Wednesday, April 08, 2009

Meet the Blastocyst

Hello everyone, this blog will describe the blastocyst. I will show you some pictures and tell you what is good and what is less good. Next time I will tell you a little about our blastocyst experience at NYU.
Let’s start with an easy one, a nice one. This is a very nice blasotocyst.


This is the type of embryo you may see on doctor’s web sites.

So what are we looking for? In no particular order, one is the thickness of the zona. This is the thin membrane around the embryo; it looks like a clear plastic shell. The thinner the better. As the embryo grows, gets larger, and becomes ready to pop out of the zona. The zona gets thinner, and this is a good sign. We don’t measure the thickness; we just look at it and make a judgment. The bigger embryo in the picture below has a really thin zona, almost impossible to see, which is a good thing.



This embryo has a much thicker zona, not as good.



What else are we looking for? We look inside the embryo. You may not be able to tell by looking right away, but the inside is hollow. Thus the name blastocyst: the inside is like a fluid filled cyst. That’s a good thing. So the next embryos have a lot of space on the inside, the cavity (the space inside) is large, another good thing.



This familiar embryo has a smaller cavity, not as good, but not a terrible embryo overall.




What about the cells of the embryo? There are 2 types. There is the inner cell mass and the trophectoderm. The inner cell mass goes on to become the fetus/baby, the trophectoderm cells go on to become the placenta. Many more cells are designated for the placenta than are for the fetus. Ideally, the inner cell mass (ICM) is easy to see as a clump of tightly bound cells more towards the center of the embryo. Here is the nice embryo we saw before with a nub of cells at about 8 o’clock. This is a good-very good inner cell mass.



These embryos have ICMs that are smaller; in fact it’s hard to see the ICM in the bigger embryo.




Next we move on to the other cells of the blastocyst, the cells that make up the outer area. These are the trophectoderm cells, troph cells for short (really sorry about all the terminology, it just goes with the territory). Cells that are more plentiful and smaller make a better embryo. The larger embryo below has very nice troph cells (and the ICM is really nice too).





This embryo has troph cells that are not quite as good: they are larger and fewer in number.




The embryo on the left below has just a few troph cells and they are really spread out, not so good.




The next embryos are not very good looking. The top left does have a cavity, and the cells are not very good. The top right has a very small cavity. The bottom embryo looks like there is no cavity.




The next embryos have cavities, but not the nice ICM cells and troph cells we have previously seen.




These embryos have thick zonas, the lower left has no cavity, and the upper right has a small cavity and few large cells inside.



This poor embryo has a nice thin zona, but just a few cells inside. The troph cell at 4:00 o’clock is just spread so thin, across almost half the embryo. The ICM at 11 o’clock is tiny.


So now you know more about blastocysts than the average person undergoing infertility. I realize that some of you are not as interested in the details, and others really use the details to get through the infertility day.
Next time I will talk a little about the numbers we assign and a little about the NYU blastocyst experience.

Thanks and see you sooner next time,

Dr. Licciardi

17 Comments:

Blogger Niki said...

I love it! I'm a biologist, so I dig the sciency stuff! Thanks for sharing this Dr. L. In the future I'd love for you to share your thoughts on the correlation between highly graded blasts and chromosomal composition. I've heard some stats floating around out there in the blogosphere that a suprisingly high % of highly graded blasts are chromosomally abnormal. I'd love to hear your thoughts on this. Thank you again for sharing your expertise with us.

7:36 PM  
Blogger Hollie said...

This post has been removed by the author.

8:32 PM  
Anonymous Anonymous said...

Thanks so much for your article. Wondering if you could comment on your opinion of day 3 vs. day 5 transfers. I read a horrible article which said day 3 transfers are only done because a clinic wants to make money off of you or because their lab isn't equipped to handle 5 day cultures. I have PCOS, I am 35 and am in the middle of my first IVF cycle. They retreived 7 embryos. Immediately after the retrieval my RE said it would be a day 3 transfer. I didn't even think they could make this judgement call without having embryos first to grade/rate.

11:59 PM  
Anonymous Anonymous said...

Sorry I meant they retrieved 7 eggs not embryos;-)

12:01 AM  
Blogger Stephanie said...

Hi Dr. L. The pictures are amazing. Unfortunately, my husband and I went through IVF unsuccessfully, and I set up a blog for women going through this, especially those whom IVF failed. Would love for you to pass on the word. I am also writing a book about the identity crisis and the resolution I was finally able to come to after I realized I would never be a Mom. The blog is: wheninfertilityfails.blogspot.com
Best wishes to you and all of your patients!

1:20 AM  
Blogger Stephanie said...

Hi Dr. L,
Really cool pictures. Unfortunately, infertility treatments were not successful for me and my husband and I set up a blog for those women, like myself, grappling when treatment fails. www.wheninfertilityfails.blogspot.com. Would love to pass the word on so women like me can get the support they need in grieving the loss.

1:23 AM  
Blogger Shinejil said...

This is so fascinating. Thanks for the perspective.

12:58 PM  
Anonymous MiracleSeeker said...

Hi Dr. L,
I follow your blog regulaurly & love it. I am 29 yrs old, have been ttc for 3.5 years, I have PCOS and endometriosis (level 2/3 - removed 7 months ago) - have tried several serophene cycles, 4 gonal f & iui cycles, have just underwent my first unsuccessful ivf, transferred 2 "excellent" (grade 1 or A) embryos (5 day transfer)and now have 5 frozen (three grade 1 and 2 grade 2). I am planning on undergoing my 1st FET in the next few months. On my ivf cycle I was taking 3 progesterone suppositories daily, but started my period before my BETA day at 9dp5dt while still on the prgesterone. Do you think that for my next cycle I would need more progesterone support? Any advice? I have never been pregnant but still remain hopeful that it can happen, but just wondering if I am missing anything or that there could be other reasons this is not working. All other tests done, say everything is fine, other than the PCOS & endo. I am also wondering what are the pros & cons of doing a medicated FET vs a natural FET. So far, I think I am leaning toward medicated as I don't usually ovulate on my own. Any help would be appreciated. Happy Easter!

11:00 PM  
Blogger andreaplants said...

Thanks so much for this. My hx:
d/c OCPs age 33, then after 5 months dx w/PCOS, started metformin and femara 2.5. responded very well to 4 femara cycles, LH started to go up (12-20) and paraovarian cyst developed on 4th cycle, which was a longer cycle. IUI in 4th cycle dx cervical stenosis.
no response to femara after dilation. clomid 50 next month and IUI, successful.

"felt" like my PCOS was getting worse

Now, started TTC number 2 at 6 months. Re-started 1500 glumetza. No response to 50 mg clomid after a light AF - had cut back on BFing. did Provera, then clomid 100 mg. On CD 14 now, and just have big grapes in there. Completely stopped the little bit (maybe 1-2 oz) of BFing this past weekend.

No measurable IR ever, lean/athletic, though CV out of shape currently and starting back into bicycling.

RE I went to has closed - started with an infertility OB for this TTC attempt. He is talking about ovarian drilling or injectables, and keeps saying that he can't believe I responded to such low doses before as "ovaries that look like yours usually take 2 or 3 clomid pills to respond"

Story sound familiar? Is there hope without having to go to injectables or IVF?

11:01 PM  
Anonymous Ali said...

Our third IUI worked but I had a miscarriage at 6 weeks.
Our RE says we should move to IVF, but we are not sure. We know that is our best chance but if we got pregant with IUI should we try again?
Ali

1:05 PM  
Blogger Maredsous said...

Dear Dr. L,

I am a 42 year old female undergoing IVF. My Dr. has insisted on both ICSI and assisted hatching. My husbands SA is completely normal and counts are great. Dr. says it is because of thick zona pellucida on "old" eggs. I am of the opinion that if it doesn't fertilize it probably shouldn't be fertilized and I don't want to waste time with an embryo transfer that is not going to result in a viable embryo. What is your opinion of ICSI for older eggs?

Thanks for you help

4:55 PM  
Blogger The Patterson's said...

Thank you so much!!! I have been wanting more information on the ICM. We are getting ready to start our second IVF, but during the first we did not have any embryos to freeze because of missing ICMs. FYI - we retrieved 6, 4 mature and fertilized with ICSI, and 2 8-celled embryos were transferred on day 3. We're doing a micro-dose lupron protocol this time and hoping for a 5-day transfer and embryos to freeze. We have been diagnosed with unexplained infertility. I really enjoy your blog and the details!

8:20 PM  
Anonymous Anonymous said...

Hello.

I have been TTC for almost 5 years. I am now 40, going on 41. Last year I got pregnant 2x (IVF, natural) but lost both before 10 weeks.

My Q is this: when I was 22 I stopped getting my period for 2 years. I was essentially borderline anorexic and exercised very heavily. I saw a doctor, who neglected to point out that I was too thin. She prescribed Provera but I did not want to take hormones (Ha!) so I didn't take it. I eventually gained weight and my period started again. So, do you think the 2 years without ovulation and menstruation could have screwed me up to the point where I am infertile? So far the only thing found "wrong" with me or my husband is my age (we have had the works done). However, even when I started trying at 36 we did not get pregnant. Yes, I know that is "old" but tons of people get pregnant in their late 30s. The only other thing is that I was *very* irregular in my teens and early 20s--cycles could last from 4 to 7 weeks--and I wasn't sexually active, so it wasn't the case that I was getting pregnant and having early miscarriages (strangely enough once I moved in with my husband I became quite regular).

Thanks for your help.

Dee

10:59 PM  
Blogger Nicole said...

This is kind of a strange question. I am really thinking of donating my eggs. The problem is I have suffered infertility for 2.5 years. Unexplained. I did get pg once but miscarried at 9 wks. I am thinking of doing it to of course help someone else but also because it would give me insight into how a IVF cycle would go if I were to do one for myself. Not to mention the $$ would help out with IVF costs. I know you can do "shared" cycles but Im not sure I would be ok with that. My question is, would they even consider letting me donate based on my history? I know there is a lot of testing but I am just wondering if my history of infertility would automatically exclude me?

11:12 AM  
Blogger Chrysse said...

Hi Dr. L,

This question ultimately asks about estrogen...here is a bit of info to put it into context...
I realize you have about a million questions, but thought I would see if you had a sec to answer. I just turned 29 and my husband and I are going on 16 months without a pregnancy. We just concluded baseline testing. Hubby's semen analysis was "slightly abnormal" in regards to morphology. He was told 33% had normal shape...my MD said not to worry about this since his count is high, etc, and all else is normal. From what I have read, that sounds right on.

However, my testing was the following:

HSG (performed by my OB): open tubes and normal intra-uterine cavity.

Labs:
Day 3 TSH, Prolactin, FSH, and LH all within normal levels

**Day 3 Estradiol Level: 20

Mid luteal phase Progesterone: 12.99 ng/mL

I have been using OPKs the past 4 mos and get a surge between days 14 and 16 and see a rise in temps about 2 days later. All charting has been biphasic. I do experience the eggwhite cm.

MD says that I am ovulating based on bloodwork and tests, but also said that my estrogen is lower than that of a post-menopausal woman.

Does this mean I am at risk for premature menopause??
Is it at all possible that the estrogen level could be incorrect?
Is there hope for a pregnancy via IUI?
Is it possible to have low estrogen but still be ovulating, conceive, etc?


Thanks for any thoughts. Also, thanks for taking the time to put together the blog. It is full of such helpful information and clarification!

4:56 PM  
Anonymous Anonymous said...

Dear Dr.Licciardi

I follow your blog regularly, once again congratulations on all that valuable information. Great way to answer to FAQ from now on. I am 38yrs old,we suffer from male factor infertility and I have already failed 4 icsi and 1 fet cycles (2 biochemical, 3 bfn), primarily due to poor embryo quality. I would like to ask you if you could comment on indications for the use of DE or DS. Thank you in advance, also for all the great work you are doing in this blog.
Veronica

5:48 AM  
Blogger Sonya said...

The blood that is shed from the endometrial tissue in your abdominal cavity has no place to go...Generic Cialis Online

11:43 AM  

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