Would you bet which is the best embryo? IVF part 2

#KnowledgeIsSuccess and when it comes to success rates in In Vitro Fertilization, quality is better than quantity.

Biologist Luis Machorro explains to us how he chooses the best embryo to transplant.

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Embryo assessment

Hello, how are you all, let’s now watch the second part of the videos on everything that has to do with in vitro fertilization and the assisted reproduction laboratory. We already saw from the capture of eggs, we also saw how sperm are trained and we saw in vitro fertilization as it is; the intracytoplasmic sperm injection technique and now we are going to see what happens from the in vitro fertilization and the five-day culture and then transfer to the future mother.

In a previous video, Dr. Monsalve already taught us the development of the embryo up to 9 months, so now we are going to see how this process and this evaluation are carried out from fertilization to day 5 of embryonic development. We must be careful in places where they want to put or transfer 3, 4 embryos that we do not know how they were evaluated day by day. Remember that quality is preferable to quantity, perhaps in other places they think or you are made to think that by placing many embryos you will have a greater probability of getting pregnant, but that is not necessarily the case, we are going to show you here in the video how there are embryos of much better quality than others and that those have a greater chance of generating a pregnancy, than if we put 6 or 7 of others that we do not know their correct evaluation to 1 or 2, for example in this case we are going to see which would be the best, the most suitable, the optimal.

The conventional evaluation of embryos without Primo Vision is approximately every 24 hours, so after ICSI or IVF we have to evaluate fertilization, fertilization as it is, where we have to observe pronuclei, we have to observe certain characteristics that tell us that everything is normal, that does not have three nuclei for example, because we discard those, we know them as triploids and on day 2 for example we can already evaluate the first embryonic division where there would have to be four blastomeres which are the same cells that each embryo that is born has. So it divides exponentially each time: 2, 4, 6, 8 blastomeres. On day 3, for example, we will have 8 blastomeres, on day 4 another process called morula begins, where there is compaction between the blastomeres, they come together and cell differentiation begins for what we know today as a blastocyst. Even on day 5 when we already obtain blastocysts we need to classify them to know which are the best. We have characteristics: Grade 1, grade 2, grade 3 and in this way know which ones are optimal and discard them.

Timelapse Primo Vision

Now in a minute we are going to see what happens practically in five days of embryonic development in this video. What Primo Vision does is capture a photograph every 10 minutes of each of these embryos and gives us the information so that we can visualize a video like this one. For example, here syngamy and the first embryonic division takes place, which would be on day 1, on day 2 we could observe how each of the embryos already have 4 blastomeres.

Each one will also have different aspects such as fragments that are not good and discarding them would also be necessary. On day 3 we will also observe eight blastomeres, which would be more or less half of this entire process, a little ahead, in the day 4 we are going to observe compaction, what we call “Mórula”, which is when the blastomeres begin to come together, as can be observed in several of these embryos, like this one, and later the final phase, which would be the blastocyst.

Here it begins to cavitate and different structures begin to form in the embryo that we call blastocoel, which is this inner part, trophectoderm, which is the part around it, which is several cells together, cohesive, and the internal cell mass, which is this. It is important to know that we have to transfer the best embryo, which for example in my opinion could be this one or this one, that has a good cell mass which indicates that they have a high probability of generating an embryo as is. To the trophectoderm, which is what gives rise to the placenta and therefore suggests that there will be better implantation and that is the importance of the evaluation of all these embryos, for example this one is discarded, discarded, because they do not have a good morphology and they cannot be transferred because they would not generate a pregnancy, so that is what primo vision gives us and it is a very powerful tool that we have at Creafam.

Development report

You as a patient must have the information that is being carried out about this entire in vitro fertilization process and everything that happens day by day until day 5 and transfer, for example, we deliver this video to patients who They come in with this type of time lapse and we also generate a report, which in our case we will send through the doctor who will inform you daily what is happening with your cycle, with your embryos.

Unfortunately, patients have come from other clinics who have informed us that they are not told how the entire process they carry out in in vitro fertilization is going. For example, they take 9 eggs, they have 5 developing and they put 4 for example, but they don’t really inform them with a photograph, also with photographs of the in vitro fertilization protocol and only they remember that they were informed by a call, etc. .. But they don’t have anything more robust that really tells them what happened.

As you can see in this report, the blastocysts that were transferred are marked in green. Actually, that choice, although Primo vision gives you the tool so that you can choose, also has a lot to do with the experience of the embryologist who can choose the best embryo based on what information is being received from a timelapse system. We put these two because they have the best development with respect to the culture time and in addition to their morphological characteristics, that is, they are the most beautiful so to speak and the two that are frozen are because they were a little slower in embryonic division and their morphology, Its shape is not the optimal comparison of the other two either. We can also decide that in red, for example, those embryos were discarded because they do not have the necessary characteristics to be neither vitrified (or frozen) nor transferred, these would have no function, with them you could not carry out a pregnancy.

We will see each other in a third video where we will address specialized studies, genetic studies where we will be able to rule out embryos that may be abnormal, so that we can have genetic information about these embryos and even be able to decide between transferring female or male embryos.

“In other places they may try to convince you that there is no point in supervising embryonic development and that it is best to place as many embryos as possible… But in IVF quality is definitely better than quantity”

Biol. Luis Machorro
Biol. Luis Machorro
IVF and Andrology Laboratory

Vitrification of eggs and embryos at the Mexican Institute of Infertility.

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