How are you, good afternoon. Look, today we want to show you a little about the daily, everyday activity of assisted reproduction treatments here at Creafam. This patient that I am going to transfer now on day 5, in blastocyst, is currently 37 years old but I saw her two years ago with a little spotting and when doing an ultrasound she had an endometrial polyp and it is also a male factor of azoospermia.

Today, after having already done a curettage for the polyp and having corrected the patient’s metabolic syndrome a little, we did a stimulation cycle, we took only 3 oocytes from the patient, that is, she had a low response, but fortunately 2 of them reached blastocyst, right now we are going to show them to you in the operating room, well in the in vitro laboratory so that you can see them and I also want to show you another patient who is a transfer tomorrow, because today they are in morula, there are 2 of the stages that the zygote has to go through once we fertilize the eggs in the laboratory and the zygote is formed on day 1, 2 and 3, which we will later show what the development of those is like in a following cycle, but today I wanted to see about morula so that they could properly identify the morula and then the blastocyst, which is the final stage where we put them and transfer them into the patient.

Once again we are here to show you the embryonic development of the blastocysts, this time we are on day 5 and the morphological parameters will be observed here in the microscope and on the little screen, so we are going to see the embryos. These already have a culture of 5 days and I am going to take the plate to place them in the microscope, the microscope has this part called the stage that is heated, therefore it maintains the temperature at the 37 degrees that the blastocytes need.

We are going to move here through the drops to focus on it and we are also going to take a photograph, a photograph of them so that the patients can see them. This is our first blastocyst that does not have suitable characteristics to be transferred, however, we have 2 more – Why? What didn’t you like about that one? It has morphological characteristics here that tend towards what cannot be a pregnancy, for example, the trophectoderm of this part here is not well defined and does not have a cell mass, so it is not a candidate for embryo transfer.

Here, next to this embryo, I have another drop with another blastocyst that is on day 5, which, this one, is perfectly suitable for transfer. Comes out? Unlike the previous one, the trophectoderm is well defined, the cell mass is also well defined, so let’s see what is left here. What is this other one, anyway, this one is perfectly acceptable, it is optimal for transfer, the morphological characteristics it has are adequate. This is “grade A” so, grade A means that it is the best embryo we have, it has adequate internal cell mass, it also has adequate trophectoderm and is ready to be transferred.

Now we are going to see the embryonic development of another patient, she is on day 4, that is, it is already happening… It is a day before the formation of blastocyst and we are going to see these. Likewise, as we can see, the morula is already forming, it has a small vacuole there but that is perfectly normal and what happens here is that all the blastomeres begin to come together to make the blastocyst.

Then we are going to visualize the following, for example; Here we can see how there is a separation which is not a good prognosis because it also has vacuoles, so we are going to discard the embryos that are not suitable.

– Do you also have to?

It has vacuoles, they are particles, well they are organelles, they are part of the cell that is taking out, it is trying to balance the embryo. So, that means that it has a little trouble regulating itself… But it’s normal too, this for example is another morula that is even starting to make the blastocyst a little bit, it still has vacuoles, it is trying to regulate its metabolism but it is very Well, then I’m going to save them so as not to manipulate them so much, but that’s essentially it.

The new system that we are using called ERICA is an Artificial Intelligence system based on an algorithm that will allow us to select or have a better prediction that that embryo, if pregnancy is achieved, will have a greater probability of May he be healthy. What this program does is that it is going to give us a report, if you notice, here is the report.

What does this report tell us? According to the photographs of the embryos, it evaluates them based on this intelligence algorithm and will give us a predictive number, for example, if you notice, we have A, B, C.

The embryo most likely to have fewer aneuploidies that we could translate into genetic abnormalities has “1.” One is as if it were a species of 10, that is, it has a high probability of being healthy. We have another one that is the B that is also at “1” that is rated as if it were a 10 and maybe one that is not as close to a 10 but we can give a 6 to a 7 that has “0.55”, which has a In relation to what we were talking about in there, which means that those embryos that were observed, if both are transferred, then we have a greater probability of a healthy child or newborn.

Very good, we are going to transfer the blastocysts that I mentioned just now, we must remember how Luis mentioned it just now in the laboratory, the Garner criteria are criteria that are used to evaluate the embryo or blastocyst that is based on giving it grades. to the trophectoderm and the internal cell mass, but in addition, we are using a new assessment system which is an “Embryonic Ranking” called ERICA. This is artificial intelligence where all the images are sent and ERICA gives you more than 20 parameters to give you a euploidy assessment, which means that it will give a possibility of whether those embryos are chromosomally healthy and obviously if they are optimal for transfer.

This patient, we start a transfer on day 1 or 2 of her period, it takes 10 days to inject, two or three checks are done, then she comes on day 12 or twelfth, the aspiration is done and then 5 days later they are introduced, what is what we are going to do right now. We already enter, we always do an ultrasonographic control to be able to see where we are located. Ok, we changed the cannula because this cannula is a little more rigid, see it has a metal guide, this helps us to be able to manipulate at the tip to be able to better enter the cervical canal.

In this other cannula, this is the cook, it is very soft. Both are atraumatic, that is, the tip is blunt, so they do not hurt the passage of the cervical canal. This has a great advantage, I already entered, see there is the little tip, I am going to point it with the arrow, you can see the tip of the cannula, so right now what we are going to do is: We take out the metal guide and we are left with only the splint and we go to load the embryos into a cannula called “Type 4.” Perfect, we are already in there with the cannula, right now what we are going to do is put the blastocysts, we will pass the cannula to Fernanda, she is going to take it and see, then Here we have this image that we call “the flush” but it is really the bubble of culture medium that accompanies the blastocysts, it is in the distal part of the uterus, obviously this patient does not have that much bladder, this here and that is why Sometimes it is difficult but the cannula was Type 1, that is, it was easy, the entire visualization of the bubble was visible.

Fernanda checks inside there in the stereoscope, in the laminar flow hood to see if neither of the two blastocysts were trapped in the cannula, obviously from now on we finish, let’s say the in vitro treatment and in 10 days the patient gives indications for a quantitative blood beta hCG. She has a probability of approximately 65 percent of pregnancy rate, because she is 37 years old and 2 blasts were placed, one very good and one good. All good. Perfect, we’re done, good luck.