Quincy and I got our Day 3 report card back yesterday from the lab. Before I go into that, I want to explain a few things the best way I can:
After the retrieval, the eggs are put in an incubator for a few hours before they are checked for maturation. This is where they discovered that out of the 12 retrieved, only 6 of mine were mature…which was kind of a letdown. Immature cells are basically worthless. If they aren’t mature, there is no way they can fertilize.
Once they identify mature eggs, they try to fertilize them by either putting them in a dish with sperm (to allow it to happen “naturally”) or with ICSI, where they literally inject one sperm directly into an egg using a tiny needle. Because of how long we’ve been unable to conceive, and not really knowing the reason why, Quincy and I had all of our eggs undergo ICSI, and it went as well as could be expected – all six eggs fertilized.
Once they are fertilized, these newly-created embryos are placed back in the incubator to, well, incubate. To start growing, multiplying, and developing into a blastocyst; which is a clump of 100+ cells, then eventually a fetus, and finally, a baby. They are left alone to do their thing and are checked again on Day 3.
Here’s where stuff really starts happening.
Embryoss are graded during their first several days incubating. The grading is based on the number of cells that make up the embryo, the amount of fragmentation seen, and the symmetry of each cell. They are each assigned a number and a letter grade.
The number grade is easy – it represents the exact number of cells that make up the embryo. On Day 3, an embryo should consist of between six and ten cells. The “ideal” embryo is an eight-cell, whereas any embryos with six cells are fewer are far less likely to continue to develop. Exactly six-celled embryos are borderline – they may or may not continue to develop, but an embryo with fewer than six cells usually start deteriorating as the other ones thrive.
So, on to the letter grade. Embryos are given a letter grade just like in school – A, B, C, etc. As are the best, Bs are okay, and Cs are mediocre. No one wants a C or lower.
Grades are based on fragmentation and symmetry. Symmetry is easy – it’s how close the cells are in size. The closer they are – the more symmetrical – the better. Cells that vary greatly in size are a bad thing and are rated lower; it implies defects.
Fragmentation is a little tricky and super scientific. From what I understand, when the cells are dividing, sometimes little chunks of cytoplasm break off and create little globs that aren’t cells – they contain no nuclei – but they are floating around in there. Also, any fragmentation takes cytoplasm away from the actual cells, which isn’t good. That genetic material has been taken away from the actual cells – they are now missing that information. Embryos with high rates of fragmentation rarely develop into blastocysts.
So. That’s the long and short of it. Now we understand what the following numbers mean.
We had six eggs fertilize. On Day 3, they were graded as follows:
8-cell, grade B
6-cell, grade B
6-cell, grade C
6-cell, grade C
4-cell, grade C
4-cell, grade C
So, yeah. Obviously not ideal. Dr. Landay says that the four-cell, grade C embryos are done. They will never survive. That leaves four. The six-cell, grade C embryos are iffy. They could improve…or not. We’ll just have to wait and see.
We won’t know for a couple of days. The six-cell and eight-cell grade Bs…those are promising. The eight-cell one is ideal, the six-cell is more of a “looks good, but we’ll have to see” scenario than anything else.
I think this is actually worse than your average two week wait. They’re right there. They’ve been fertilized. If they were inside my body right now, they’d be preparing for implantation. I’d technically be pregnant.
But they’re not. And if this had occurred inside my body and not in a lab…two would have already died, even before trying to implant. Now I have to wait until tomorrow for our Day 5 report, just to see if any have survived to be biopsied for defects/chromosomal abnormalities. Then, after that, the REAL two-week-wait begins. We won’t know the status of any biopsied, frozen embryos for another two weeks.
So, we’ll have a good Thanksgiving…or we won’t.
My Stork Got Lost 