How do you know that Dominion Fertility’s IVF lab is A+?
One of the most important keys to success in any IVF cycle is the work that happens in the lab following the egg collection and fertilization. We are fortunate to have an outstanding IVF lab that contributes to our high success rates including a stunning 41 positive pregnancy tests in 49 frozen-thawed embryo transfers (FET) in January, 2019.
Day 0: Egg Collection and Fertilization
Day 0 is the day of the egg collection. The actual egg retrieval procedure is done under light sedation in our Arlington office. In Natural Cycle IVF the vast majority of cycles result in just one mature follicle containing a mature egg. In stimulated IVF, we use fertility injections to stimulate extra follicles, usually end up with 10-18 eggs. Some women produce very few follicles [decreased ovarian reserve] and others produce many follicles [PCOS patients]).
The eggs are fertilized on day 0. In most of our IVF cycles this is accomplished by injecting a single sperm into each egg using a thin glass needle. This process is called Intracytoplasmic Sperm Injection or ICSI, a safe procedure first described in 1998.
Day 1: Fertilization Check
On day 1, our excellent team of embryologists examines every egg retrieved the previous day to check for fertilization. Eggs that fertilize normally will possess 2 distinct circles located within the interior of the egg…one of these is the genetic material (pronucleus or PN) from the egg and the other pronucleus is from the sperm. We call this normally fertilized egg a 2 PN egg.
Day 2 and 3: Cleavage Stage
The fertilized egg then starts dividing. By day 2 it is 4 cells and by day 3 it is 6-10 cells (see 8 cell embryo below).
Day 5 and 6: Blastocyst Stage
By day 5 the embryo should now consist of hundreds of cells organized into a hollow ball or blastocyst. The outer rim of cells are called the trophectoderm and these will ultimately become the placenta while the inner cell mass cells will become the fetus.
Not all day 3 embryos will grow to a blastocyst. In general, about 50% do reach the blastocyst stage.
Fresh or Frozen Embryo Transfer – Which is Best?
Here are some points to consider.
1. All PGT-A cycles are freeze all cycles. Patients electing to have PGT-A to check their embryos for aneuploidy need to defer a fresh transfer since the PGT-A results are not available until about a week after the embryo biopsy that is performed on Day 5 or Day 6 of either a Stimulated IVF or a Natural Cycle IVF.
2. All stimulated IVF cycles at Dominion are freeze all cycles. Stimulated IVF results in an endometrium (uterine lining) that may be less than ideal because of the high estrogen levels and the significant drop in estrogen levels that occurs following an egg collection. This drop in estrogen can be especially profound in stimulated IVF using Lupron trigger.
3. Almost all Natural Cycle IVF treatments end with a fresh ET. Natural Cycle IVF is often performed without any PGT-A and without any hormone stimulation (it is performed in a woman’s natural cycle, hence the name Natural Cycle IVF). For most NC IVF cycles, a fresh ET is performed.
Fresh ET: How do we decide Day 3 vs Day 5 transfer
For our stimulated IVF patients, we always grow the embryos to day 5. With our Natural Cycle IVF program, the first embryo transfer is on day 3. If pregnancy does not occur, the next Natural Cycle IVF transfer is performed on day 5. . Natural Cycle IVF allows us to track the egg all the way to a baby and this has allowed us as a clinic to offer some unique insight into fertilization and development that few other clinics possess. For example, most clinics discard eggs that do not show definitive signs of fertilization on day 1. In our NC IVF program we have seen these eggs with uncertain fertilization grow to blastocyst and result in healthy babies.
At Dominion Fertility we are focused on helping our patients attain a successful outcome and we remain innovative and flexible providing the widest range of treatment options.
John David Gordon MD