One of the most important factors that determines whether an IVF cycle will succeed is embryo quality.
This is why patients are delighted when they hear that they have top-quality embryos available for transfer. They know that good-quality embryos have a higher chance of implanting and becoming healthy babies.
On the other hand, when patients are told that their embryos are fragmented or poor quality, they often become extremely anxious and start blaming themselves.
However, before jumping to conclusions, it’s important to understand what embryo fragmentation means and why it happens.
The first thing every IVF patient needs to understand is how embryos are graded in the laboratory. More importantly, your IVF clinic should provide you with photographs of your embryos.
After all, a picture is worth a thousand words.
If your embryologist simply tells you that your embryos are “Grade A” or “poor quality,” you are completely dependent on their interpretation. By contrast, when you have embryo photographs, you can see the embryos for yourself and better understand the quality of the embryos that were transferred.
This doesn’t mean you shouldn’t trust your embryologist. However, good medical practice requires proper documentation, and embryo photographs are one of the most valuable pieces of information an IVF clinic can provide.
You don’t need to become an embryologist to appreciate whether an embryo looks healthy or severely fragmented.
So why do embryos fragment?
The most common reason is poor egg quality.
As women get older, the quality of their eggs declines. This is why older women and women with diminished ovarian reserve often produce embryos with higher levels of fragmentation.
However, poor embryo quality is not always caused by poor eggs.
Sometimes the problem lies in the IVF laboratory itself.
Growing embryos successfully requires a highly skilled embryologist, excellent culture media, strict quality control, and a stable laboratory environment. If the laboratory standards are poor, even good-quality eggs and sperm may fail to develop into healthy embryos.
Another often-overlooked cause is poor ovarian stimulation.
Many patients assume that once injections are given, the eggs will automatically be good quality. Unfortunately, this is not true.
The way the ovaries are stimulated has a major impact on the quality of the eggs that are collected.
This is especially important in women with polycystic ovarian syndrome (PCOS).
Many doctors are so frightened of ovarian hyperstimulation syndrome (OHSS) that they stimulate these patients very cautiously. While avoiding OHSS is important, excessive caution can result in inadequate follicular development and poor-quality eggs, which subsequently produce fragmented embryos.
The key point patients need to remember is this:
Poor-quality embryos are not always a reflection of a problem with you.
Sometimes the problem is with the stimulation protocol. Sometimes it is with the laboratory. Sometimes it is with the clinical team’s expertise.
This is why patients should be very careful before accepting recommendations such as using donor eggs after a single failed IVF cycle with poor-quality embryos.
If your embryos were poor quality, it may be worthwhile to seek a second opinion and carefully review the quality of the clinic and laboratory before assuming that your eggs are the problem.
A better clinic with a better laboratory and better embryologists may be able to produce significantly better embryos from exactly the same eggs.
- As IVF patients, you need to become informed consumers.
- Ask for your embryo photographs.
- Ask questions.
- Review the evidence.
And remember that poor-quality embryos are not always your fault.
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