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02.03.2015


At Arizona Center for Fertility Studies, all embryology laboratory equipment, incubators and ancillary Assisted Reproductive Technology (ART) equipment has back-up electrical power in case of a power outage. Fertilization occurs in 4-6 hours in humans but there are no visible signs until approximately 17-18 hours later.
There’s another interesting feature of blastocysts and that is their ability to expand- and contract.
In the picture below, you can see another photograph of a blastocyst in the middle of hatching, half in and half out of its shell. What does all this embryo progression, embryo scoring and achieving blastocyst stage mean for a person’s chance of pregnancy? The bottom line is that even with all embryo characteristics that have been proposed as predictors of implantation and pregnancy, there is not yet one test which accurately predicts which embryos will develop into babies.
Symptoms after ivf embryo transfer - invia fertility, The symptoms women often experience in the first two weeks after ivf embryo transfer can be hard to deal with.
Pregnancy: pregnancy week by week calendar, symptoms, Pregnancy week to week pregnancy week to week is the one source you will need to learn about every stage of pregnancy, as well as other pregnancy and child bearing. If you can't get pregnant, IVF is usually the next port of call - but there are alternatives, as Paula Goodyer discovers.
Interest is growing in the benefits of traditional Chinese medicine - herbs and acupuncture. It was 2005, and after nine months of IVF treatment and a positive pregnancy test, 36-year-old Jill King was having a routine ultrasound to check that all was well.
Some cases of unexplained fertility may have a cause that is overlooked if IVF is used as a first, rather than a last, resort, says Dr Anne Clark, medical director of Fertility First, a clinic in Sydney's Hurstville.
It would be helpful if we can hear from everyone who used alternative tharapies that did not work. I had various methods of fertility treatment for more than 10 years and was unable to conceive. Before going to the Naturopath I was very negative towards alternative therapies and medicines, now I am convinced that in certain circumstances they are an option definately worth exploring. Embryo transfer is a simple procedure that follows in vitro fertilization (ivf) and is often considered the simplest and final step of the in vitro fertilization process.. Symptoms after embryo transfer can be either because of pregnancy or because of the hormonal load to which the patient has been subjected. The first signs that fertilization have occurred visibly in the development of two round bodies in the center of the egg.
It is not designed or intended as a substitute for personal evaluation by a physician; nor should this information be used to diagnose disease, illness, or other health problems, or to develop an independent course of therapy. This stage is brief, lasting only a few hours and occurring approximately 16-18 hours after insemination.
If the 2PN stage zygote looks like the egg swallowed two chocolate chip cookies, then the tiny spots within each cookie that look like chocolate chips are the nucleoli.
When the fertilized egg divides for the first time and forms two cells, it has entered the cleavage stage of development. Embryologists have long looked for characteristics at this stage which will identify which embryos will go the distance. The morula stage is characterized by a transformation from a loosely associated group of cells to tightly connected cells that are acting more like a tissue.
Reaching the blastocyst stage of development is considered a very favorable sign for implantation and pregnancy. Interestingly, one study using time lapse photography of collapsing and re-expanding blastocysts found a connection between the frequency of collapse and the size of collapsing blastocysts and an increasing frequency of monozygotic or identical twins from IVF. The photo to the right shows an empty zona and four fully expanded blastocysts in various stages of hatching.
I am hopeful that a combination of existing evaluation methods and future analytical tests will one day identify those embryos that will produce a healthy pregnancy and child.
But when she turned to the screen, expecting to see a heartbeat, there was just an empty embryonic sac. Being overweight, smoking or drinking too much - even a lack of vitamin D or iodine - can sabotage conception or increase the risk of miscarriage, points out Clark. At the urging of a work colleague and my husband, I very reluctantly visited a Naturopath in Bondi who specialised in fertility treatments. If any images that appear on the website are in violation of copyright law and do not agree with it being shown here, please contact us and We will remove the offending information as soon as possible.
One of the commonest questions patients ask me is - " doctor, what are the dos and don'ts after the embryo transfer ? The slightly smaller body is the female pronucleus and contains 23 chromosomes that the egg contributes to the embryo; the other round body is the male pronucleus and contains the contribution of 23 chromosomes from the sperm. Robert Shabanowitz from Geisinger Medical Center for their generous permission to use their embryo images in this blog.
Seeing more than 2PN (say 3, 4, 6PN or more) are all abnormal numbers of pronuclei which can not be corrected and result in an abnormal embryo which may fail to develop further.


Characteristics that are favored by embryologists include same sized cells with little or no fragmentation. The process by which cells change from loose association to tight association is called compaction.
The absence of an ICM means game over for the embryo since these cells have died off within the blastocyst.
With time, the blastocyst will re-pump the fluid and “re-expand”.  A “compacted” blastocyst is likely a transient condition in which the fully pumped up blastocyst has “deflated’. Researcher Dianna Payne described her theory that the frequent collapse was a sign of local areas of cell death. You can see a bubble of cells sticking out (hatching) out of the left side of the top left embryo.
Evaluation or scoring based on appearance of  the fertilized egg, cleavage stage or blastocyst stage embryos have all been proposed by embryologists to determine which embryos have pregnancy potential and which don’t.  Some clinics have done retrospective studies of embryo progression- a functional test.
In a cruel biological hoax, the sac minus its embryo - called a blighted ovum - was causing positive signs of pregnancy.
While the clinic offers IVF treatment, 25 to 30 per cent of couples conceive without it after correcting certain lifestyle factors.
I had completely given up any hope of falling pregnant and felt it was the biggest waste of time. It is critical that the egg is checked at this point in time for fertilization, because over the next 6 hours or so, the two pronuclei come together in a process known as syngamy, where the two pronuclei join chromosomes, forming one nucleus of 46 chromosomes. What embryologists look for are two well-defined transient structures called pronuclei in the center of the fertilized egg.  In the picture below, the PN look like two chocolate chip cookies inside the egg. The four cleavage stage embryos in the picture at the right are a good example of nice cleavage stage embryos on day 3, when the embryo is expected to have cleaved into at least 8 cells. A compacted morula is a group of cells (usually around 30) which have squeezed together inside the zona. It is unusual for 100% of a patient’s fertilized eggs to get to blastocyst stage but it can happen.
As long as the blastocyst is capable of expansion, this temporary deflation is not a problem.
The frequent collapses allowed embryonic cells to move and relocate to a second site within the blastocyst, setting up two ICMs that could lead to identical twins. Directly below this embryo, you can see an embryo that is completely free of its shell and its empty shell or zona pellucida has floated to the top of the photo. Notice how thin and small the zona looks relative to the first photo of the fertilized egg. The embryo progression of sibling embryos was compared from patients who got pregnant to patients who did not get pregnant after day 3 transfer.  Did these sibling embryos stall out or progress to blastocyst stage? To my absolute surprise I was pregnant after just one visit and now have two beautiful boys. Also please could you explain the terms “cleaved”, “compacted”, “non-expanded” blastocysts and possibly give some percentages as to the chance of pregnancy when, e.g. These “cookies” contain the male and female DNA and for normal fertilization, there should be exactly two pronuclei or as embryologists like to shorthand, “2PN”. Embryologists need to identify these abnormally fertilized eggs and remove them from the viable embryo pool. Embryologists talk about expanded blastocysts, non-expanded blastocysts and hatching blastocysts- all stages in the continuum of blastocyst development. The other troublesome sign is when the blastocysts seems to have a low number of cells, suggesting that the transformation program began before cell division was completed, leaving the embryo with an inadequate cell base for development. In fact, prior to vitrification, many programs routinely deflate their blastocysts to optimize the vitrification procedure. Excessive cycles of  collapse and reexpansion could kill the blastocyst if it becomes unable to expand.
If you look closely, you will notice that the edges of this hatched embryo is irregular and not shiny like those of the blastocysts that are still enclosed by the zona. Some of the newer culture mediums are better designed to allow the natural thinning of the zona in preparation for hatching, making assisted hatching procedures to artificially open a hole in the zona largely unnecessary except for cases in which embryo biopsy is required. Generally speaking, patients whose excess embryos went to blastocyst stage were more likely to get pregnant than those patients whose remaining embryos did not progress to blastocyst stage. By the time she discontinued IVF two years later, King had produced 50 embryos, but no babies, at a cost of about $50,000. In the picture on the right, you can see a little fragmentation between the morula and zona pellucida (the shell) but not too much. By the blastocyst stage, the embryo has reached 50-150 cells and is starting to strain at the confines of the zona pellucida.
The blastocyst stage typically occurs on day 5 of culture and we would see hatching early on day five, especially if the zona was hatched earlier for embryo biopsy. After freezing and thawing, a sign of recovery is re-inflation or re-expansion of the blastocyst, showing that the embryo is alive and pumping- literally.


In another study, the ability of a blastocyst to reexpand after thawing was used as a predictor of better pregnancy outcomes.
The two smaller blastocysts to the right of the hatched blastocysts are still expanding, note their relatively smaller size. Embryo biopsy (removal of one or more cells) from the embryo for genetic analysis requires that a hole is made in the zona at either the eight cell or blastocyst stage embryo.
So progression is a good functional test of viability and selection of embryos at day 5 of culture is a good tool to identify the embryos that can make it at least that far.
You can watch a great video of development from the fertilized egg to the blastocyst stage on the NIH stem cell website. If the embryo is only two cells on day 3, this is not a good sign and likely indicates the embryo has ceased to grow.
The name morula comes from mulberry (Latin: morum), perhaps because the morula looks somewhat like a mulberry.
This straining is not simply due to cell division but also active pumping of fluid by embryo cells into the inner space of the blastocyst, forming a cavity or blastocoel.
Genetic testing for embryonic abnormalities that prevent pregnancy may be the key to identifying the embryos that make babies but those tests are still under development. A note about “days of culture” related to embryo stages: When I refer to day 3 of culture, day zero of culture is egg retrieval day. Normal embryos have a fairly strict rate of progression which starts at the time of fertilization. Notice that in each picture from fertilized egg to zona, the zona is still about the same size, but the dividing cells within it are getting smaller and smaller with each division. The filling of this space with fluid expands the blastocyst and we call this embryo an expanded blastocyst.
Differences in culture medium or other features between programs may explain why some programs see full expansion and hatching on day 5 and others see this more on day 6.
Testing of embryo metabolism or metabolomics is another promising arena for developing new predictive tools to determine embryo viability.
After three months of using Chinese herbs and acupuncture, King conceived naturally and gave birth to a daughter last year.
Test results showed she had no obvious problem, but Matthew had fragmented DNA in 33 per cent of his sperm.
If the time of fertilization is delayed (for example, if rescue ICSI is used), the start time of the embryo’s progression program is delayed and the embryo may reach the eight cell on day 4, not day 3 of culture since fertilization occurred a day later than expected.  But except for delays in fertilization, progression should follow an expected predictable rate. In our program, we expected to see most if not all the embryos in a patients group of embryos reach this stage on day 5. At Clark's suggestion, he reduced his weekly beer consumption from 24 to seven, stopped drinking Coke and took a daily multivitamin. He also took supplements of coenzyme Q10 and vitamins E and C, antioxidants that, according to some research, help reduce sperm damage.
The expansion of the blastocyst helps thin the zona and eventually helps to rupture the zona and let the blastocysts escape or hatch from the zona pellucida. How can it successfully treat a problem it can't diagnose?" Lyttleton is the first to admit that TCM is no cure-all for infertility, but it can help to normalise hormone levels, thus making ovulation more regular.
In the expanded blastocyst, the embryologist can see the inner cell mass (ICM) within the blastocyst. It also improves the lining of the uterus and helps to prevent endometriosis and polycystic ovary syndrome (common causes of fertility problems in women). The pressure of ageing impels couples towards IVF, too, she says.Francesca Naish, from the Jocelyn Centre for Natural Fertility Management in Sydney, agrees.
The other cells that surround and protect the ICM and line the inner side of the zona pellucida are the trophectoderm cells. Miscarriages can occur because other problems aren't being sorted out first," she says.
When she recommends waiting until the lifestyle changes kick in, some couples feel pretty thrown to begin with. At 39 and after four months on a preconception-care program and a high-dose folate supplement, Piebenga got the go-ahead to try to conceive. East meets WestAcupuncture and IVF might come from opposite sides of the medical fence, but there's growing interest in combining them.
Some studies show an improvement in pregnancy rates if acupuncture is used at embryo transfer, says Jane Lyttleton, a traditional Chinese medicine practitioner who works in partnership with IVF clinics.



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