Had my last ultrasound/labs of this first IVF cycle this morning. Pleasant trip to the clinic. Everyone there is so nice, 3 pokes for blood this time and some discussion on how we are going to get a good vein for my IV on Sat. Do pushups she told me, I'm like ummm ok lol. Hopefully one will cooperate or we'll have to do some shots I guess to keep me under and comfortable during the retrieval.

I've been praying during these past two weeks about having 20 follicles. Things started out so slow last week we where thankful when the Dr. said there was 5-7, then things progressed this Tues to 11 and today the Dr. said to me guess what you got around 20 good size mature follicles. My jaw dropped, I was like really 20, wow. I was thankful for what we had the 11 and then God blessed us now with 20. He was listening :)

703.4 was my estrogen a little down but I'll start supplements on Sat. for it. 3.30 progesterone

Follicles Sizes: 18.38, 17.8, 17.11, 16.62, 16.43, 16.38, 16.24, 15.39, 15.24, 13.2, 12.52, 11.98, 11.74, 11.74, 10.74, 10.09 and 19.69, 19.04, 18.58, 16.3, 16.2, 15.21, 15.18, 12.9, 12.6, 11.55

Will be doing my trigger shot of Ovidrel at 10:30pm tonight. Felt weird like here we go when I did the trigger.

Friday I get a break no pills, no shots, YAY!.

Egg retrieval is on Sat. (no food/drink after midnight on Fri.) got to be there at 8:45am. to prep and then procedure should be around 9:30am. Will be around 30min for retrieval, I get to have both Dr.'s for it as the IVF nurse is out so one will do my IV and the other the procedure.Then 60 to 90min of recovery and we go home. I am sure I'll be napping and taking it easy rest of the day and of course drinking lots of Gatorade.

Next step is for those eggs to fertilize. Before we leave Sat. they will let us know how many eggs they got. We are doing ICSI so our fertilization rates will hopefully be great. The lab will call us Sunday with how many fertilized over night. Sunday is considered Day 1 (see my explanation of how that all works in another of my previous posts) If we have 8 or more good looking embryo's growing we can wait to Day 5 transfer otherwise they may suggest a Day 3.

About 48hrs after fertilization our embryo's will be given a grade which determines their quality and if they will be viable. Most of the egg quality is determined by the chromosomal and genetic competence of the individual egg. By getting numerous eggs, we have a better chance of having one or more with "high egg quality" - in other words, an egg that is fully competent and capable of fertilizing, developing normally, implanting and going on to become a healthy baby.

What is embryo grading?

The quality of the embryo, or fertilized egg, is one of a number of important components in the success of an in vitro fertilization (IVF) pregnancy. There are several types of information used to evaluate the health of embryos, including the number of cells present and the grade, or quality of the embryo. Assigning a grade is one way to identify the best quality embryos for the selection of embryo transfer during an IVF procedure. Using this information, determinations are made about how many embryos to transfer, how many to freeze, and what to do with embryos that are not developing well.

Between 16 and 18 hours after the eggs and sperm are placed together it can be determined whether or not fertilization has occurred. The embryo is then allowed to develop for another 24 to 36 hours. Forty-eight hours after fertilization, the clinician evaluates the size and number of the divided cells, as well as the degree of fragmentation, which is a process in which portions of the embryo's cells have broken off. It is preferable to have little or no fragmentation; the more fragmentation seen, the poorer the embryo quality. Also evaluated is the thickness of the shell surrounding the embryo, and the number of nuclei per cell. These, along with other indicators, help to determine the viability of the embryo.

What is the system for embryo grading?

Selection criteria or grading systems must be applied for all stages of embryo developed from days two through four in order for the most viable embryos to be selected for transfer. Embryo development is evaluated approximately every 24 hours. Embryos are graded, or evaluated, by their appearance under the microscope for the number of cells, the characteristic of cells and the presence or absence of fragmentation.

Good quality embryos divide rapidly, have equal number of cells with clear cytoplasm, and have only few fragments. Some IVF clinics classify the embryos into grades one through four. Grade 1 includes the best quality embryos. These have a higher chance of implantation than those of grade 4. Research has shown that up to one-third of embryos are genetically abnormal. There is no guarantee that a normal looking embryo will be genetically normal.

The four level grading system for multi-cell embryos is evaluated in the following way:

Grade 1: even cell division, little to no visible fragmentation
Grade 2: even cell division, small fragmentation (less than 20%)
Grade 3: uneven cell division, moderate fragmentation (more than 30%)
Grade 4: uneven cell division, excessive fragmentation (more than 50%)

When selecting embryos for an embryo transfer, the most viable embryos are typically chosen. Those considered most viable are embryos that are rapidly dividing with little or no fragmentation. Therefore, embryos that have reached the most advanced developmental stage and have the least cellular fragmentation (Grades 1 and/or 2) are selected for transfer. Some labs may use a different system, so please check with your lab to learn which grading scale it uses.

What is the average life cycle of an embryo?

Day 0: Eggs are retrieved and combined with retrieved sperm
Day 1: Physician will check for fertilization
Day 2: Embryo should be fertilized and have 4 cells
Day 3: Embryo should now have 8 cells
Day 4: Embryo is now in morula stage and ready for embryo transfer
Day 5: Blastocyst stage of development

What is a blastocyst?

Multi-cell embryos that are graded level 1 or 2 often develop to the blastocyst stage. A blastocyst is an embryo that has developed to the point of having two different cells and a fluid cavity. They usually reach the blastocyst stage within five days after fertilization. Blastocysts are graded differently than younger embryos, with a number and two letters.

When grading a blastocyst, the number represents how much it has expanded (1 is the least expanded, 6 is the most expanded). The first letter (A, B, or C) lets patients know about the quality of the cell – this is essentially the part of the blastocyst that is going to be the baby. The second letter refers to the quality of the part of the blastocyst that is going to be the placenta.

Number of eggs retrieved and IVF success rates according to female age ...

This graph shows our live birth rates by the number of eggs retrieved & female age

The data in the graph above shows that:

Women under 35 have the highest success rates in all of the "egg number" groups
Women under 38 in our IVF program have acceptable live birth rates even with only 3 - 6 eggs, do better with more than 6 eggs, and do best with more than 10 eggs.
Women 38-40 and 41-42 years old have low live birth rates with low egg numbers. Success rates are much better when relatively high egg numbers are obtained.
All age groups have very low success rates with less than 3 eggs retrieved

This is another example of decreasing egg quality with increasing female age. As women age, we need more eggs to be able to make IVF work - because of the lower quality of the eggs.

This is why IVF centers stimulate women in order to get sufficient eggs

We are not trying to get more eggs so that we can transfer more embryos
We are trying to get "enough eggs". So when the expected drop-off occurs as some embryos arrest their development (a normal process) - we will still have one or 2 "good" ones for transfer back to Mom.