Drug Use Kansas City: In Vitro Fertilization – Which Embryos Are Used?

The success of in vitro fertilization (IVF) has everything to do with which embryo or embryos are chosen for transfer to a woman’s uterus. Yes, there are issues surrounding response to fertility drugs and other aspects of the process, but the embryo is where it all comes together.

What your fertility doctor wants to know (and so do you) is whether an embryo has a good potential for implantation. Figuring out whether the embryo is more or less likely to implant requires a fairly complicated evaluation.

Fortunately, the evaluation system has become increasingly sophisticated and reliable over the years. Today, IVF success rates run at about 50 percent. This number compares with 15 percent just 30 years ago. The improvement has come because IVF laboratories have used better evaluation techniques to arrive at more dependable “scores” that help determine an embryo’s likelihood of implantation.

So what goes on in an evaluation that results in an embryo’s “score”? The key word here is “morphology,” the embryo’s physical appearance as seen through a microscope.

Depending on whether you’re scheduled to have your embryo implanted three days or five days after fertilization, the evaluation follows one of two courses. The criteria for evaluation are different for the two scenarios.

For embryos scheduled for implantation three days after fertilization, three factors play a role:

• Rate of cell division. If the embryo has between seven and nine cells, its chances of implantation are higher. Fewer than seven cells or more than nine cells lower the chances of implantation.

• Cell symmetry. If an embryo’s cells divide unevenly, the odds of successful implantation are lower. The cells should show symmetry in size and shape.

• Fragmentation. If more than 20 percent of the embryo has come apart during cell division, its chances of implantation are reduced.

Embryos scheduled for implantation five days after fertilization are scored using these criteria:

• Expansion. By the fifth day after fertilization, it’s no longer possible to count the embryo’s cells. It has become a ball-shaped blastocyst. How well the ball is expanding becomes the basis for a rating.

• Outer cell layer quality. The outer cell layer of the blastocyst will become the placenta. The cells should be packed tightly.

• Inner cell mass. This is the part of the blastocyst that will become the baby. These cells also should be tightly packed.

A lower evaluation score does not necessarily mean your fertility doctor will rule against embryo transfer. There are a number of circumstances in which lower-scored embryos will be used. The success rate for these embryos is lower, but there still might be a good chance of implantation.

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