IVF - how sperm and eggs are selected

[jazcat]

We have our first consult on Thursday. I'm a very nervous nellie about this whole IVF thing, but mostly about the fact that someone is choosing the one egg and one sperm that will eventually be our baby. Does anyone have info on sperm and egg selection, how the embryologist decides, grading system, etc? Maybe if I knew more about the process, I'd feel better about it. Any good websites?

[cincynana]

Here is a good website that describes the ivf process:
http://www.sharedjourney.com/ivf/what_is.html

Are you doing icsi? They'll look for the best sperm and directly inject the egg. Then after 3 days (sometime 5) the best looking ones are chosen for transfer. My clinic did mainly 3 day transfers and then on day 5 if the embryos were still dividing, they would be frozen. We didn't have any make it to frozen, so that was a bummer.

Best wishes on your consult!

[EmmaJane]

For eggs, they generally try to fertilize all retrieved that are "mature." You'd usually have a good estimate of how many before retrieval, since those eggs will come from the biggest follicles.

Then, for transfer, assuming you have more embryos than they're willing to transfer at your age, they'll pick out the best looking embryos: high cell count, low fragmentation. Ideally, one where cells have been dividing promptly and cleanly.

I liked Sherman Silber's book, How To Get Pregnant (actually, I read an earlier edition -- I started cycling in 2003!) The man has an ego, and how , but he really describes what embryologists do in a lot of detail.

Good luck!

[jazcat]

Originally Posted by cincynana

...

They'll look for the best sperm and directly inject the egg.

This is what I'm wondering - how do they select the "best" sperm? If you have two seemingly good sperm, how is one selected over another? Is it better to not go with ICSI, so that some sort of natural selection can take place?

[jazcat]

Originally Posted by EmmaJane

For eggs, they generally try to fertilize all retrieved that are "mature." You'd usually have a good estimate of how many before retrieval, since those eggs will come from the biggest follicles.

So there's no grading of the eggs - only of embryos?

Originally Posted by EmmaJane

I liked Sherman Silber's book, How To Get Pregnant (actually, I read an earlier edition -- I started cycling in 2003!) The man has an ego, and how , but he really describes what embryologists do in a lot of detail.

Good luck!

Thanks, I've got the book on hold at the library. This is what I want to know - in detail, how does an embryologist go about his/her job?

[Julia'sMom]

I agree that the eggs are graded, they're either mature or not mature. You can discuss with your RE if you need ICSI. It's typically used when there is a mf issue. My RE recommended it to everyone, but since out issues are female, we opted to not use icsi. It's my understanding that when you don't use icsi, all the eggs and sperm are combined to see what fertilizes. We were lucky and sperm reached all of the eggs. Another good website is www.advancedfertility.com and scroll to the bottom for the educational links.

[jazcat]

Thanks Julia's Mom. The idea of combining all the eggs with all the sperm makes me happy. We'll see what the RE says on Thursday.

[LisaG]

Echoing what others have said, when they do the egg retrieval they retrieve (ideally) all the eggs that are within a certain ideal size range and considered "mature". They also do some prep of the sperm - I believe they separate it from the semen and get rid of the ones with poor morphology.

I have to say that when we were first struggling with IF, I said I would never do IVF. It seemed too forceful, too invasive, too meddling - it seemed so contrary to something I considered to be incredibly sacred.

So we tried some more, and some more and nothing. And I got to the place where I knew if we didn't try IVF I would always wonder "what if?". Along the way I realized that for me, even with all the medication and intervention and high tech that's involved, conception is no less sacred. Even as much as IVF is a science, it is still so unpredictable. There are no guarantees and a cycle that looks "perfect" may fail and cycle that looks like it's hanging on by a thread can come through with flying colors. I feel like there's still something bigger at work even when it feels like science is the only thing in control.

I have a good friend I met through MDC and she conceived her daughter using ICSI, where a specific sperm is injected into a specific egg. I am quite confident that she feels her daughter is as magical, amazing and miraculous as any child conceived with less intervention.

It is hard to let go of how we think things are "supposed" to be. I don't think anyone hopes they conceive their child in a petri dish. But I still believe that our children find us one way or another, even when technology helps them get here.

[Julia'sMom]

LisaG - You articulated that beautifully! I couldn't agree more. Even having been thru ivf, and planning to do it again, I do still struggle with the morale implications and how my views have changed.

[JavaFinch]

Originally Posted by LisaG

she conceived her daughter using ICSI, where a specific sperm is injected into a specific egg. I am quite confident that she feels her daughter is as magical, amazing and miraculous as any child conceived with less intervention.

I wanted to say this is how I feel. My daughter is the result of an IVF with ICSI and assisted hatching and I feel she is so very special. In fact, after all the time we waited for her and how hopeless it seemed, I'm even more amazed by her conception and the idea that had the embryologist reached for a different sperm instead of JUST that one we'd have a different baby or no baby just makes me say WOW. I am SO grateful for science!!! I would go with what your RE says regarding ICSI. I chose assisted hatching, too, because of the idea that 'older' eggs have a harder shell. Good luck!

[jazcat]

Thank you for the discussion - just what I needed. I suppose the feelings, perception and acceptance is a process that one must move through. I've got a ways to go

[LisaG]

Originally Posted by jazcat

Thank you for the discussion - just what I needed. I suppose the feelings, perception and acceptance is a process that one must move through. I've got a ways to go

Absolutely. Give it time and be kind with yourself.

[jazcat]

Had our appt yesterday and it went really well. I have a very good feeling about the doctor. She's very young, but has all the credentials and her stats are excellent.

One concern was that her twin rate was very high (thus the good stats I suspect). But she was completely supportive of an elective single embryo transfer. She told us all about the embryologists on staff, their credentials, experience and skills....all very encouraging. They do 3-day and 5-day transfers, depending on the situation - mine will most likely be 5-day. They do ICSI and non-ICSI, depending. And when I asked about genetic testing, they offer it, but she seemed to discourage it, unless there's something specific to look for - not in our case. She said it's not always accurate, taking one cell could be damaging, they just don't know. And it's been her experience that not as many of those transfers survive. She acknowledged there's conflicting data out there. Interesting!

She's already got us down for a mid-December harvest/transfer, but that's assuming I start my period in the next week. I'm usually like clockwork, but I was very sick in October, which could push it back - it's happened before, a 3 week delay. If that's the case, I guess we'll go for January.

Feeling really good about it at this point

[Aly22681]

Yay! I'm so glad that your DR helped you feel comfortable with the whole process. I really hope everything works out for you! Good Luck!!!

[jazcat]

Thanks Aly. I'm so sorry you lost one of your twins I remember you from one of the message boards awhile ago and celebrated when you became pregnant. That must have been hard

[by-the-lake]

YAY Jazcat, my old IUI cycle buddy. I shall stalk you faithfully!!