this stage that in most cases doctors transplant the embryo into the woman's uterus. They can also be frozen. This is done to save “extra” embryos for the next cycle.

The entire embryo is surrounded by the zona pellucida. After transfer, this shell breaks. The blastocyst comes out and is embedded in the wall of the uterus. This process is called hatching, which means hatching.

Some couples undergo preimplantation diagnosis to detect chromosomal and genetic mutations early. In this case, PGD is done precisely at this stage, when some of the cells begin to protrude beyond the outer membrane.

At this stage of development, the criteria for embryo quality are:

• internal cavity size;
• the degree of penetration of the embryo beyond the membrane;
• number and density of cells.

The size of the internal cavity is estimated in numbers, the other two criteria - in letters.

Based on size, there are six degrees of blastocyst maturity:

• 1 - cavity inside the embryo is less than 50% (early blastocyst);
• 2 - the cavity inside the embryo is more than 50% of its volume;
• 3 - the cavity occupies the entire volume of the embryo;
• 4 - the cavity increases, and the membrane of the embryo becomes thinner (expanded blastocyst);
• 5 - trophectoderm (outer layer of the blastocyst) penetrates the zona pellucida;
• 6 - the blastocyst “hatches” and leaves the shell.

The cells of a high-quality embryo must be grouped. Imagine tennis balls packed inside a soccer ball. The more there are, and the more densely they are located, the better the embryo.

This parameter is reflected in letters:

• A - a tightly packed “soccer ball” with a large number of cells;
• B - average number of cells inside the blastocyst;
• C - small number of cells.

The trophectodermal layer is also assessed. Continuing the analogy, we can compare it to the leather from which a soccer ball is sewn. The fewer segments (cells) and the more densely they are located, the better.

This parameter is also evaluated using letters of the Latin alphabet:

• A - many cells;
• B - average number of cells;
• C - few cells.

Accordingly, the general characteristics of the embryo are displayed by a number and two letters. For example, record 4AA means that the embryo is at the stage of an expanded blastocyst, there are many cells inside, and the outside of its trophectoderm is also represented by a large number of cells.

The process of embryo development is very complex. The IVF procedure is considered successful if at least 40% of them reached the blastocyst stage of good quality on the fifth day of development.

One or two embryos are transferred into the uterus. The rest can be frozen. If the current IVF protocol does not result in pregnancy, they can be used in the next cycle. When freezing, the IVF clinic uses the method of vitrification, that is, ultra-fast freezing, which helps protect embryos from damage by ice crystals.

Characteristics of IVF embryos

Characteristics of IVF embryos

In the process of stimulating ovulation at the first stage of IVF, doctors receive not one, but several female germ cells at once.

All resulting cells (oocytes) are fertilized using IVF or ICSI. However, not all embryos are transferred into the uterine cavity.

As a rule, these are the 1-2 most promising embryos, in the opinion of the embryologist.

We evaluate the quality of IVF embryos mainly by their morphology. There are many criteria for evaluation:

1. The number of cells in the embryo. Normally, it should not be more or less than the amount corresponding to the day of embryo development.
2. Degree of fragmentation (nuclear-free fragments of the cytoplasm, the number and location of which can affect the further development of the embryo)
3. Uniformity and synchronism of crushing. After the fusion of the egg and sperm, a zygote is formed (a fertilized egg that begins to actively divide). This process is called cleavage, and the embryonic cells are called blastomeres. They should be same shape and sizes.
4. The presence or absence of various inclusions in the cell cytoplasm.

We also pay attention to the presence of so-called multinuclear blastomeres. This term refers to the presence of blastomeres that have not one, but several nuclei. Normally, such blastomeres should not exist.

Assessment of IVF Embryo Characteristics

There are several classifications of the quality of embryos in the first days of development. First of all, the specialist looks at the number of cells.

Normally, on the 2nd day of development, the embryo consists of 2-4 cells, on the 3rd day - from 6-8, and on the 4th day - the number of cells is difficult to count, because their fusion begins and the embryo turns into a morula.

When describing an embryo of 2-3 days of development, a letter is added to the number indicating the number of blastomeres, reflecting the quality and morphology of the blastomeres themselves, and the presence or absence of fragmentation.

• A – there are no nuclear-free fragments, the blastomeres are smooth, of the same size, have one nucleus, homogeneous cytoplasm;
• B – the number of nuclear-free fragments of the cytoplasm reaches 25%, but does not exceed this limit;
• C – the number of fragments without nuclei ranges from 25 to 50%, there are disturbances in the size and shape of blastomeres, there are inclusions in the cytoplasm;
• D – more than 50% nuclear-free fragments, etc.

This condition is called total fragmentation. Such embryos are not used for transfer into the uterine cavity (except in the situation where there are no embryos of a different quality, and the patient insists on transfer). It must be said that even in such cases a normal pregnancy can occur, only the probability of occurrence will be many times lower than when transferring embryos of quality A or B.

At VitroClinic we use alphanumeric characteristics. In this case, the number reflects the number of blastomeres in the embryo, and the letter indicates the morphology and quality.

Classification of IVF blastocysts

A blastocyst is an embryo of 5-6 days of development. It consists of several dozen cells connected into a spherical formation with a cavity, surrounded by a membrane. After the rupture of this membrane (hatching), the process of implantation (introduction of the embryo into the mucous membrane of the uterus) begins.

There are several classifications of blastocysts; at VitroClinic we use the Gardner scale. This scale consists of one number and two capital letters. The number describes the size of the blastocyst cavity, the first letter is the quality of the embryoblast (inner cell mass), the second letter is the trophoblast (the quality of the outer cell mass):

1) Size of the blastocyst, volume of its cavity:

1. The cavity occupies less than 50% of the blastocyst.
2. The cavity occupies 50% of the blastocyst.
3. The cavity occupies more than 75% of the blastocyst.
4. Blastocyst, the cavity of which is 2 times the cell mass.
5. Blastocyst in which the opening of the shell has begun (hatching)
6. Blastocyst, completely freed from the membrane, ready for implantation.

2) Characteristics of the cells from which the embryo will develop (inner cell mass):

• A. There are many cells, the boundaries between cells are indistinguishable.
• B. Cellular forms are distinguishable, the presence of some minor defects in them (granularity, etc.) is noted.
• C. The defects in the cells are significant, there are signs of apoptosis.
• D. Degeneration of cellular composition.

3) Characteristics of the cells of the outer cell mass that form extraembryonic structures (placenta, amniotic membrane).

Hello! We are forced to do IVF with a donor egg. But the bank where we planned to take the cells does not give any guarantees. That is, they are not assessed according to quality criteria, like embryos, for example. Please tell me how you can get the highest quality donor eggs? This IVF is our last chance.

Hello, I would like to clarify what guarantees we are talking about. Oocytes are frozen at the MII stage (which essentially means the cells are mature). There are no other established criteria for cell quality. It is assumed that immature or mature cells, but with visible morphological defects, are not initially sold by cryobanks, but the clinic has no chance to control this. Therefore, if you have the opportunity to choose an oocyte donor in the cryobank of the clinic where you plan to do IVF, it is better to do so. We can also offer you the option of using not frozen eggs, but fertilizing donor eggs on the day of the donor's puncture. Then the additional stage of freezing and thawing eggs is removed, because the modern protocol for freezing and thawing oocytes (unlike embryos) is not 99-100% effective. If the issue is genetics, we recommend doing PGT-A on the resulting embryos. Oocyte donors are examined healthy women without problems with reproduction, but they are also people, and aneuploidy is characteristic of humans as a species.

Is it possible to carry out PGD of all obtained embryos before cryopreservation, so that in future cryoprotocols we do not rely on low-quality cells and do not have to thaw them only for PGD?

Embryologist: Kullyev Andrey Pollyevich

Hello! This is usually what happens: the embryos are first biopsied, then cryopreserved. Information that the program involves PGD is discussed with the attending physician in advance, and informed consent to PGD is signed by both spouses. PGD ​​on cryopreserved embryos is rather an exception to the rule, but it is also possible if embryos are already available and stored, and patients have a request for analysis of embryos in storage.

Good afternoon! Please tell me which of the 4 embryos is suitable for IVF transplantation / Are they all female? My karyotype is 45,XX,der(13;14) - female with a Robertsonian translocation between chromosomes 13 and 14, my husband’s is normal.

Embryologist: Kullyev Andrey Pollyevich

Hello! That's right, all embryos are female. Embryos number 1 and number 3 are suitable for transfer. The karyotype of embryos suitable for transfer can be either normal or balanced translocation (the analysis method does not distinguish between these options). Embryos numbered 2 and 4 are carriers of an unbalanced translocation and are not suitable for transfer.

Hello, dear doctor! After stimulation, 11 eggs of excellent quality were obtained, all of them were fertilized with high-quality donor sperm, all developed in nutrient media under the same conditions, but on day 5 there were only TWO embryos left suitable for transfer. In such cases, what happens to the rest, if they were initially of high quality?

Embryologist: Kullyev Andrey Pollyevich

Hello!

The remaining embryos either lag behind in development - in this case, you can wait another day and if they grow up, freeze them, or have completely stopped developing - this means that they are not viable, and the transfer of such an embryo will not lead to pregnancy.

On day 5, the viability of the embryo and its suitability for transfer can be assessed more accurately than at earlier stages of development. That is why embryos are usually grown for up to 5 days before transfer, in order to select the most promising ones.

Good afternoon. There are two embryos 3AA and 4BB, which were frozen on the same day. I have tubal factor infertility, there were no IVF attempts before, there was only an ectopic pregnancy, the tube was not preserved, the second one was impassable. In what case will the chances of pregnancy be higher if you undergo one 3AA, one 4BB, or both at once?

Embryologist: Kullyev Andrey Pollyevich

Hello!

Embryo 3AA - excellent quality. When it is transferred, the chances of pregnancy will be slightly higher. 4BB is a good quality embryo with good chances.

If you transfer two embryos at once, there is a high probability multiple pregnancy. It is better to transfer one by one. First 3AA, if pregnancy does not occur - secondly 4BB.

Then, in total, the chances of pregnancy will be the best, and the risk of multiple pregnancy will be minimal.

Hello! If cryopreserved spermatozoa. I have two failed IVF attempts. We went to a new clinic. At the first appointment, the fertility specialist recommended trying regular IVF instead of IVF with PIXIE. Can this procedure be performed with cryopreserved sperm?

Embryologist: Kullyev Andrey Pollyevich

Hello! Yes, this procedure can be performed with cryopreserved sperm. But if the quality of sperm has not deteriorated over the course of cryopreservation, then it is better to use sperm from fresh biomaterial obtained on the day of puncture for fertilization.

You can find out how the quality has changed by comparing the spermogram taken now with the spermogram on the day of freezing.

Hello! I was transplanted with two 3-day-old embryos different quality 5B and 8AB. What is the probability that at least one will take root and will they become a hindrance to each other?

Embryologist: Kullyev Andrey Pollyevich

Hello!

Embryos will not interfere with each other. On day 3, an 8AB quality embryo has a better chance of engrafting than a 5-cell embryo.

The probability of embryo implantation on day 3 is up to 45%

In order to answer the question about the likelihood of pregnancy in a particular case, it is important to know other parameters (age, state of the endometrium, etc.); the reproductologist who performed the transfer can answer this question more precisely.

There are two frozen embryos of 3BB quality. In your opinion, does it make sense to defrost both before transferring, with the expectation that at least one will survive, or to defrost one and hope for the best?

Good afternoon. There was IVF, the transfer was successful, there were 9 cryopreserved embryos left. We want to try to get pregnant again. Please tell me, if we want a child of a certain gender (a girl) due to an identified disease, can we defrost the embryos, conduct PGD and find out if any of them are girls, and then freeze them again? If there are, we would use them, and if not, we would perform new stimulation. How much can thawing and re-freezing affect the quality of embryos?

Embryologist: Kullyev Andrey Pollyevich

Yes, you can thaw embryos, biopsy them for PGD, and freeze them again.

This procedure may degrade the quality of the embryos and some embryos may not survive the procedure. It is advisable to check with the clinic about the quality of cryopreserved embryos. If the embryos are weak, it is better to immediately move on to new stimulation.

Hello! After puncture, 25 eggs were obtained, followed by 12 embryos. One was transferred, 11 had to be frozen. The pregnancy did not occur, so I went to the clinic with the desire to undergo cryopreservation, but it turned out that only one embryo was frozen. How could this happen? Did they die when frozen? The clinic has not yet provided an answer.

Embryologist: Kullyev Andrey Pollyevich

As a rule, most embryos survive freezing and thawing normally. If the embryo still does not survive the freezing, this usually becomes noticeable after defrosting.

It is better to clarify this issue with the clinic.

Please tell me how long after oocyte puncture should ICSI be performed? How can delaying the fertilization procedure due to the lack of suitable sperm in the husband's sperm affect the eggs?

Embryologist: Kullyev Andrey Pollyevich

Hello! It is advisable to perform ICSI within 6 hours after puncture. Delaying the procedure for more than 9 hours after puncture may reduce the number of good quality embryos resulting from the IVF cycle.

Hello! During the transfer, the reproductive specialist was unable to penetrate the cervical canal the first time and returned the tube with the embryo to the embryologist. For several minutes I paved the way with an empty tube, and then again with a tube with an embryo, this time successfully. Now I'm worried whether this could have negatively affected the embryo, because it turns out that it spent too much time in the tube. Pregnancy has begun, but this question constantly gnaws at me.

Embryologist: Kullyev Andrey Pollyevich

The embryo is drawn into a tube (catheter) along with a medium that allows it to feel comfortable. This environment is sufficient to nourish the embryo for a long time, much longer than the transfer can take.

The reproductive specialist did the right thing by returning the catheter to the embryologist. The embryologist placed the catheter on a heated surface so that the embryo awaited transfer at a temperature of 37C. The subsequent pregnancy shows that all manipulations were performed correctly.

Good afternoon We did the first IVF, the quality of two eggs after fertilization was assessed as 3pn and 8pn. The doctor said that they are not suitable for cultivation and further transfer, and we should consider the possibility of using donor cells. Please explain why ours didn’t fit?

Embryologist: Kullyev Andrey Pollyevich

Good afternoon The result of fertilization should normally be 2pn - this means that the future embryo received one maternal and one paternal set of chromosomes.

3pn and 8pn are abnormal fertilizations, indicating that the resulting embryos contain the wrong number of chromosomes.

Abnormal fertilization can be caused by polyspermy - the penetration of several sperm into the oocyte at once. This is possible if fertilization was performed using IVF. To exclude this cause, fertilization using ICSI can be performed in the next cycle.

If the oocytes were fertilized using ICSI, then 3pn and 8pn are the result of the properties of the cells, most likely the oocytes. In this case, there is a high probability of incorrect fertilization in subsequent cycles, which is why it is recommended to consider the possibility of using donor cells.

Hello, please tell me, can the quality of cavitating morula change from C to B in a few hours, and then to A by the 5th day?

Embryologist: Kullyev Andrey Pollyevich

Hello! The cavitating morula is a very early stage of blastocyst development, the pre-blastocyst. At this stage, the development potential is not yet very clearly visible. Letter designations corresponding to the quality of the blastocyst are usually assigned later, starting from the 2nd or 3rd stage of its development. The change from C to B or from B to A may depend on the quality of the blastocyst at the time of transfer.

I have heard more than once that cells after cryopreservation are of better quality than fresh ones. How is this possible?

Embryologist: Kullyev Andrey Pollyevich

Hello! If cryopreservation is performed using the method of vitrification (ultra-fast freezing), then after cryopreservation most embryos are no less quality than before it. Moreover, during the cryocycle, the endometrium is often better prepared for embryo transfer, so during the cryocycle the chances of pregnancy may be higher. But this is individual - not for every patient and not in every situation, cryotransfer is better than transfer in a fresh cycle; it is necessary to separately consult a reproductologist for each case.

Hello, I had my first IVF, my husband had normal sperm, they took 20 eggs, 17 were fertilized on the 3rd day, all 17 survived on the 5th day, only 2 blastocysts of quality 5bb and 5 cc, we did not transplant them and are preparing for the second retrieval, the question is, is it possible to transplant a blastocyst of quality 5cc? what's your forecast?

Reproductologist: Osina Ekaterina Aleksandrovna

Standard practice is that a 5CC blastocyst is a poor quality blastocyst that is extremely unlikely to produce a healthy pregnancy, and such blastocysts are not usually transferred or cryopreserved.

Another question that arises based on the data presented is the reason for the formation of such large quantity blastocyst, given the good spermogram indicators. To discuss this, we advise you to sign up for a joint consultation with an embryologist and a reproductive specialist.

Good afternoon Please tell me, an embryo with 1 pronucleus can give normal pregnancy And healthy child? If yes, then with what probability? Do they dispose of it or watch its development?

Hello! There is a possibility that an embryo with one pronucleus will give rise to a normal pregnancy and birth of a child. This occurs in situations where pronuclei in the zygote appear asynchronously. Such embryos are monitored until the fifth day, and if the embryo becomes a high-quality blastocyst, it is possible to carry out transfer or cryopreservation, provided that there are no other embryos and taking into account the clinical picture.

Good afternoon I am 44 years old and have never been pregnant. AMH-0.14, male factor tesoozonospermia, IVF + ICSI was performed in November 2018 in the Kulakov center. 2 oocytes were obtained. then 2 embryos. But the replanting was not completed. Because the embryos stopped developing. I can’t get a document on what day the embryos stopped developing. According to the embryologist, one embryo stopped developing on the 3rd day, the other on the 4th day. And today the doctor sent me an embryological card in which: number of oocytes M II-2 (dark cytoplasm) fertilization - ICSI Sperm indicator per day TVP concentration - 70 ml/ml; mobility PR-53%. sperm morphology-3% number of zygotes (2pn 2pb) culture medium-Irvine Sc CO2-incubator-COOK crushing assessment D5-8v ATR (mor) cancellation of transfer due to unsatisfactory quality of embryos. I ask YOU to decipher the assessment of fragmentation, D5 - as I understand it, the assessment was performed on the 5th day, how can this be if, according to the words, one embryo stopped developing on the 3rd day, the other on the 4th day???? And please describe the quality of the cultural environment - IrvineSc / (have you read that special environments are used for older patients?) For me, it is very important to understand this in detail in order to develop further tactics. In which clinic should I make the second (and for me the last) attempt, what needs to be done to the maximum!!! On what day should I do the transfer and PGS. Really looking forward to your reply!

Embryologist: Lyamina Irina Vladimirovna

You need to understand that the most determining factor in your case is age. Therefore, there is a reduced ovarian reserve, and, accordingly, the quantity and quality of oocytes and embryos obtained, and a high risk of genetic disorders. The medium used is the most optimal for embryo cultivation. It allows embryos to develop within 5 days without the need for additional intervention by an embryologist.

From your letter it follows that embryos on the fifth day of development have the number of cells corresponding to the third and fourth days of development. On the fifth day, the embryo should become a blastocyst. For PGS, embryo biopsy must be performed on the fifth day at the blastocyst stage. Since the embryos had stopped developing, PGS was not possible. You may be advised to repeat stimulation attempts, but most likely the result will be the same.

It is also possible to transfer the embryo at an earlier stage (2-3 days), if it corresponds to the stage of development, but there is no information about genetic disorders.

Hello! Please tell me if after defrosting the embryo did not expand or, as I was told, did not recover in volume, is there any point in transferring it? At the same time they say that he is viable

Embryologist: Lyamina Irina Vladimirovna

The embryologist evaluates the embryo over time, looks at the quality of the cells after thawing and, based on this, makes a conclusion about the transfer. If they say that the embryo is viable, then it should be transferred. The chances of implantation may be reduced, but you can only say more accurately by looking at a specific embryo.

Hello! Please help me decipher the embryolist. And tell me, are there any chances of a successful pregnancy?

Embryologist: Lyamina Irina Vladimirovna

Hello! From the protocol you sent, it follows that 16 oocytes were mature, 15 embryos were obtained. Of these, 10 became blastocysts of varying quality and were cryopreserved. This is a good indicator. From the point of view of morphological assessment of embryo development, the chance of pregnancy is high. However, there are other factors - the condition of the endometrium, genetic disorders in embryos.

Good afternoon We have the following situation: oocytes were frozen due to the complete disappearance of sperm in my husband during IVF. We have been actively treating my husband for three months in order to catch cells for fertilization. The question is: if you manage to catch sperm, it’s better to freeze and wait on a certain day my cycle or is it better to fertilize immediately. Is it possible to plant two days before the start of the cycle? Thank you.

In your case, it would be advisable to freeze the first sperm caught, if they are of decent quality, and then on the day of the expected thawing of the cells (for your cycle) try to get more, but you will already have a safety net in the form of cryo. It is logical to defrost the cells, fertilize them, and then freeze the embryos again only if the sperm are weak and cannot survive cryo. The embryologist will tell you this after receiving it. Embryos are not transferred two days before menstruation.

Good afternoon We have the following situation: oocytes were frozen due to the complete disappearance of sperm in my husband during IVF. We have been actively treating my husband for three months in order to catch cells for fertilization. The question follows - if you manage to catch spermatozoa, is it better to freeze and wait for a certain day of my cycle or is it better to fertilize immediately. Is it possible to plant two days before the start of the cycle? Thank you.

Embryologist: Lyamina Irina Vladimirovna

If sperm are found in your spouse’s ejaculate, then in any case it is better to cryopreserve it. You can use a cryopreserved sample for fertilization and adjust it to your cycle, or you can thaw the oocytes on the day of sperm collection and then cryopreserve the embryos. Which option is best should be decided by you together with your doctor and embryologist. The transfer is prescribed by a doctor based on ultrasound and hormone data, usually from 18 to 23 days of the cycle.

Good afternoon Help me decipher the embryological extract. What quality are our embryos and what are their chances of survival?

Embryologist: Chelombitko Oksana Mikhailovna

Unfortunately, the photo is not of very good quality and the blastocyst grade is not visible, so I cannot comment on the quality of the frozen embryos. And the extract indicates that 4 mature oocytes were obtained, fertilized using the ICSI method, 3 of them were fertilized, 2 developed successfully.

Hello! I'm 31, my husband is 27. AMH is 2.5. Many antoal follicles. Tell me, please, what could be the reason? I had 2 IVF protocols in different clinics. In the first short protocol (2017) there was stimulation with gonal at a dosage of 150, in the last 2 days of stimulation the dose was increased to 200. 36 hours before the puncture, an injection of Pregnil 10,000. 17 oocytes were taken, 14 of which were mature. 10 oocytes were fertilized using ICSI. The remaining 4 were left for IVF, but fertilization did not occur due to low sperm morphology. There was no transfer due to the risk of hyperstimulation. Subsequently, 8 morulas were frozen on the 4th day of cultivation due to the fact that the 5th day was Sunday. They didn’t give me an embryological statement, but they said that the morulae were good, class M2 and M3. Before transferring, they were defrosted a day before, they successfully grew to a blastocyst (I don’t know the quality, but the doctors said they were good). There were 2 unsuccessful cryotransfers with these embryos. There are still 4 pieces left. This month there was a second protocol in a very respected clinic with many good reviews. There was a long protocol: from DC 23 (June 5), I started injecting Decapeptyl Daily with half a syringe and taking Duphaston. On June 15, a new cycle began, from June 16, 100 injections of Puregon were prescribed, I also continued to inject Decapeptyl. The ultrasound showed more than 10 follicles. Estradiol was monitored regularly. For 11 days I injected Puregon and Decapeptyl, then an injection of Pregnil 10,000, after 35 hours a puncture. They took 13 oocytes, the doctor was very pleased. They said that they would do IVF fertilization, I asked to do ICSI, because... My husband’s morphology is 2%, to which I was told that most of the oocytes are mature and they have already begun to be fertilized. The next day the embryologist called and said that only 3 cells were fertilized, the rest turned out to be immature. On the 3rd day (today) there was only 1 excellent student left, the remaining 2 stopped dividing. The transfer is scheduled for day 5, if the cell survives... Whose fault could this be? Incorrect stimulation pattern? Embryologists didn't want to do ICSI? Disadvantages of my body? But last year he gave good results...

Embryologist: Chelombitko Oksana Mikhailovna

I cannot comment on the stimulation scheme - this still has to be done by a doctor. I can only say that the first protocol was successful - 8 morulae out of 14 cells is a very good result. The lack of fertilization in IVF should have alerted the embryologists of the second clinic; I don’t know why this didn’t happen... What worries me most about your story is the lack of pregnancy after two cryotransfers. Apparently, it is necessary to consider in more detail the medical history, the method of preparing the endometrium before cryotransfer, the support scheme after the transfer... But suddenly all this is not needed and pregnancy occurs this way the only embryo?!

Good afternoon I would like to know what my embryos mean?

Embryologist: Lyamina Irina Vladimirovna

You received 6 oocytes, only 3 of them could be used for fertilization, all 3 were fertilized. On the third day of development, one embryo was transferred High Quality. The rest were cultivated until 5–6 days. By the sixth day, the first embryo was 2 days behind in development, the second became a low-quality blastocyst. Such embryos are not used for cryopreservation or transfer, since the chance of pregnancy is low.

Hello. I am 36 years old and will have a 4 BA blastocyst embryo transfer. Are you very concerned about the chances of success? The doctor does not suggest transferring the second 4BB blastocyst due to the possible loss of two strong embryos at once or the occurrence of twins. There are also two 3 BB blastocysts. Before this, a 4 AA blastocyst was transferred, the result was negative. Maybe to increase the chances of pregnancy you can transfer two embryos 4 BA and 3 BB? Thank you.

Embryologist: Lyamina Irina Vladimirovna

This embryo is of morphologically good quality and has every chance of implantation, provided that it does not have genetic abnormalities and the endometrium was correctly prepared at the time of transfer. If you are not ready for twins, then it is better to transfer one embryo. Transferring two embryos slightly increases the chances of pregnancy, but the chances of twins increase greatly (especially if both embryos are of good quality). If the doctor does not want to transfer two due to the “possible loss” of two embryos at once, then perhaps he is not confident in the quality of the endometrium and does not want to take risks. When transferring one embryo, hatching (cutting the membrane of the embryo) can be done in order to facilitate its exit from the membrane and increase the chances of implantation. This is especially recommended when transferring thawed embryos.

Good afternoon Help decipher the quality of embryos. 1 embryo B13AB, 2 embryos B11

Embryologist: Lyamina Irina Vladimirovna

The notation is not entirely clear from your question. I can assume that 1 B13AB embryo (the number “1”, this is most likely the Latin letter “l”) is a good quality blastocyst. The number “3” means the size of the cavity, and the letters indicate the quality of the cells of the inner cell mass and trophectoderm (A is the highest class). The second embryo, if the number 1 means the letter “l”, is an early blastocyst.

Good afternoon, I am now waiting for hCG on May 14th, after the transfer of a class 8A embryo in a fresh protocol - a three-day-old one, I now found out that 2 blastocysts 4AB and 4AC were frozen, I am a little confused what the numbers 8 and 4 mean, that a three-day-old one is better, but the blastocysts are lagging behind , worse? Thank you.

Embryologist: Chelombitko Oksana Mikhailovna

Good afternoon. Love. Your embryos are all developmentally appropriate and of good quality – each for its own stage. The number in the blastocyst assessment indicates the size of the cavity, the letters indicate the quality. The number in the evaluation of a three-day embryo is the number of cells, the letter is quality.

Hello, please tell me the transfer said the embryo was 4th century with fragmentation. 4th century I figured it out, but what does fragmentation mean for blastocysts? Are these letters the degree of blastocyst fragmentation? Those. BB is fragmentation up to 20%? It was confusing that the embryologist not only said 4th century, but also added with fragmentation? Thank you in advance

Embryologist: Chelombitko Oksana Mikhailovna

Ekaterina, good afternoon. In the evaluation of blastocysts, the number is the size of the cavity, the letters are the quality of the internal cell mass and trophectoderm (components of the embryo). Fragmentation is not indicated here, so the embryologist said this separately. Fragments are not part of the blastocyst; they are formed during cell fragmentation; if fragmentation is less than 50%, then this does not affect viability.

Oksana Mikhailovna, good afternoon! Tell me, please, can an embryo with four pronuclei give a normal pregnancy and a healthy child? If yes, then with what probability? Is it worth the risk?

Embryologist: Chelombitko Oksana Mikhailovna

Good afternoon, Yuri. An embryo with four pronuclei is considered abnormally fertilized and does not participate in transfer. There is a chance of normal chromosomal composition, but it is very low (you can ask a geneticist for the percentage), but the problem of an imbalance of maternal and paternal chromosomes arises (the so-called imprinting diseases). I would not transfer such an embryo, given the high risks of pathology.

Oksana Mikhailovna, good afternoon! How could you comment on our situation: 1. Male factor - oligoterratoasthenozoospermia. On the female side, after numerous examinations, only the right tube is impassable. 2. There were 2 failed ecos. In the first one, only 2 oocytes were obtained (there were 6 follicles, 4 empty), after xi 1 was degraded. The second one was planted on the third day (according to high quality assessment). Pregnancy did not occur. In the second, 8 oocytes (8 follicles) were obtained; after 1x, 6 went into degradation. 2 embryos (assessed again to be of excellent quality) were transferred on the third day. Pregnancy did not occur. My husband had karyotyping done - the result was without deviations. I haven’t done it myself yet, I just signed up for analysis. In your opinion, what should we pay attention to in such a situation, some other diagnostics? There are two eco clinics in our city, both of them said that in our case we need PGD (they don’t do it in our region). But, as I understand it, PGD is done when a larger number of embryos are obtained... Or in our case, is it still better to tune in specifically to PGD? Thank you in advance for your response.

Embryologist: Chelombitko Oksana Mikhailovna

Based on the information you described, I do not see any indication for PGD. The only thing is, I don’t know your age – it can also be an indication for PGD. The amount of degradation after ICSI may indicate “weakness” of the eggs or incorrectly chosen stimulation. In the first case, only multiple attempts can help, a simple “search” for that same egg, and the second situation can be discussed with a doctor... As an embryologist, in the next attempt I would try to grow any number of embryos to a blastocyst - it is useful to know how development proceeds after the third day for prescribing PGD...

Hello, we initially had azooospermia, we were treated and only a single sperm appeared. It was Eco+ixi. For some reason, half of my follicles ovulated, more than 20 grew, they took 12. On the 5th day, the embryologist called with a report and said that they had frozen 1 blastocyst, 3 bb and 3 morulae!!! And I was left confused why they froze the morulas, which were lagging on the 5th day, and did not leave them until the 6-7th day. Tell me your opinion on this matter, what do you do in this case. And is there any hope when defrosting that the morulae will be able to become a blastocyst and it will be suitable for transfer?

Embryologist: Chelombitko Oksana Mikhailovna

Inessa, good afternoon! Morulae on the 5th day are not a lag, but a variant of the norm, so you can freeze them if the embryologist is confident in their quality. When thawed, the morulae continue to develop and become blastocysts. You can defrost them a little early to make sure they develop.

Good afternoon We are from the city of Omsk, we did eco-ixie with a pixie 3 times, and all three times were unsuccessful, the doctors say that we have a male factor, they take 9 eggs from me, 6 were fertilized, on the 3rd day 4 embryos developed well, and 2 lagged behind, On the 5th day before the transfer, I was told that there was nothing to freeze, there was 1 embryo left at the morula stage, it was transferred, but it did not take root. More than one doctor cannot give a specific conclusion. Maybe you can tell me what’s wrong and what needs to be treated. Sperm DNA fragmentation index 15.6%

Embryologist: Chelombitko Oksana Mikhailovna

Good afternoon According to the spermogram results, you have a male factor, but it is not critical. For ICSI, the “morphology” parameter is important, but here everything is fine. The development of embryos depends not only on the quality of sperm, but also on the quality of the egg. Dynamics of development “everything is fine until the third day, and then everything goes bad.” Makes me think about genetics - check your karyotypes just in case. And try variations with stimulation of superovulation. Good luck!

Hello. What are the chances of implantation for a 3AB blastocyst? I read that these embryos do not implant well, is that true? Thank you.

Hello! There was a short protocol, 3 embryos were obtained at the blastocyst stage. All three were hatched. 2 were planted, and the 3rd was frozen. Is a cryopreserved embryo after hatching suitable for a cryoprotocol, since hatching is usually done after thawing? Thank you.

Embryologist: Chelombitko Oksana Mikhailovna

Irina, good afternoon. Hatching before cryopreservation is not scary. For example, hatching is mandatory for all embryos for PGD, and then they are frozen (otherwise it is simply impossible to do a biopsy). These embryos thaw well and have a high chance of implantation.

Good afternoon I beg you, help! They cannot give us an answer why both of us, healthy spouses, receive a class 4c oocyte.... A little bit of our history... In 2014, the first IVF, 6 oocytes were received, 3 were fertilized. The transfer did not take place due to developmental arrest. I am attaching the protocol. The second IVF was from 03/12/2018 to 03/29/2018...2 oocytes were received, 1 was fertilized. 1 category 4C embryo was transferred into the uterine cavity....in general, they said the chances are very small, we probably need to look for an egg donor. The embryologist cannot answer our questions about why this happens.... They don’t say what examinations to take next.. We want to establish the reason in order to avoid mistakes and fully prepare for the next IVF... I’m 33, tests for me and my husband perfect... I'm sure it's some kind of immunological incompatibility.... Or genetic... I don’t know.... If you can, tell us how we should proceed. Thank you in advance for your attention to me... And my problem..

Embryologist: Chelombitko Oksana Mikhailovna

Good afternoon. Both protocols for culturing embryos really cannot please us, but in my opinion it is too early to immediately switch to a program with donor oocytes. Firstly, it seems to me a good idea to change the stimulation protocol (both of yours were “short”). You are only 33 and since your hormones are ideal, you can try different regimens. As an additional, but expensive and somewhat time-consuming study, karyotyping can be done for both. Immunological problems may appear at the time of embryo implantation, but not during the process of fertilization and early development. Therefore, you need to start by changing the stimulation, if your attending physician cannot do this, you can change the doctor...

Hello, I am 30 years old, my husband is 30. Both have no bad habits. Experience of infertility for almost 5 years. At first, doctors could not find the cause of infertility, for about three years we heard from different specialists “try again” or “strange, everything is fine.” Then various diagnoses began to be added. 2015 polyp removal cervical canal, in 2015, an HSG was performed - according to the conclusion, both pipes are passable, chronic cystitis, with frequent relapses, in 2017 a hysteroscopy was performed - based on a biopsy - chronic endometritis - treated with antibiotics and physiotherapy, then my doctor decides that the problem is in the tubes - he sends me for laparoscopy + I asked for an endometrial biopsy almost a year after treatment on the same LSC - the result: they couldn’t break through one tube, the second one was also, in the surgeon’s opinion, not functional, but they didn’t remove them because they didn’t pose any harm, there was also a small area of ​​endometriosis - they removed them. According to the results of an endometrial biopsy - abnormal cells, i.e. no endometritis was found. They sent me for IVF. Next is a short protocol (pergoveris stimulation 1 injection per day, on the first and from the 9th day Cetrotide 1 uk/day) on the 15th day injection of hCG 1500 on the 17th day puncture of 14 follicles, of which only 9 oocytes, IVF was performed (good spermogram, normozoospermia, sperm DNA fragmentation was done last year, also antisperm bodies - everything was normal), when I asked about ICSI - they said better than IVF. The next day, all 9 cells were fertilized. On the 4th day, everyone was alive, one excellent student, the rest said they were lagging behind, they left them for the 7th day (it was on Friday - they ended up on the weekend), the transfer was on Friday on the 21st day - one embryo. On Monday I called the embryologists - one embryo remained “good” for freezing, the rest remained at the morula stage and the embryologist did not even advise freezing them, i.e. only 2 cells out of 14 turned out to be suitable for replanting. After the transplant, my stomach was constantly pulling, the sensations were like before the start of my period, the doctor said to put papaverine rectally, on the 9th day after the transplant it started pink discharge, then on the same day there was a slight bloody discharge, the doctor sent me for hCG - the result was 1.2. My husband and I had a karyotype taken and everything was normal. The endometrium during replantation was a good 12 mm. What is the reason for the failure? what to consider in the next attempt? The embryologist, when asked about the reason for the lag of embryos, said “only God knows.” Well, how can that be? what kind of answer is this, because there must be a reason!

Embryologist: Chelombitko Oksana Mikhailovna

Good afternoon, Tatyana. Unfortunately, the reasons for good or poor embryo development are rarely clear enough to the embryologist. The quality of development is a fact that we observe and can explain after the fact, provided we have sufficient information. It is difficult to draw any specific conclusion based on one attempt. You can only make assumptions, but for this you need to see at least the cultivation protocol.

Hello! What is the probability that 4 embryos cryopreserved by vitrification at the blastocyst stage (which, according to the results of PGD, are good and recommended for transfer in the first place) will turn out to be non-viable when defrosted? And what could be the reason for their death?

Embryologist: Lyamina Irina Vladimirovna

Hello! The probability that embryos after vitrification will not be viable is 5-10%. The results of PGD only indicate the quality of the genetic material of the embryo. The survival of the embryo depends on its quality and morphological characteristics.

Help me explain the protocols please.

Embryologist: Chelombitko Oksana Mikhailovna

Good afternoon. Your protocol says that the patient received 5 mature cells out of seven; after fertilization, three embryos were obtained, which began to fragment, but after the 3rd day they developed poorly and stopped completely by the 5th day.

Hello, I have Eco Ixi. I am 38 years old and have never been pregnant. The first day there are three oocytes 2 pn, the second day the number of cells is 2,2,3 for all class A, the third day the number of cells and class 5A, 5AB, 3 A; fourth day 5AB, 5B and 3 A. Help, is there a chance of pregnancy

Embryologist: Chelombitko Oksana Mikhailovna

Hello, Katerina. The initial quality of your embryos is good, but the fact that there are no signs of development from the third to fourth days is a little frustrating. Perhaps this is a temporary phenomenon of developmental inhibition and then everything will be fine, or maybe a complete stop in development. You need to wait for the blastocyst (5-6 days of development). For now it is difficult to say anything definite. Good luck.

Good evening! Please tell me, I had cryotransfer of two embryos, quality 3AB and 3BB, on the 11th day after the transfer, hCG 65, what is the quality of the embryos, and are there any chances that both will survive?

Embryologist: Chelombitko Oksana Mikhailovna

The embryos are rated as good. The number of your hCG indicates that pregnancy has occurred, but it is not possible to judge that both of them have attached - much depends on the laboratory where the analysis was carried out (there are different interpretations). Ultrasound will show! Good luck!

Good afternoon Help me please! We already have a child, 2 years old. Six months ago I had a miscarriage at 5 weeks. My tests are fine, my husband's results are attached. Ultrasound is fine. Please tell me what can be done, the doctor just prescribed vitamins. Thank you in advance

Embryologist: Chelombitko Oksana Mikhailovna

Your husband's test results don't indicate global problems in sperm. She can fertilize the egg. Prescribing vitamins in this case is the right tactic. And it would also be good to take a repeat spermogram to see the dynamics. Six months after curettage is a short enough time to talk about problems with conception; you need to wait and strengthen the body as a whole.

Good evening! Can you please tell me if the embryo is of good quality? Is implantation successful with such an embryo?

Good afternoon. On the third day of development (I count the day of puncture as Day), the embryo had three cells. As I understand it, this is not very good. Because an odd number of cells is undesirable and on the third day there should be at least 6-8 cells. This embryo was left to grow until day 5 and if it continued to divide, it was frozen. It’s difficult for me to objectively assess whether there is any point in freezing an embryo of initially dubious quality or can they catch up in development and become just as excellent? And what criteria should an embryo suitable for freezing have on day 5?

Embryologist: Chelombitko Oksana Mikhailovna

A three-cell embryo on the third day of development is indeed not very good, but we must take into account that each embryo has its own pace of development. Your embryo that lags on day three may become a good blastocyst on day five or even six and produce a successful pregnancy. Therefore, there is a point in prolonged cultivation, and if the embryo catches up in development, it should be frozen. Good luck with the protocol!

Hello, our clinic sends photos of embryos. In pictures on the Internet, all day 5 embryos look round and even, but mine is oval and lumpy! Please tell me is this embryo normal? How would you rate its quality!? Thank you in advance

Good afternoon, Ekaterina! This is a good embryo. A similar configuration can occur after thawing or trophoblast biopsy. Also, at the time of shooting, the embryo could have been affected by external factors (for example: cold), so it looks a little swollen. As soon as the embryo finds itself in a comfortable environment, it will straighten out and take the correct shape.

Hello! Please tell me what is the quality of the embryo with the following data: Oocyte assessment MII, fertilization 21N - April 21, 2015. Embryo characteristics: April 22, 2015 - 4A April 23, 2015 - 8B April 24, 2015 - M3 (then cryopreservation using the Kitazato vitrification method). What are the chances for such an embryo (M3)?

Hello! I'm interested in this question. Why is it that almost nowhere now they do PGD diagnostics on the 3rd day? Is PGD of an already frozen embryo possible? And is any preparation necessary for PGD? I am interested in the PGD NGS method. I learned about it at the NGC clinic. They said that the method was wonderful, ultra-modern and all that. I would like to hear different opinions, thank you.

Embryologist: Mokaid Mohamed Rashid

Ksenia, hello! Why nowhere? For example, we often perform PGD on the 3rd day. PGS on blastocysts (5th day of development) makes it possible to extensively diagnose the embryo based on 24 chromosomes, while the fish method consists of studying only the main, most common aneuploidies. On the other hand, this technique is much simpler, cheaper and gives quick results, which also plays a role in the patient’s choice. PGD ​​is possible on frozen embryos. PGD ​​takes place as part of the IVF protocol, so it does not require special preparation, unless we are talking about preparation for PGD for monogenic diseases, where the preparation takes 2-3 months. NGS allows not only screening for all chromosomes, but also more clearly detects mosaicism in embryos. Today, this is the most accurate and informative diagnostic method.

Hello. Help me figure it out please, there were 4 attempts at IVF and all without results. We can’t understand and the doctors also don’t know what the reason is, they suggested donation, but what they themselves don’t know is either an oocyte or sperm. My husband and I have normal hormones. Sperm is normal. normal, the eggs are good, but in the end nothing. The karyotype was not checked. Please look at the protocols and see what we can do next, we are very upset.

Embryologist: Mokaid Mohamed Rashid

Guzel, hello! In a good way, you need a face-to-face consultation with a specialist with a thorough analysis of your medical history, protocols, etc. In such cases, we resort to two parallel solutions to the situation. First: special media for older patients, or patients with not quite high-quality embryos (when we can assume hypersensitivity to in vitro cultivation) Second: we do not grow such embryos until the fifth day, but instead perform PGD on days 2-3 to exclude a number of chromosomal aneuploidy, and immediately transfer suitable embryos. Thus, we give a chance for implantation in a natural environment for embryos.

Good afternoon. Please help me clarify the situation. There was a puncture and 10 eggs were ripe, of which 7 were oocytes. All seven cells were well fertilized and divided well. On the 3rd day, 5 embryos began to fragment by more than 30% and became covered with some kind of white film, and 2 emboions also began to fragment, but within the acceptable limit of less than 20%. As a result, 2 morulas of those that had fragmentation of less than 20% were transferred to the 4th day. And 5 embryos were disposed of. The question is: What could have influenced this outcome of events. My husband is diagnosed with asthenozoospermia activity 25%, immobility 50%, the mar test is negative. My LH and FSH ratio is normal, AMH is 3.4, and according to ultrasound I have multifollicular ovaries. My age is 30 years old, my husband is 35.

Such behavior of embryos in cultivation may indicate either the quality of your cells (if, for example, you have endometriosis or polycystic disease, this may reduce the quality of the cells), it may also be associated with a high level of sperm DNA fragmentation (this characteristic is usually not associated with the quality of the spermogram).

Good afternoon, Please help me understand the possible reasons for failures in IVF. I am 38 years old and have been trying to get pregnant for six years. There was an unplanned pregnancy at 22 years old (abortion). They did an HSG in 2014, the tubes were patent, laparoscopy in 2015, there was slight endometriosis, polyps in the uterus and they discovered obstruction of both tubes!!! But the doctor said that it was possible that there could be a spasm of the tubes.... There was a hysteroscopy in 2016 and 2017 to remove a polyp, no other pathologies were identified. Of the tests performed, only AMH was 4.0 in 2015 and 0.77 in 2017, the husband’s spermogram was normal. We did IVF 4 times: 1 IVF - Stimulation Gonal F, Cetrotide, Ovitrelle, only Crinon 1p in day was supported. 10 eggs were punctured, 4 were fertilized, 2 were implanted on the 3rd day, the rest stopped developing. Result Biochemical pregnancy. 2 IVF - Stimulation Gonal F, Cetrotide, Ovitrelle, only Crinon 1p in d was supported. 9 eggs were punctured, 5 were fertilized. Removed from the protocol due to increased progesterone. We froze 2 * B3BB/SS on day 5 and 1 * B3BB on day 6. RESULT: Two cryotransplants without implantation. 3 IVF – Stimulation Menopur, Pergoveris, Cetrotide, Ovitrelle, only Utrozhestan 3*200 was supported. We punctured 4 eggs, 2 were immature, 1 was lagging behind, so we implanted one, but of good quality, on the third day. RESULT: There was not even implantation. 4 IVF – AMH 0.77, FSH 9. Stimulation Menopur, Gonal F, Cetrotide, Ovitrelle, only Utrozhestan 3*200 was supported. 5 eggs were punctured and all were grown until the 5th day. We planted 2 blastocides of BB quality, the rest stopped developing on the sixth day. RESULT for today: hCG at 10 dpp - 46, at 11 dpp - 69, at 13 dpp - 145, at 17 dpp - 239, 19 dpp - 205. What is this Biochemical pregnancy again, what can it be associated with? What do you think is the reason for failure? What are the chances of a successful pregnancy with your egg? Can I change the protocol and medications for the next time? What additional tests and maybe examinations would you recommend? Thank you in advance for your response! With uv. Tatiana!

Embryologist: Yulia Aleksandrovna Shtyrya

Good afternoon, judging by the protocols, the fertilizing ability of sperm is reduced. It might be worth trying ICSI. You did not indicate what happened to the degree of maturity of the oocytes and what spermogram your spouse had. It may be advisable to further examine/treat your spouse before the next attempt. Perhaps fertilization using the PIXI method will give better results. In the latter protocol, the quality of embryos and oocytes may have been reduced due to increased FSH levels. You can try depot drugs, or a long protocol for stimulating supervulation with diferelin as an inducer and without embryo transfer in the stimulation cycle.

Hello! I kindly ask you to help me figure it out, I had a transfer on the 5th day. They said that the six-day embryo developed MG4 Morolo and did not reach the blastocyst. moved because He is the only one left out of 8. Tell me MG4 - what kind of quality is this, I looked all over the Internet and didn’t find such designations... and if he is behind in development, is there a percentage that he can attach and develop in me? For what reasons could it happen that 7 stopped, 1 morula lagged behind in development? I read that people can only get pregnant with the transfer of a good quality blastocyst, what can you say about my morula, I’m really looking forward to your answer.

Embryologist: Mokaid Mohamed Rashid

Transferring the morula to the 5th day is not so bad. You have a chance to have a normal pregnancy. MG4 is the morula. A stop in the development of 7 embryos indicates that the quality of these embryos is not very good. It would be interesting to find out on what day the embryos stopped developing. In IVF, it has now become popular to leave embryos until the fifth day of development, but I would recommend this method only if there is a large number of cells.

Hello. I have a question. There is one frozen embryo of class 4BB - please decipher what are my chances of a successful pregnancy? Which %.

Hello, Lesya! The likelihood of embryo implantation depends on many factors, the main ones being the patient’s age, medical history, and whether genetic diagnosis has been performed. For each set of parameters, the probability of pregnancy will be different. As for the quality of the embryo, it is a blastocyst, with large size cavity and good quality (B) of the internal cell mass (the part of the embryo from which the fetus itself is subsequently formed) and good trophoblast (B) (the part of the embryo responsible for implantation and development of the fetal membranes). Typically, such embryos are implanted at a high rate. Good luck!

Hello. We have a new protocol. MF. About 50,000 sperm of all categories. About 20% category A (after long-term treatment this is the most best result). IVF+Ixi. 4 eggs were obtained. 1 with morphological features, was not fertilized. 3 embryos developed perfectly until day 3. One slowed down closer to 4 days. On day 4 there were 2 morulae of excellent quality and one lagging embryo. One category A morula was transferred. On the 4th day. The next day, both remaining embryos remained at the same level as on day 4. We watched for up to 6 days, they stopped. With what it can be connected? Is it possible to do PIXI with such a low sperm count? Does the transferred embryo have a chance?

Embryologist: Lyamina Irina Vladimirovna

The arrest of embryo development may be related to the quality of the oocytes. It would be possible to answer this question more accurately if, for example, you had several protocols with a similar picture of embryo development; also, the quality of oocytes is influenced by age and stimulation protocol. Sperm can also influence the development of embryos, but, as a rule, this happens less frequently. Moreover, you did not send a detailed version of the spermogram indicating the morphology. PIXI can be performed if there is a sufficient number of sperm. The transferred embryo has a chance of implantation, but this question could be answered more accurately if it were transferred on the fifth day of development at the blastocyst stage.

Hello! Please tell me about the quality of the embryos transferred to me, I couldn’t find the same designations on the Internet as in my extract! 2 embryos were transferred XYOK-BL5K XXOK-BL3K Now there is one fetus in the cavity, but we don’t know the gender yet, in your opinion which embryo had a better chance? Or are they not predictable? Thanks in advance!

Embryologist: Yulia Aleksandrovna Shtyrya

Judging by your extract, the XYOK-BL5K embryo has a better chance, but the morphological characteristics of the embryo do not have an absolute correlation with the likelihood of pregnancy. Wait for screening or have your blood taken for a non-invasive perinatal test to make sure the embryo is healthy.

Hello. I underwent IVF in my city, during the transfer of the embryo on the 5th day to the blastocyte stage there were 6 good embryos, 2 were transferred, 4 were said to be observed until the 6th day, but they began to slow down in development and were not frozen. Please tell me what could be the reason that all four good ones suddenly began to slow down and did not go into cryo, why embryos on the 5th day in the blastocyte stage are observed until the 6th day, and the two that were transferred on the 5th day can also be on the 6th oh stop developing, what is the chance of pregnancy?

Embryologist: Mokaid Mohamed Rashid

Interesting to see your embryo protocol. There is no reason to leave good quality embryos until the 6th day; they will come out of the shell and will no longer be subject to either transfer or cryopreservation. Since they were left to observe, it means that those embryos were lagging behind in development corresponding to the 5th day. Regarding transferred embryos, don't worry. On the contrary, once in their natural environment, they have a higher chance of implantation and further development.

Anna Alexandrovna, hello! Please comment on our protocol. They gave me one five-day plan and compact morality. There is nothing in cryo. What happened to the remaining cells? Thank you

Embryologist: Mokaid Mohamed Rashid

Olga, hello! Judging by the embryo protocol, fertilization proceeded perfectly until the third day. Then at the differentiation stage I see a slowdown in growth. This happens in embryological practice. I attribute this to three factors: 1. Cell quality; 2. Type of media; 3. Hypersensitivity of embryos to in vitro cultivation. It may be more appropriate in your case to transfer the embryo on the 3rd day of fertilization, or change the cultivation medium in the next protocol.

Hello, please tell me there was a transfer of one Gr1-2 embryo. What does this mean and what kind of embryo is it, help me decipher

Good evening. I would like to know whether it is worth paying for storing embryos at the morula stage on day 5? Or does freezing at this stage not promise anything good and is it just another pumping out of money?! There was another blastocyst. They planted it.

Embryologist: Gusareva Anna Alexandrovna

Hello, Ekaterina! Morula is normal on the 5th day of development, this bottom line norms. Such embryos have a chance of further development. Each embryo develops according to its own individual pattern and speed of development; it is not always legitimate to judge the quality by the low speed of development. Good luck!

Good afternoon, please tell me. They did IVF, transfer of blastocyst 4ba and morula compacta on day 5, the remaining 5 embryos were told that they were not yet ready for freezing. Is it possible to grow for more than 5 days? The clinic told me to call on the 6-7th day. Thanks for the answer.

Hello, please tell me. I am 30 years old, I had two unsuccessful attempts at IVF, there was no implantation, although the embryos are excellent (8A), the endometrium is good, three-layered, the support seems to be good. They don’t know the reason, I tested the antibodies to hCG myself, it turned out that the G antibodies were elevated, and after the second IVF they increased even more. Can they interfere with implantation? And what to do with them before the third attempt at eco? Thank you in advance.

Good morning. Please answer my question. Did it make sense to freeze embryos with ss and ds morphology, or in simple terms, “I was scammed for money”? Thanks in advance for your answer

Embryologist: Gusareva Anna Alexandrovna

Assessing the morphology of embryos is a difficult and rather subjective matter. In order to answer your question, I need to see a photograph of frozen embryos. The letter designations that you use are only part of the nomenclature; the quality is usually fully (if these are blastocysts) characterized, for example, BL3CC or BL2AB, etc.

Good afternoon Please help me figure out the following questions: 1. How can I tell if all the oocytes were mature? 2. Are embryos lagging behind in development? 3. What does the abbreviation “con” mean on the 4th day of embryo development? Thanks in advance for your answers!

Embryologist: Gusareva Anna Alexandrovna

Hello, Natalia! 1. You were fertilized using IVF. It is impossible to determine whether the oocytes were mature at the time of fertilization, because they are not cleared of surrounding cumulus cells. However, judging by the fact that the next day at the time of fertilization control 4 of 16 oocytes remain immature (designations GV and MI), then at least a quarter of the oocytes were initially immature. 2. According to this protocol, it is not clear what happened to the embryos after the 4th day of development. All embryos develop differently, some are lagging, some are developing normally (5 and 11). 3. It is difficult for me to judge what is meant by con. Perhaps this means the presence of compaction - a transition from crushing to the morula stage.

Good afternoon, after IVF, a frozen pregnancy occurred at 5-6 weeks (1 4aa embryo was implanted). Indications for eco include tubal obstruction and male factor. Kruger morphology before treatment - 2%, after - 4%, almost all sperm have pathology of the head. How do you know if it is worth transferring the remaining 2 4aa embryos that were frozen?

Embryologist: Gusareva Anna Alexandrovna

Hello Anna! The morphology of sperm according to Kruger has nothing to do with the feasibility of transfer. Each embryo is genetically unique; if one has a frozen pregnancy, this does not increase the chances of the same outcome with the remaining embryos. Of course they should be moved. Good luck!

Hello, Doctor. I had a fresh protocol and was hooked on 8a for three days, is this of normal quality? Now there will be cryo2av and 5av, is this of good quality? I read that the car is defective, what does that mean? Please explain, I'm waiting for your response. Thank you doctor

Embryologist: Gusareva Anna Alexandrovna

Hello, Lesya! An 8a embryo on the third day of development is of excellent quality. 2av and 5av are the classification of blastocyst quality. Both embryos are of good quality, 5av - a little further advanced in their development.

Hello, Doctor. I need your advice - my daughter had her first attempt at IVF, but there was no replanting. Today we received a statement from the embryologist, but no one explained the reason for the failure. please look and if possible help us find out what the reason is, regards

On the fifth day, 2 embryos were of poor quality, and one did not correspond to the day of development. There was no point in transferring embryos. The reasons for obtaining low-quality embryos may be due to genetic factors.

Good afternoon, on the 7th day after the transfer, hCG 4.55 is there any hope of success? We endured 2 five-day periods of good quality.

Hello. Please tell me how many embryos are usually frozen in a straw (if I call it correctly)? I have 4 embryos stored at the Ava-Peter clinic and how long are they usually thawed for transfer? And they probably don’t freeze it again?

Embryologist: Murza Galina Valerievna

At the Embrylife clinic, 1 or 2 embryos are frozen per straw. For transfer, a straw with 1 or 2 embryos is thawed, followed by their transfer into the uterine cavity. In some cases, repeated cryopreservation of the embryo is possible, but this is individual and depends on the quality of the embryo after thawing.

Good afternoon, can you please tell us that we did IVF plus IX and it worked out and 4 embryos were fertilized on the third day there were 2 embryos 7b 4b and 2 embryos at stage 8c the doctor decided to do the transfer on day 5 when they came for the transfer they implanted one for us at the NC stage, how is that? The doctor explained that they were developing and the others at stage D were not suitable for transfer.

Good afternoon During the IVF protocol, after puncture, 3 oocytes were obtained (one ovary is practically non-functional due to resection). All three are fertilized and develop equally well, there are no differences between them. They don’t do genetic testing in the clinic; on what day is it better to do the transplant - on the third or fourth? and if all three are of equally good quality, is it worth transferring all three or somehow selecting only two? Eco first, primary infertility of unknown origin.

Good afternoon, tell me today there was a transfer on the 4th day from dia, M and Comp embryos, please decipher

Good afternoon I want to do a cryoprotocol at Nex, how do you accept embryos from other clinics, for example Lapino? Is this even possible? I have 1 embryo, there is a very high risk - since there is only one, and not 2 or 3.

Embryologist: Yulia Aleksandrovna Shtyrya

Yes, we accept embryos from other clinics. To carry out transportation, you need to first contact a lawyer of our clinic, she will give you a list of documents that the giving party will need to prepare, and will give you a package of our documents for the giving clinic, when all issues with the documents have been resolved, you will be given a thermos for transporting the embryos and We will agree on the transfer time. If you are not comfortable carrying out this process yourself, you can contact one of the companies licensed to transport human reproductive organs and tissues, and they will carry out all the necessary preparation for transportation and the transportation itself without your direct participation. If all transportation rules are followed, the risk is minimal, whether for one or several embryos. It is clear that you are worried about transporting your embryo, but don’t worry, this procedure is well established, embryos came to us not only from other clinics in Moscow, but also from other cities, and not only from Russia, and everything went smoothly.

Good afternoon Please tell me. I’m 27, my husband is 37. I did Eco. We took 15 cells, 12 of which were mature. 9 were fertilized using ICSI. Only 1 blastocyst and 1 morula of average quality survived until day 5. Fragmentation of all cells was observed from day 1 of fertilization. As a result, I got pregnant. "IVF in the EC - the cell was not fertilized. My husband has 2% according to Morphology, other indicators are normal - mobility, etc. I had hyperstimulation as a result of IVF. They took a karyotype - both are normal, as well as compatibility in normal. What could be the reason for such a small number of blastocysts?

Embryologist: Yulia Aleksandrovna Shtyrya

The presence of fragmentation of embryos from the 1st day of cultivation may indicate the quality of the oocytes. I can recommend to my husband to take a DNA test for sperm fragmentation - if the indicator is bad, then treat it and try again in the ICSI-PIXI protocol. I also do not recommend embryo transfer using a hyperstimulation protocol. Perhaps this is your body’s reaction to specific drugs used in stimulation, then it makes sense to either switch to a different regimen or try again in a natural cycle (see the quality of embryos without hormonal stimulation). Good luck to you!

Hello, please help me decipher the protocol, what can you say about development and why all the embryos died?

Embryologist: Lyamina Irina Vladimirovna

It is very difficult to evaluate the work of another laboratory based solely on the protocol. In addition, embryo number 1 (2BL) does not have a description according to international criteria, so it is impossible to determine its quality based on the extract provided. 1. Embryo development often depends on the quality of oocytes. It is important to know how embryos from the same donor developed in other cycles. 2. Another reason for stopping the development of embryos may be the quality of sperm. What was in previous IVF protocols, if any? In this case, it is better to get comments from your laboratory. There are a lot of nuances for correspondence assessment.

Good afternoon. Please tell me whether the bl1 embryo is normal or not, what are its chances of implantation? When I asked if I was normal, the emriologist answered that he was good. But for some reason in the document there are no letter designations characterizing quality, only bl1.

Reproductologist: Gerkulov Dmitry Andreevich

This abbreviation does not correspond to the currently used classification of embryos. In a particular case, the quality of the embryo should be clarified with the embryologist who participated in the transfer.

Hello. Eco is planned in 2 weeks. My husband's culture revealed Enterococcus fecalis 10 b4. Leukocytes are not elevated. Nothing bothers me. I've been treating it for a year, but it's still going away. Question: 1. How will Enterococcus affect embryos? On the nutrient medium in which they are grown? 2. If you undergo treatment with ciprofluxacin before IVF (on the sensitivity list), will this affect the quality of sperm? On the quality of embryos accordingly? 3. Is it better to treat or not to treat?

Embryologist: Gusareva Anna Alexandrovna

Hello, Ekaterina! 1. If you do ICSI, then there is no risk to the embryos. 2. I would not recommend it, because... It is unknown how this will affect sperm quality. 3. I think not. Especially considering that after treatment it is sown again. Simply, the method of choice for fertilization should be ICSI.

Good afternoon The other day I had a cryo transfer, during the process the embryologist said that the embryo began to unbend after thawing. Is this a bad indicator and what can it lead to? Thank you in advance!

Embryologist: Gusareva Anna Alexandrovna

Hello, Natalia! Probably the embryologist meant “began to straighten out.” If you had an embryo transferred at the blastocyst stage, then during cryopreservation they shrink, because fluid leaves the blastocyst cavity. When thawing, the liquid is again sucked into the cavity and the blastocyst expands.

Good afternoon. We are planning cryo with a surrogate mother. I am a carrier of the Hep.B antigen. I was ill as a child. PCR negative. Is this a contraindication for a surrogate mother? Can an embryo be infected with hepatitis?

I did 2 IVF + ICSI in 2015, both unsuccessful. I think it makes sense to try again. I went for a consultation with an Embryologist, but didn’t understand anything human. Help me decipher the result. Thank you very much in advance!

Embryologist: Yulia Aleksandrovna Shtyrya

You went through the embryological stage very poorly, if you try again, it makes sense to examine and perhaps get a husband, change your stimulation scheme, grow the embryos up to 5 days and not transfer them into a new cycle, go into cryoprotocol. And do not just ICSI, but ICSI-PIXI. Good luck to you!

Answer please. We obtained 6 embryos of excellent quality, class AA; they were frozen because the endometrium was not ready. Then we defrosted all 6 embryos and cultured them to the blastocyst stage, resulting in 4 embryos. 2 blastocysts were added, the remaining 2 blastocysts were frozen again, quality 4AA and 4BB. What is the chance of re-frozen blastocysts when defrosting? This is my last hope.

Embryologist: Gusareva Anna Alexandrovna

If the vitrification method was used for freezing, re-freezing does not pose any risk. The embryos developed well after thawing, and therefore proved that the first freezing did not harm them. Blastocysts tolerate vitrification even better than crushed embryos, so most likely a second freezing will not harm them. Good luck!

6 embryos of excellent quality, class AA, were obtained. We cultured them to the blastocyst stage and got 4 pieces. 2 blastocysts were added, the remaining 2 blastocysts were frozen again. What is the chance of re-frozen blastocysts when defrosting? This is my last hope.

Embryologist: Yulia Aleksandrovna Shtyrya

Blastocysts obtained after culturing thawed embryos are incorrectly considered re-frozen. If we are talking about the negative effects of repeated freezing. They would be considered re-frozen if, for example, you had 2 embryos thawed for 5 days, one was transferred, and the second one was frozen after the transfer - so it would be re-frozen and its quality could suffer during subsequent defrosting. In your case, we are talking about embryos that were cultured for two days after thawing; this time was enough for them to overcome all the negative effects of freezing and fully recover.

6 3-day-old embryos were frozen, then thawed and cultured until there were 4 blastocysts. 2 were planted and the rest were frozen. What is the chance of surviving after defrosting?

Good evening! out of 5, 1 embryo of class 6 BB remained, please tell me what kind of quality this is?? He is in cryo now, is there a chance that he will survive? Thank you

Hello Oksana Mikhailovna! I am 34 years old. There was a short protocol, they took 9 cells, 5 were fertilized, and on the day of replanting there were 2 embryos of five days of average quality, they said 4.3! The endometrium has not matured, so it was frozen and replanted after two cycles. What are my chances with these embryos? How to hang them.

Embryologist: Chelombitko Oksana Mikhailovna

If the embryos survive defrosting normally and the endometrium grows well, then the chances of pregnancy are very high. 4.3 is not such a low score to have doubts about success. Considering that the endometrium is not always responsive, it will be necessary to treat it as critically as possible so as not to “waste” the embryos. Good luck!

Good afternoon I would like to contact you to explain to me about my embryos, 05/07 fertilization 2 eggs 2PN, split. 08.05 1-2; 2- 3 unev. 09.05 1-8; 2-7 sunev. 10.05 1- 9comp; 2-p.comp. transfer 10.05 GR 1st 1-2; 2nd 1. My embryos are generally alive or they were transferred just to put an end to their work, but it’s none of their business. Thank you.

Embryologist: Yulia Aleksandrovna Shtyrya

Judging by the embryological extract, the first embryo developed ideally, the second a little worse, but for transfer you had two early blastocysts, that is, embryos of good quality corresponding to the development period.

Good afternoon Please tell me, if they do IVF without IX, then there are sperm on the embryo that did not penetrate the egg, then cryopreservation on the 5th day, and then cryopreservation, can live sperm remain on the embryo after these stages? And another question is whether a five-day embryo after cryotransfer can divide completely, i.e. did you get 2 fertilized eggs?

Embryologist: Chelombitko Oksana Mikhailovna

After standard IVF, large quantities of sperm remain on the surface of the embryo, but by the 5th day they can no longer be alive, that is, additional fertilization cannot occur. And a five-day-old embryo can very well split, and then there will be two fertilized eggs.

Hello! I am 30 years old, my husband is 33. I underwent IVF + ICSI in April 2016 for primary female infertility combined, caused by endometriosis (laparoscopy - single focus of heterotopia on the peritoneum. CSU tubes are patent) and MF - teratozoospermia. 5 years of infertility experience. The latest SGs are good according to ALL WHO criteria. Body weight deficiency. Stimulation was carried out for 8 days with Gonal-F, course - 1200 IU, 3 days of cetrotide at 0.25 from the 6th day of stimulation, 250 µg of ovitrel as a trigger. TVP, 36 oocytes were obtained from 40 follicles. oocytes 27m2, fertilization 27 2pn, fragmentation 2 days 13-4a, 8-2a. On the 4th day the data is the same. Conclusion: arrest in the development of all embryos at the stage of 2-4 blastomeres. It’s not clear why, but when asked about the condition of the embryos on days 2, 3, 4, they told me that the database had not been updated... And when we came for the transfer on the 5th day, we were stunned. If everything was known, why didn’t they say... No one can understand what happened. They said that this was their first time. Although there are quite a lot of patients there and the ART department has a lot of experience. They assumed that it was a YAK problem and so on. since you have to go with DY. Is it really impossible to do anything, to investigate? Is it possible that the quality of Yak "suffered" due to the stimulation and development of a large number of follicles at the same time? my EC lasts 32 days with ovulation on days 16-17, and here everything ripened so quickly... In the family on both sides, no one had problems with childbirth and pregnancy, there was no fading B, Gen. There were no deviations in the family either. What's wrong with us?

Embryologist: Yulia Aleksandrovna Shtyrya

Stopping embryos from developing at such an early stage requires additional research. The quality of eggs can suffer from a lack of body weight, also from the type of stimulation, I would recommend next time to carry out a softer stimulation with a change in drugs in order to get no more than 10 oocytes. In this case, it is better to carry out a protocol with cancellation of the transfer; in your case, a lot of oocytes were obtained. You can also run a natural cycle protocol to assess the quality of your cell without stimulation. You can also conduct a study of the karyotypes of you and your spouse, if you have not done this already, in order to exclude genetic factors that could lead to a similar situation. Considering your and your husband’s age and clearly good ovarian reserve, I would wait to enter the program with DU until you have tried all the available options with your oocytes. Good luck to you.

Hello, I have 1 cryostraw with 4 embryos in storage - morulae (M, M3, rm, rm). Please comment on the quality of the embryos? What are the chances that defrosting will be successful and pregnancy will occur? After defrosting, will the morulae already be blastocysts?

Embryologist: Yulia Aleksandrovna Shtyrya

Judging by the classification, you have frozen fairly good embryos, with a high chance of defrosting. In your case, I would recommend thawing the embryos one day before transfer. That is, we defrost the embryos on the 4th day, cultivate them for up to 5 days, transfer those that have become blastocysts, if we get more than 2 blastocysts, then we freeze the remaining ones again. Good luck to you!

Good afternoon. This is the situation. I was preparing for eco. After another ultrasound, the doctor suggested a donor egg. because I had only 2 follicles. I had 4 donor eggs ready for the puncture. After the puncture, the doctor dumbfounded me. She said that she took 5 from me! And the donor ones defrosted and fertilized perfectly! As a result, I had 9 embryos that day. As a result, I was sent home for 5 days. Before replanting. I was preparing for cryo. Arriving for the transplant, the doctor stunned me again - she said that only two of them survived to day 5, and mine! And everyone else stopped on day 3! I asked the embryologist why this happened? She refers to her husband's poor quality sperm. Although she said that ICSI was with DYATS, and with hers it was just IVF. Question: it turns out that the DYATS were of poor quality? And that mine were stronger than eggs? Or is there really a pathology in the husband’s sperm? The doctor suggested a sperm donor. But I still don’t understand, why not get him checked by a urologist? Why both donor and sperm? This is our 5th attempt at IVF. Thanks in advance for your answer.

Embryologist: Yulia Aleksandrovna Shtyrya

Predicting the outcome of the embryological stage, even when using donor gametes, is often very difficult. Stopping the development of embryos on the 3rd day indicates the presence of male factor infertility, so given the number of IVF attempts you have, it is advisable to have your husband thoroughly examined by an andrologist before the next protocol, and based on the examination results, make a decision on the use of donor gametes.

Good evening! Please tell me, they did an egg puncture, within 3 days 5 embryos were fertilized, on the 4th day only one reached the morula stage, and on the 5th day there was an embryo transfer and this one remained at the morula stage without becoming a blastocyst. It was transferred to the uterus. Please tell me there is a chance of pregnancy and further development? Thank you very much in advance for your answer.

Good afternoon. Please tell me about the situation. I am 32, my husband is 33. Both have primary infertility. There were two IVF + ICSI protocols. In the first, 8 eggs were taken, 6 were fertilized, only 2 of poor quality survived until day 5. There was no implantation. In the second protocol, they took 5 cells, 4 were fertilized, and again two made it to day 5, but the quality was already better - one was a solid C, the second would have become good by the evening. In the second protocol, implantation occurred, but the hCG grew very slowly and at 11 dpp was only 51. What is the reason for the pregnancy to fail at such an early stage? What additional examination is necessary?

The most common cause of pregnancy failure in the early stages is genetic abnormalities, but changes in the body induced by stimulation of superovulation cannot be ruled out. Poor quality of embryos can be associated either with poor quality of germ cells (for example, it is known that the quality of embryos drops sharply if a woman smokes), with stimulation (it happens that in natural cycles the embryos of a given woman develop normally, but in stimulated cycles they go into fragmentation) or with poor embryology performance. It is impossible to understand from the information provided which of this applies to you.

Hello. We did eco+ixi+pgd. The result was 3 healthy blastacysts. Two cryoprotocols did not produce results. Getting ready for the third. The weakest embryo of class 2BB remained. Please tell me what are the chances?

Embryologist: Troshina Tatyana Gennadievna

Blastocyst 2 bb is a good quality embryo, the chances are high. However, if you have already transferred euploid (genetically normal) embryos of good quality and pregnancy has not occurred, it can be assumed that there are some factors preventing implantation. In this case, you need to conduct additional research to understand the reason for the failures, remove it, and then make the transfer.

Tell me, is it possible to get pregnant with this NPC analysis? ??+ 1. NPC 2-4% Not calculated (per 900 points of view 136 NPC) 2. In preleptotene-zygotene 0.66 +/- 0.16% 2.3 3. In pachytene 0.45 +/- 0.10% 0.7 4. In diplotene 1.11 +/- 0.26% 0 5. In diakinesis, MI, MII 0.04 +/- 0.02% 0 6. Spermatocytes II + spermatids 91.99 +/- 0.89% 95 7. Undivided spermatids 22.98 +/- 2.65% 5 8. Unidentified. germ cells 5.85 +/- 0.85% 2 9. Epithelial cells - 28 10. Leukocytes - 14

Embryologist: Troshina Tatyana Gennadievna

The only thing that can be said from this analysis is that there is no block 1 of the meiotic division: most cells are at the spermatocyte II and spermatid stage. In order to get pregnant, you need sperm in the ejaculate/testicular biopsy. It is unclear whether they are present in this case.

Good afternoon We are planning an IVF program with genetic testing of embryos using the array CGH method (according to medical indications, transfer of XX embryos is necessary). Please tell me some points: 1. Does your clinic use a biopsy of the trophectoderm of the blastocyst for gene testing? 2. Is the biopsy performed with a laser or mechanically? 3. How long does it take to receive analysis results? 4. Is it possible for an embryologist to try to identify XX spermatozoa, so to speak, by any method? I will be very grateful to you for your speedy response

Embryologist: Yulia Aleksandrovna Shtyrya

1 – The clinic performs a biopsy of embryos on the 3rd or 5th day; in the case of CGH, it is recommended to do it on the 5th day (torfectoderm). 2 – biopsy can be performed either with a laser or mechanically, depending on the specific embryo. 3 – if the analysis is carried out in a cryo cycle, then about a month, it is possible to obtain results more quickly (within a week), depending on the workload of the genetic laboratory. 4 - effective methods for such selection this moment does not exist.

Good afternoon, I have 2 frozen embryos - storage by RNIIAP. Do you see any difficulties in preparing for the transfer of embryos frozen by another embryologist? I want to change the clinic, but I’m afraid this will negatively affect the quality of the embryos.

Embryologist: Chelombitko Oksana Mikhailovna

There is no difficulty in thawing “foreign” embryos - we often receive embryos from other clinics, and usually everything goes well. The only thing you need to know is how the embryos were frozen, and, accordingly, whether we have the media on which your embryos need to be thawed. The main difficulty in this is transportation. As I understand it, your clinic is located in Rostov-on-Don, right? If you take them to Moscow, it is safer to use the services of a special transport company. Good luck!

Oksana Mikhailovna, hello, I have a few questions for you. I am 39 years old, after stimulation, 17 eggs were taken, 10 of them were mature, all of them were fertilized and lived until the 3rd day (although all of them were mostly of quality B and worse, but not a single one was) 4 survived until the 5th day ( 2 BB, BC and morula). I'm a little confused by the 17/10/4 ratio. On the one hand, I understand that 17/10 mature to immature is a matter of not the most thoughtful stimulation. But these 10/4 are even more offensive; this is a question for the reproductologist and the equipment. The clinic where I did IVF had old single-gas incubators. They make the mixtures themselves according to the protocols of different companies. What I'm interested in is this: 1) what is the average percentage of embryos that survived to day 3 to those that survived to day 5? Do I understand correctly that it’s still not 10/4? 2) Could this be related not to the equipment and incubator, but to the age of 39 years and endometriosis (not ovarian)? 3) if I want to pick up my embryos, bring them to you and do cryopreservation in your clinic, can you defrost them if the embryos were frozen by vitrophication on Kubayama 200? (this is my main question) 4) do I have a chance to transport embryos by train in an open 5 liter thermos with nitrogen if the entire journey from clinic to clinic takes 8 hours? 5) are there any companies with which you can transport biomaterial with which your clinic cooperates? Thank you very much!

Embryologist: Chelombitko Oksana Mikhailovna

I’ll answer your questions... in order: 10 mature cells out of 17 are not a very good result, it’s difficult to name the reasons, since I don’t know the stimulation and the initial hormonal status. But the fact that all mature cells were fertilized and all developed suggests that everything is in order with embryology in your clinic. The peculiarities of cultivation in single-gas incubators do not involve the preparation of mixtures, so this information will have to be taken as misunderstood. According to statistics, a 50% blastocyst yield is considered normal, but your 40% at 39 years old is a good result, that is, everything is in order with the equipment and incubators. We will be able to accept and defrost vitrified embryos; there is a chance to transport them in a five-liter thermos in eight hours, but this is associated with great risk. Our clinic does not provide services for the transportation of biomaterial, but you can contact Reprobank - this center has more than once helped our patients in transporting frozen biomaterial. If you decide to transport your embryos to us, then please call us - we will clarify the necessary documents for accepting the embryos. Good luck!

Good afternoon Please tell me, my husband has aspermia and diabetes mellitus type 1 for 13 years, the sperm is not released at all, it all goes into the bladder. We did Eco+Ixi once in Krasnoyarsk, sperm were removed by puncture of the epididymis. 16 embryos were fertilized and all froze before day 5. There was no transfer. 22% of us were tested for DNA fragmentation, the doctor says there is no point in trying with my husband’s sperm. Now we want to go to Moscow, tell me, is there a chance of getting pregnant from my husband? Maybe some other test can be carried out to select the best sperm? I heard something about Pixie and Imsy. will they help us?

Embryologist: Yulia Aleksandrovna Shtyrya

It is not necessary to immediately go to the program with donor sperm. In my opinion, you have every chance of getting pregnant from your spouse. Firstly, the level of DNA fragmentation is amenable to drug correction. In cases where the therapy is ineffective, it is possible to obtain sperm surgically (but preferably not from the epididymis, but from the testicle itself), and use them to fertilize your cells. Typically, the level of DNA fragmentation in testicular sperm is lower than in the ejaculate, and in general, sperm in the testicle are more intact, the only negative point is their immobility, but embryologists know how to deal with this. In the case of surgical sperm retrieval, IMSI can be used as an additional technique for sperm selection.

Good afternoon Could you please advise me on the following situation? I am 36, my husband is 33. My husband has poor morphology (1% according to Kruger, the spermogram was not done in your clinic). As a result, we decided on IVF in a natural cycle (I really didn’t want stimulation). True, IVF was not done in your clinic. As a result, on the 3rd day after puncture, the result was an 8A embryo without ICSI. It took root, there was a pregnancy, but it froze at 8-9 weeks (all my tests both before pregnancy and during the beginning of pregnancy were normal). What could be the reason for this? Could this be due to morphology? On the other hand, the embryo was good and took root. Or just bad luck? My husband’s karyotype is normal male, although sperm DNA fragmentation is about 30% (although this analysis was done a long time ago, it could have changed). I have been taking tests for the past 3 years (while we are treating my husband) and have never been diagnosed with any abnormalities, either in hormones or anywhere else.

Embryologist: Yulia Aleksandrovna Shtyrya

A low number of morphologically normal sperm does not indicate a reduced fertilizing ability of sperm. That is, if an ugly sperm reaches the egg, it will still be able to fertilize it, and such an embryo can give birth to pregnancy. The male factor of infertility turns on on the 4th day of embryo development, where the main selection with culling occurs. That is, not every beautiful 3-day embryo will produce a beautiful 5-day embryo. Again, even a morphologically imperfect embryo can take root and develop into pregnancy.

Quite often, the cause of pregnancy failure in the early stages is male factor infertility. The cause may also be genetic abnormalities of the embryo, or problems with the endometrium, the blood clotting system, as well as other reasons. A high level of DNA fragmentation can lead to poor quality embryos, and can also be one of the factors in the failure of pregnancy or its failure.

It's a pity that your pregnancy stalled. But its very fact tells us from a diagnostic point of view about several positive points: firstly, your spouse’s sperm is fertile, and secondly, your endometrium is able to accept an embryo. Good luck to you!

Hello. Of my 6 oocytes, only 4 were fertilized. The gynecologist told me to call on the third day and find out what and how. Tell me, isn’t it dangerous to keep such a small number of oocytes until the fifth day? What quality the doctor said she didn’t know.

Embryologist: Chelombitko Oksana Mikhailovna

Cultivation before the fifth day cannot be dangerous, but unsatisfactory results are possible. The decision on prolonged cultivation is made by the embryologist based on the dynamics of development, i.e. quality of embryos. You can successfully grow a blastocyst from one embryo if you need to check the quality of development.

Hello! I had 2 unsuccessful attempts at IVF; in 2 cases weak eggs were taken, which resulted in weak embryos and no pregnancy. I was tested for karyotype 46, xx. Then the question is why when good analysis Is it due to genetics that we get weak eggs?

Reproductologist: Gladkova Marina Dmitrievna

The quality of embryos depends on the initial state of the cells (sperm and egg), on the influence of genetic and immunological factors and the age of the patients. It is believed that women over 35 have “weaker” eggs, i.e. their functional abilities are reduced, and after 40 years significantly. A blood test for karyotype reflects the chromosome set and the likelihood of any chromosomal damage. There are many gene and genomic disorders that cannot always be detected using blood tests. In your case, it is possible to try the IVF program in a natural cycle in order to assess the quality of the egg and embryo without the hormonal influence of drugs. And also undergo some additional examinations that are prescribed when unsuccessful attempts IVF: 1. HLA typing class 2 (an immunogenetic factor characterizing reproductive potential in general) - both spouses; 2. Blood for non-random inactivation of the X chromosome - factor, directly assesses the abilities of the X chromosome - only the spouse; 3. Blood for antibodies to hCG, antisperm antibodies - factors that affect the process of embryo attachment. 4. Assess the quality of the endometrium where embryo implantation occurs - hysteroscopy.

Good afternoon After 2 unsuccessful pregnancies (missed at 7-8 weeks, intrauterine death at 18-19 weeks - no fetal pathology was detected), my husband and I underwent a full examination, except for genetic analysis. Everything is fine with me. and my husband has a bad spermogram. We made EMIS. We have a child, we want a second one. Can I plan to have a child or is treatment necessary? Is it possible that the reason for the interruption is a bad spermogram?

Embryologist: Chelombitko Oksana Mikhailovna

According to the EMIS results, everything is not so bad. The fact is that a man's sperm quality is variable, perhaps it was the best option, and perhaps the worst. To assess sperm quality and prescribe treatment, you need to know the dynamics. You can take two spermograms in one center with a difference of a week (EMIS is no longer necessary). There is no reason yet to blame the male factor for abortions. It’s a pity that there are no results of a genetic analysis of you, your husband and your fetuses; that would be more informative. In addition, the interruption occurred at different dates– the first (7-8 weeks) could be due to genetic abnormalities, judging by early, but the second one is more like problems on the part of the mother’s body. Although there is clearly not enough information and it is very difficult to assume anything specific.

Good afternoon Please help me evaluate the quality of the embryos. (I don’t really understand what the last number means). Thank you in advance.

Embryologist: Chelombitko Oksana Mikhailovna

The quality of embryos in this case can be understood as follows: the number and letter first indicate the number of blastomeres (embryo cells), and the last number is the overall quality rating (from 1 to 4 - from best to worst). The frozen embryos, judging by the records, are all of good quality and correspond to the development period.

Hello! I had an IVF cycle, 5 eggs were taken for puncture (according to the doctor, all were good), 3 were fertilized through ICSI, 2 were transferred three days later and a biochemical pregnancy occurred. One was frozen on the sixth day. When the eggs were collected, two eggs were left to fertilize on their own, but they were told that on the second day they were fertilized incorrectly instead of double ones they became triple ones and it seemed like, according to the doctor, this was some kind of genetic compatibility. I would like to clarify what kind of problem could arise during fertilization. And what tests do you need to take? the doctor says everything is fine. And could a biochemical pregnancy occur due to poor quality embryos? They could not get an answer from the doctor. Thanks in advance for your answer.

Embryologist: Ivakhnenko Viktor Nikolaevich

Hello! Biochemical pregnancies, unfortunately, indicate that the treatment cycle was not successful on the one hand, but the good thing is that hCG (human chorionic gonadotropin) or pregnancy hormone detected in the blood indicates that the implanted embryos were viable for quite a long time. Simply, for some reason, the embryos were unable to attach to the wall of the uterus. There may be several reasons, and your doctor will help you identify them if you have them. The fact of biochemical pregnancy in itself, especially a single one, does not indicate problems with reproduction in general. Typically, when 5 or fewer eggs are obtained, embryologists perform ICSI on all or some of them. In your case, embryologists left 2 eggs for independent fertilization, which showed that the sperm are normal and capable of fertilizing eggs. Incorrect fertilization, as happened in your case, is possible when two sperm simultaneously penetrate the egg, instead of one sperm. Often this occurs due to the incomplete maturity of the resulting egg, and not genetic incompatibility. Despite the fact that your treatment attempt was not successful, it showed positive results - that the ovaries produce viable eggs, that the embryos develop before freezing on day 6, that the implanted embryos developed and produced pregnancy hormone (hCG) . These are all good signs! I'm sure your doctor will take all this into account in your next attempt. Preferably successful!

Good evening! I have several questions: 1. Is it possible, after defrosting 3-day-old embryos, to try to grow them to 5 days before transferring them? 2. Do you think cryo embryos are weaker than “fresh” ones? I read somewhere that embryos that have undergone freezing and thawing become even stronger than fresh ones, so to speak, they undergo another natural selection. 3.Are embryos frozen ONLY of good quality? they won’t be able to survive the freezing, they won’t survive, do I understand correctly?

Embryologist: Yulia Aleksandrovna Shtyrya

When cryopreserving embryos on the 3rd day of development, it is possible to defrost them, followed by cultivation until the 4th or 5th day of development, so that the transfer is carried out at the morula or blastocyst stage. When choosing such a cryotransfer strategy, your attending physician and embryologist must be warned about this in advance, since your doctor must select the appropriate day of the cycle for transfer, and the embryologist must culture the embryos. Since, in general, embryos of excellent and good quality are selected for cryopreservation, the freezing and thawing procedure should not affect their quality. In some situations, embryos of average and poor quality are cryopreserved; it all depends on the specific clinical case; when cryopreserving such embryos, the patient is always warned about the possible bad outcome of thawing this material.

Hello! My husband and I have been married for 6 months, we are planning a child for 8 months. I am 22 years old, my husband is 24. My husband took a spermogram test... conclusion: normospermia. I was diagnosed with a bilateral cyst in 2009 - no surgery was performed. Now there is no cyst. I took a test for the patency of the pipes (the analysis was done using liquid), both pipes were passable. Please tell me what other tests my husband and I can take? How would you advise us to act? Thanks in advance for the advice!

You need to undergo a hormonal examination and, together with your husband, take a blood test for HLA typing of the 2nd class. I also recommend doing folliculometry - this is ultrasound monitoring of the maturation of the dominant follicle in the 1st phase menstrual cycle and signs of ovulation and the presence of the corpus luteum in the 2nd phase of the menstrual cycle.

Hello, Doctor. I have two questions that concern me the most today. 1. The spouse’s MAP test is 90% for IgA (laboratory norm is up to 50%) for IgG - 10% (normal is up to 50%). Is it possible to take it on your own? And if IVF, then is it necessary to use ICSI? (Everything is normal for me) 2. We have a match for two HLAII loci, is it necessary to do LIT for 2 or can it be done? (My husband has a history of hepatitis A as a child)

Embryologist: Yulia Aleksandrovna Shtyrya

To fully answer your question, it is advisable to familiarize yourself with the remaining parameters of the spermogram; it is believed that the IgA MAR test values ​​are more clinically significant than the IgG values. It is impossible to completely exclude the possibility of spontaneous pregnancy, although the chances are quite low. A number of researchers believe it is possible to treat the immunological form of infertility through intrauterine insemination, although the result of similar studies does not show a significant increase in effectiveness compared to the rate of spontaneous pregnancy in couples with a similar diagnosis. The choice of fertilization method in an IVF program depends on a number of reasons; patients with a positive MAR test are recommended to undergo an IVF/ICSI program; if a sufficient number of cells is obtained and normozoospermia, partial fertilization using the IVF + ICSI method is possible, that is, part of the cells will be fertilized using the classical IVF method, and some using ICSI. The opinion of modern medicine regarding the need and effectiveness of LIT therapy for infertility is quite contradictory. Typically, a possible positive effect of this therapy is indicated when 4-5 loci coincide. Our colleague, Boris Aleksandrovich Kamenetsky, has an excellent review “Immunology of implantation and infertility”, which discusses in detail the immunological causes of infertility and approaches to solving them. Hepatitis A is not a chronic infection, unlike hepatitis B and C, however, before starting LIT therapy, if you decide to perform this manipulation, it is advisable to test your husband’s blood for chronic infections and, based on its results, once again assess the risk ratio /benefits of this manipulation.

Reproductologist: Khovrina Elena Alekseevna

The effectiveness of the cryoprotocol depends on the quality of the embryos before freezing, the successful thawing of the embryos, and the woman’s readiness for cryotransfer (gynecological component and somatic health). The pregnancy rate per cryotransfer (during hormone replacement therapy or in a natural cycle) is approximately 50%. When transferring 2 embryos, a twin pregnancy can occur (about 40%). I can’t say for sure how many embryos to transfer for you - I don’t know your medical history, your somatic status. This is something you and your doctor decide together. Wish you luck!

Hello, Oksana Mikhailovna! My husband passed the SG a week ago, here are the results: volume 3 ml; liquefaction period 0.5 (I think 0.5 hours) pH 7.0; milky white with a yellow tint; in 1 ml - 128 million; act-supply of sperm 25pr; low mobility of sperm 40; fixed sperm 35pr; lecit.grains-moderately leukocytes-2-3 in the field of spermiogenesis 15-18 in the field of pathol.forms: heads 25pr, neck 10pr, tail 3-5pr. oscillatory motion - up to 40pr; multiple small agglutinates. The doctor who did the PCT reported the presence of a large number of leukocytes in the cerebral fluid. In other words, “it looks like something like an allergy,” I asked again, could this be a reaction to inflammation? What do you recommend: take additional tests and “try” yourself, curing the cause of the failure, or go for AI?

Embryologist: Chelombitko Oksana Mikhailovna

The reason for the presence of leukocytes must be found - this really might be the case. infection, so you need to take an extended smear, you can do PCR (it’s more sensitive), you can do a culture. The husband's sperm is fertile, the only thing that is alarming is the presence of agglutinates - this can interfere with pregnancy, but it can be cured. My husband needs to take the SG with a MAP test. If your tubes are passable, no infection is detected and sperm agglutination is not catastrophic, then you will have to think about AI with stimulation.

Hello, Doctor! More than 2 years does not occur natural pregnancy. Help me understand the spermogram results... are there any obstacles to pregnancy?..: abstinence period is 3 days. volume - 4 ml, liquefaction after 21 minutes, consistency - viscous, color - gray, pH - 7.4, cloudy, viscosity - 0.1 cm, 1 ml of ejaculate. - 102 ml, immobile sperm - 13%, actively motile sperm - 75%, inactive sperm - 12%, normal sperm - 16% (not less than 14%), agglutination - no, spermine crystals - no, leukocytes - no, erythrocytes - no, macrophages - no, lipoid bodies - moderate.

Doctor, good afternoon. Is pregnancy possible in a natural cycle with the following indicators: - quantity - 6.4 ml - PH reaction - 7.5 - viscosity - 7 mm - quantity in 1 ml - 8 million - mobility - 41 - normokinesis - 37 % - hypokinesis - 7% - akinesis - 59% - number of living - 44% - number of dead - 56% - normal form - 87% alive - pathologist. shape - 13% live - head - 10% - neck - 3% - tail - 0% - leukocytes - 2-3 in the field of view - erythrocytes, Bötcher crystals, spermatogenesis cells, aglutination - absent - lecithin grains, mucus - insignificant amount - in. The movement is rectilinear translational, partially pendulum-like.

Embryologist: Chelombitko Oksana Mikhailovna

SG indicators, of course, are greatly reduced relative to the standards given by WHO for fertile sperm. Based on this SG, we can say that the chances of natural conception small. Is this the only SG? How many days of abstinence were there? You need to try to abstain longer and retake the test, perhaps this will clarify the situation with such a small concentration of sperm.