As couples go through their marital journey, some may undergo diagnosis of infertility and they need to attempt pregnancy using In-vitro fertilization (IVF). The process usually starts with meeting their physician and beginning the first step of the process that includes preparation, stimulation, and monitoring along with their doctors and nurses. The actual functioning of the IVF laboratory framework can be unfathomable.
The specialist who mixes the sperm and egg which helps the developing embryos to grow in a regulated environment is called an embryologist. Most clinics limit one’s access to their laboratory or embryologists. Seldom a patient would receive embryology observations until a failed attempt or cycle but often times the information is revealed by the clinician. This is so because although embryology insights can be very diagnostic, they are best made clear by a clinician as they are well-educated in general to parallel those insights with specific patient demographics.
So even if you are behind the screen, embryologists are still very much a part of your IVF journey. Assent to the fact that each patient/partner combination is so different, but then there are a few insights from an embryologist perspective that every patient should get acquainted with before they arrive at a fertility clinic.
1. Every Embryo is Unique
Every egg, sperm and the emanating mixture are two distinctly different and that’s what makes every attempt at IVF using different gametes a diverse experience. When a typical infertility patient walks through the clinic, they can imagine a grocery store where they could open a container of a dozen eggs and each one looks perfectly same. However, this is not the case with human eggs.
From the eyes of an embryologist, each egg looks different but we can’t see the DNA of the “good” eggs as it requires a microscope. Each and every egg is aspirated from a different follicle. Vaginal ultrasounds can signify or illustrate how many follicles are growing and how much the measuring sizes are each day when medications are delivered into the body at standardized doses. Get it right that all the follicles differ in size amid the process and some can measure at 14mm while others might be 19mm. The follicular measurements can correspond to healthy follicular environments, chemical communication, and egg health, in a way that we still cannot completely comprehend.
There is a bracket of ideal follicular size, but that ideal varies for each human (just like body temperature). Not every egg supposedly makes a baby as in every sperm will not fertilize an egg. If you draw the same variables, you can make out that every embryo is very different. Why some eggs do not fertilize, some embryos do not grow or turn into a blastula, why some don’t freeze well or survive the thaw, are just signs that there is probably something defective about them we don’t make sense of yet.
2. Embryologists can’t rectify eggs
Embryologists would care and nurture your gametes, but could not repair or make a new embryo. Eggs are made when the female is in uterus around 18-20 weeks incubation period. Therefore, eggs have the same biological age of a woman. There is proof that the follicular environment and the health of the gamete provider during the stimulation process can influence an outcome. Additionally, having a normal body mass index (BMI), non-smoking, limiting alcohol intake and avoiding narcotics have all been proven propitious to the success of IVF.
On the contrary, most men make sperm daily which on an average are only 3 months old. Their daily health and lifestyle choices can affect ejaculation 60 to 90 days later. Having your clinician would tone up you and your partner’s health a few months before the attempt that might give you and your partner time to optimize your emotional, physical and financial health. Watch out for internet stratagems/advice about how these supplements or lifestyle adjustments can improve your fertility and do remember to ask those questions to your medical provider.
3. Everyone’s IVF journey and outcome are not the same
In this process, it is natural to seek comfort and support by reaching out and comparing yourself to others. It can feel reassuring when the other person’s story is akin to yours and ends up with family expansion. It is important to chew over the fact that everyone’s IVF journey and outcomes are different. Because of this, contrasting and comparing your experience to that of others may not truly be as beneficial as it may seem on the surface. Going through IVF is not only emotional and painful but patients may find themselves with overwhelming stress or challenging relationships and hence it’s important to enhearten patients to reach out to professionals like fertility coaches or counselors. Ultimately, picking up someone you trust is the key.
You and your partner may be affected by each other’s decision or process these changes differently, but try and remember that his/her path and place is just as legitimate as yours. Communication is the key during these testing times.
4. There are no magic numbers that will assure success
As clinicians, we get many calls from patients who are distressed that they did not have the same outcome as another patient or as per their expectations. This could stem from semen analysis which results to the number of eggs retrieved during an IVF cycle or egg aspiration. Your clinician will give you pointers whether your result is unexpected or is it clinically significant. The online forums are inundated with data on the number of eggs retrieved, embryos been created, and embryo grading scores. Keep in mind that there are no magic numbers that dictate success. Embryo culture is a framework which is designed for an embryologist to collect information about each individual embryo’s growth pattern and quality in order to efficiently evaluate embryos for implantation potential. We pick the best of embryos you have. There are no indicators that can fortify 100% success. It’s paradoxically true to have seen patients who have beautiful grade A embryos not get pregnant and embryos that were grade C make beautiful twins.
Every clinic has a different grading system to grade embryos in their clinic. Asking the clinic to explain their grading system to you will help your personal understanding of the technicalities and level you up to speak the same language. Sometimes embryo implantation in the endometrium does not develop successfully. This failure can occur for different reasons. A particularly important factor is endometrial receptivity. The endometrium is receptive when it is ready for embryo implantation to occur. This period of receptivity is called the window of implantation. Endometrial Receptivity Array(ERA) is a diagnostic method where a biopsy is quickly and easily taken by gynecologists which are sent to a lab and computational predictor analyzes the data obtained, classifying the endometrium as Receptive or Unreceptive.That being said, if only you produce grade C embryos and experience failure in your first attempt, that information might guide your clinician to suggest that your physical, emotional, or financial investment in another attempt may be better invested in donor gametes or a substitute path for family expansion.
Know that your IVF journey is unique and while it is always good to be informed, don’t mistake reliable information in terms of contrasting and comparing your experience against the experiences of others. The goal of IVF is one healthy baby, and your embryologist is also a major part of the team effort in making this happen.