On what basis is the quality of embryos defined and what factors decide about embryos quality?
When embryo quality is to be described it’s not only the egg but also the sperm. We can then divide these factors into two groups and analyse the internal and external quality of the embryo. What is what? Can embryo quality be improved? The experts will explain this in details in 3on1 #IVFANSWERS:
- Olena Bondzyk – Embryologist, fertility specialist, The Institute for Reproductive Medicine Prof. F. Dakhno Clinic
- Dr Alejandro Aldape Arellan – senior consultant in reproductive medicine, currently Medical Director of Institut Marquès Ireland
- Dr Inna Moroz – Fertility Specialist at ISIDA Clinic
Answer from Olena Bondzyk - embryologist
The embryo quality is the most important for the successful IVF cycle. There are many factors that can influence the embryo development and quality. I want to highlight the most significant of them.
The first one is the quality of male and female gem cells.If oocyte or sperm have poor quality, the embryos probably will be poor quality, too. Oocytes’ quality depends on age, ovarian reserves stimulation protocol, health, weight and lifestyle of a woman. Sperm qualities such as quantity and motility can decrease by obesity, stress, bad habits, etc.
As you see, the second factor influencing the embryo is the patient’s lifestyle. But fortunately you can control your lifestyle and this bad influence can be improved. The third factor is attentive realisation of doctors’ recommendations during treatment. All protocols are individual in timing and doses, so you doctor will choose the best protocol for you.
Next group of factors are genetic factors. If yo have reasons for pre-implantation genetic diagnosis (PGD) , you should do this procedure. PGD gives you the opportunity to choose healthy embryo for the embryo transfer. The next point are manipulations with gametes and embryos, such as ICSI, cryopreservation and thawing, biopsy, etc. Your embryologist must be highly qualified and have a good work experience.
Last factors I want you to know are the conditions of embryo cultivation. Your IVF clinic must have modern equipment and use high quality culture media for every protocol and procedure.
In conclusion, I want to emphasise that abnormalities in the embryos are the reasons for about 60% of all miscarriages. Transferring the best quality embryo during your IVF treatment increases your chances for successful pregnancy.
Answer from Dr Arellan - Medical Director
When we are talking about embryo quality, we have to take into consideration not only the egg but also the sperm. We can divide the internal quality of the embryo into the genetic quality and the energy quality. The external quality refers mainly to what we can see about the embryo. And then we can talk about the morphological quality. To grade this, we can assess the expansion, the number of cells that are in the trophectoderm and also the inner cell mass. All of this is going to give us the external quality.
Probably the internal quality of the embryo would the most important, so the genetic and the energy one. The genetic quality is mainly influenced by age. It refers mostly to the situation when a patient is over 40 and the internal quality of the embryo can be potentially compromised. We can check the internal quality with the genetic investigation such as PGS ( pre-implantation genetic screening) and see if all the chromosomes are there. Of course we still don’t have the investigation for checking the energy of the embryo.
When it comes to external factors that may influence the quality of the embryo, the two most important ones would be the culture medium and the laboratory of IVF, as well as the incubator we are using for the IVF cycle. And for that reason it is mandatory to go to the clinic where they have all the accreditations and best standards. In terms of the genetic investigation, we are using the PGS and the PGD. With these, we can assess all the chromosomes in the embryo and ensure that the embryo we are going to transfer is completely normal.
When we are talking about the embryo quality, it is a little bit more complicated. We need to take into consideration the sperm quality as well. We need to assess the sperm quality in advance before going to the treatment. In order to do this, we need to check the DNA fragmentation and take the FISH test. If both are completely wrong and the outcome is poor, the recommendation would be to proceed to the treatment and do genetic testing into the embryo.
Answer from Dr Moroz, fertility specialist
The quality of embryos can be influenced by a large number of conditions. The most important one is the age of a person. The older the woman, the worse the situation. The embryos can develop genetic abnormalities. Even the performance of ICSI embryos can inhibit the formation of blastocysts.
The second important factor is the quality of the sperm. The poor sperm quality but the high DNA fragmentation can have negative impact on the development of healthy embryos and healthy fetus.
The third very important factor is the cultivation conditions in the laboratory. Early stages of the embryo development have a lot of important processes. If you have a rare cultivation condition, the embryology lab is very crucial. Even the fertilization time is very important for the formation of blastocyst is very important for formation of blastocysts.
It is also worth to mention that the appearance of the embryo and the genetic content is very related. But sometimes even the medium quality embryos can create normal pregnancy.