Hatching a Plan

Hello everyone and welcome

to Hatching a Plan episode five.

My name is Simon Tomes.

I'm Emma the embryologist

aka Emma Whitney's husband

and we are here today to

run an Ask Me Anything.

All right?

Yeah.

Ready for this?

Yeah.

So we've had quite a lot of

questions come in haven't we?

yeah you're gonna keep me on

my toes that's for sure

yeah we're gonna go rapid

fire aren't we we think um

that's probably the best

way to do it just to jump

straight in let's go but

first up thank you for

joining us uh wherever you

may be uh feel free to pop

um where you're visiting us

from or tuning in from

today on the chat we can

see on the chat you can ask

questions on the chat as

well I do have a massive

list of questions for us to

go through so if we don't

get to the questions in the

chat um we'll do our very best to

don't know we'll work it out

yeah so for those

unfamiliar I guess we

should dive in just taking

a step back yeah why are we

doing this podcast and

these live webinars what's

the thinking behind it all

so I think I over the years

of doing embryology have

realized that a lot of

people come to this journey

I hate that word but it is

what it is with anxiety and

I think a lot of the

anxiety is from unknowns and

misinformation and everyone

jumping on the fertility bandwagon,

Dr. Google.

And I figured that actually

it shouldn't be that hard

to get good information.

And given that I have been

in this job for twenty two years,

I probably hold quite a lot

of the answers to what I

think is my day to day.

It's actually massively

overwhelming to many people.

Yeah.

Well,

you've helped thousands of people and

we want to help a lot of people today.

So this is available as a podcast.

You can go to EmmaTheEmbryologist.com.

Look for the link to podcast.

We've got four episodes out already.

I'll give you some details

about them a little bit later.

So stick around for those

and also some information

about some of the posts

that Emma has been putting

out on EmmaTheEmbryologist.com.

Some good stuff,

but we will come back to

that at the very end.

So some folks checking in.

I'm just going to check on the chat.

Here we go.

Oh, wow.

Lovely.

So Emma from Bristol,

Hayley from South Sea,

Maria High from New York.

Wonderful.

Sarah from Manchester, Chloe from Reading,

Catherine from Walton on Thames, Surrey.

Oh, it's quite near us.

Leon C, Lincoln.

This is great.

Thank you for tuning in, folks.

We're very, very grateful.

Jump straight in.

OK.

Right.

So bring up my questions.

Go.

Go.

Okay,

so... I feel like we're in that

gladiator show.

Gladiators, ready.

Yeah, no, it's fine.

Maybe I'm showing my age,

although that is now back on the TV.

I mean, it's fine.

It's fine.

I think, you know, serious topics,

but we've got to keep it light as well.

But we're going to get

serious when we need to get serious.

So let's do that.

So Amy asks,

how long have we been

implanting biopsied embryos?

I love that question.

So biopsying embryos has

been around since...

The mid-nineties, Alan Handeside,

which is one of my I'm not worthy people,

started biopsying embryos in the, yeah,

about ninety five.

I think the first paper came out.

But you've got to remember

that they were always

biopsied on day three when

we started doing it.

So day three embryos are

only eight cells big.

So very quickly, question for you.

What does biopsy mean?

Wow.

See, this is why you're here.

This is why I'm here.

Because otherwise I just start ranting on.

Yeah, you get all sciencey.

I get all like into my zone.

What is a biopsy?

So a biopsy is when we take

a small sample of the

embryo to try and

understand its genetic health.

So normally we're looking for...

chromosome copy number,

which is the genetics being

the compatibility with human life.

Sometimes we're looking for

genetic disease such as cystic fibrosis.

Sometimes we're looking for

things called a translocation.

Ultimately,

we're taking a sample of the embryo.

So a cell or cells from the

embryo that will allow us

to see into the embryo.

OK,

so back until about two thousand and ten,

we were biopsying or taking

a single cell from day three embryos.

which we now realize to be

absolutely bonkers because

it's only eight cells.

And by taking a cell,

you're taking a whole eighth of it.

So you could actually be

damaging its road to going onwards.

It did used to work,

but not as well as it does now.

And throughout your whole career,

how many of your patients

have you had to biopsy?

Is there a ratio of how

typical it is to biopsy these days?

So now it's really,

really common to do PGTA.

I think sixty percent of my

treatment cases are PGTA

just because of the age of

the patient that comes to it.

But we used to biopsy on day three.

So in answer to Amy's question,

how long have we been implanting?

biopsied embryos um yeah

since nineteen ninety five

but they used to be day

three and then in two

thousand and ten we all

switched pretty much to

biopsying day five embryos

where you could take more

than one cell you can take

five six seven cells

because the embryo at the

stage day five or day six

is a blastocyst it has a

hundred and fifty to two hundred cells

And if you want to learn more about PGT,

we've got a great podcast episode on that,

a whole dedicated episode

where we went deep into that world

say we did and I've got uh I

think there's an article as

well there is somewhere yep

yep we've got that written

you have written that we

can come on to that I'll

give you a list of some of

the good stuff that emma's

been writing about as well

as the stuff that we've

been talking about on the

podcast so great question

amy thank you for that okay

holly louise asks first

four aafet from batch

twelve frozen embryos ended

in tfmr uh for a trisomy no

translocation sorry

to hear that, Holly Louise.

Would you recommend PGTA for

the remaining eleven?

Is there an increased

likelihood now one was aneuploidy?

I'm really sorry about the TFMR.

I think anyone that knows us

knows that we also have

been in that awful position.

So a trisomy for anyone

listening is when there's

three copies of a certain chromosome.

So actually Down syndrome is

considered a trisomy

because it's three copies

of chromosome twenty one.

It depends how old you are.

So if you are dealing with a

batch of twelve embryos and

you are under thirty five,

the chances are you were just really,

really unlucky if you are.

older than that,

then the percentage chance

of the remaining embryos

being abnormal is in

keeping with your age.

I've got a really nice post

on my Instagram about

percentages of aneuploidy

in age groups versus the

day of the embryo being frozen.

So it really depends.

It doesn't mean that the

others will be more likely

to be aneuploid just

because you've had one that was aneuploid,

but the others will be in

keeping with age and day of freeze.

Got it.

Thank you for your question.

Hi, Louise.

Let's jump to Maria.

Maria asks,

what are the chances of an

aneuploid being retested

and then being a euploid?

So before we jump into that,

can you very briefly say

what an aneuploid means and

what a euploid means?

So aneuploid is when the

embryo is abnormal,

which means it's got an

incorrect copy number of chromosomes.

So for example, a trisomy,

like Holly's just talked about,

is three copies of a chromosome.

So instead of having forty six chromosomes,

it's now got forty seven or forty eight,

depending on what there is.

a euploid embryo is what we

consider to be normal so

that forty six chromosomes

with no losses or gains and

what is the chance of an

aneuploid embryo being

retail so this is a really

good question and actually

depends on who the genetics

testing laboratory is a

little bit and also the

technology being used so

over the years as you can

imagine the technology's

changed quite a lot so we used to use

So if you were talking about

an embryo that was ten

years old and we used the

technology we used ten years ago,

then there would definitely

be a probability that a

certain number of those

would probably come back

different to what they did.

But we were using the

technology that we had at

the time that was the best

we had at the time.

So the technology we have

now is far more robust.

So I think if you had

anything tested in the last

sort of three or four years,

then you will...

no,

there's no evidence that an unemployed

embryo will come back any

differently if you if you retest it,

it's pretty robust now.

But if you're dealing with an old embryo,

then yeah, it's different testing now,

right?

So you move with the

technology with your time.

So at the moment, no,

there is no evidence for

what I'm testing now is

coming back any different.

And they've actually done

quite a lot of studies on

this where they retest

embryos that are donated to

science to see if the

technology is working.

So

Yeah, if that makes sense.

Yeah, yeah, absolutely.

Very interesting.

Okay,

let's jump into... Did you want to

take one from the chat?

I was just seeing how many we had on here.

Oh, yeah, there's lots coming in.

So if you want to whiz back to the top,

perhaps, and take one of the earlier ones,

I can do that for you.

Okay, so...

I think that's in there as well.

So that's probably quite a

good one to cover.

So the one from Emma.

Yeah.

Yep.

So question from Emma.

Emma asks, question about embryo glue.

Is it worth trying it for my

third euploid FET next week?

I'm thirty three and so far

unsuccessful with medicated FETs.

But this will be my first

time trying a natural FET.

I read up a bit on embryo glue.

There is a link study on the HFO website.

So FET is an acronym for

those who are unfamiliar.

Frozen embryo transfer.

Frozen embryo transfer.

OK, for those unfamiliar.

So firstly,

I think one of the questions we

had actually came in

earlier is what is embryo glue?

So embryo glue.

Firstly, I mean,

let's give it let's give a

round of applause to the

people who called that name up.

I mean it's clever right it

makes you sound like it's

like some sort of amazing

sticking power it really

does I have actually met

the person that came up

with that um that name and

I did actually say to them

well done they've actually

got the name it represents

exactly what it's doing

well no not really because

I think people think that

embryos have got to stick

to the lining and they

don't actually they don't

stick nothing sticks it's

like if you can imagine an

embryo um in fact let's

cover all these questions

off because there's a

question that came in

earlier about what happens

when an embryo goes back

after you put an embryo back, right?

So let's talk about implantation.

So what actually happens is

an embryo will go back.

If it's not already left its shell,

it will leave its shell.

Then there has to be a communication.

There's lots of signals

between the lining and the embryo.

And actually the embryo doesn't,

although the embryo

sort of invades the lining

it doesn't stick as such

and the lining actually has

to engulf the embryo so it

almost like it gobbles it

up really it's quite if you

watch it it's fascinating

so there's lots of

signaling and lots of

communication between the

lining and the embryo and

then it all goes like

invades into the lining and

then it burrows in and it

starts filtering into its

own blood supply

Hence, then you get a pregnancy.

But embryo glue is a hyaluronic rich,

hyaluronic acid rich medium.

And the reason it's meant to

work is it's meant to help

that conversation between the two.

I will hands up say we're in

an embryo glue trial at the moment.

Actually,

it is not detrimental whatsoever.

I hundred percent hand on

heart does not think that it's harmful.

It's a bad product.

Whether or not it increases

pregnancy rates, I'm not sure yet.

We've got a bit more data to do.

It's definitely working very well.

But I think I always say

this over and over again.

It's about the context,

the context of the patient.

Emma, you've had failed transfers.

So then the question would

be if you don't use this

product and you get another

negative test I think the

point of regret will be

quite high It'll be what

would have happened if I've

done this and I can hand on

heart tell you it's not

detrimental It's actually a

really nice media to work

with as an embryologist.

It's a bit thicker.

It gives you a bit more

control Whether or not it's

worth the price tag and

whether or not it will give

you your positive pregnancy

test I'm not a hundred

percent sure about yet.

I

I don't think it's a magic wand,

but I know it's not harmful.

So I think it's worth a go.

Great advice.

I hope that helps answer your question,

Emma.

Thank you for asking.

okay let's jump on in um

let's have a look let's

take this one from chloe so

here we go from chloe thank

you for your question chloe

does the amh level impact

the embryo quality I have

lower amh than the average

from my age and I'm about

to start my first cycle and

I'm quite anxious due to my

low amh well sorry to hear

you're feeling anxious

chloe but let's get let's

hear from you amh

anti-malarian hormone is

all that tells me about is how many eggs

I'm likely to get from your

ovaries when we give you stimulation.

Your AMH doesn't tell me

anything about the quality of your eggs.

The only thing that tells me

about the quality of your

eggs is your age.

So you can actually have

people that are in their thirties,

like early thirties with a really low AMH

their chance of getting pregnant,

you've got to remember that

we're not testing Joe

Bloggs on the streets AMH.

We're just not,

we're not looking at

everyone who's getting pregnant.

So all it tells us is

potentially that you're in

an ovarian decline earlier.

Equally, that might not be the case.

You may actually have the

same AMH for the whole of your life.

Like some people have just

naturally got a low AMH.

It does, it does,

if you're ovulating and you're,

you're cycling properly.

AMH shouldn't be the reason

that you're not getting

pregnant because it's to do

with the age of the egg.

What it does mean is if you

do end up coming to IVF,

it's a bit more challenging

because you don't get twenty,

thirty eggs.

You get a smaller number of

eggs because that's all

that we can get from you

with what your ovaries will

give us during stimulation.

So no,

AMH tells me nothing about the

quality of your eggs.

It tells me

how many I'm likely to get

and what I've got to work with.

And when I talk about the funnel,

what my top of my funnel looks like.

And then you advise patients

based on that and how long that, you know,

how many cycles are we going to need?

How much journey this is

going to look like?

But no, it's not to do,

your age is still the sole

defining factor of quality

and chance of implantation and working.

Do we want to talk more

about age or should we jump

into questions?

Go for questions.

Yeah, of course.

Thank you for asking that, Chloe.

All right, let's take,

did you want to point at

one that you want to take?

This one here?

Yeah.

Brilliant.

It's a great question.

Great question from Kate.

Hi, Emma and Simon.

From a theoretical,

scientific point of view,

how many days could you

keep growing an embryo in culture for?

Great question.

I love this.

So you are legally,

legally allowed to keep an

embryo in culture under

research purposes for fourteen days.

Fourteen days.

There is a reason for that.

What's the reason so at fourteen days?

They think that the neural

tube starts to form which

is your nerve endings Oh, I see.

So they think there is a

potential for something to

be able to have feelings

I'm completely do not agree with that.

So actually

Yes.

Physically, in a laboratory like I've got,

I don't think I could

sustain an embryo much

longer after it has left

its shell than about twenty four,

thirty six hours because it

is looking for a blood supply.

It needs more than the

culture media surrounding it.

But in certain research labs,

they can add.

um probably things that we

can't add to the media to

help the embryo survive

yeah and actually in

certain research labs they

have kept the embryos tool

like I said legally in this

country it's fourteen days

in other countries it's

they don't have many laws

so it all gets a little bit

wayward but yeah you can

definitely get um what we

call differentiation of

embryos in the laboratory

and you can start to see it

forming into certain

aspects of things but it's

You probably I mean,

I don't know of all the data,

but I know that, yeah,

you can keep them alive,

but not not beyond probably twenty days,

twenty five days.

I wouldn't have thought you

can't sustain life without

a uterus and a womb and all of that.

I don't think we're quite

into Brave New World just yet.

Maybe maybe not far off.

But but yeah,

so the legal the legal

requirement in this country

is fourteen days.

Fascinating.

That is a great question, Kate.

Thank you for that.

I could see Emma's geeky

science brain light up at that question.

It blows my mind that you can do that.

Yeah, it's fascinating.

Shall we jump on to some of

the questions we had from Instagram?

Okay, so let's take this one.

from Stiedale, their username.

They asked the question,

what's the most important

thing to consider when choosing a clinic?

Big question.

Now, just before we dive in,

we do have a... This is my

favourite topic.

We have an episode on this.

We've got a whole episode on this.

I actually think the most

important thing when

choosing a clinic is you

understanding what's called

the Vienna Consensus.

so yeah so check out

previous episode vienna

consensus you can get that

on um emilyembryologist.com

select podcast you'll find

it there we also have a

post called ten questions

to ask your ivf clinic to

help you decide which one to go with

That is a very good post.

Emma shared lots of good info.

So yeah, go for it.

So for me,

where you have your treatment

and where you choose your

clinic has to be led by your context.

So what is your context?

Why are you coming to this clinic?

Why are you needing treatment per se?

So for example, if it's for genetics,

I think you need to be

making sure that there's

someone in the building

that understands genetics.

So I'm a genetic expert in embryology.

I'm quite a rare breed because we...

I came to this quite in a different way.

But I also think that you

need to make sure that you

understand what's important to you.

So does the clinic grow

embryos to day seven, for example?

Are they going to keep them growing?

Will clinics allow you to use time lapse?

Because I still think that

is one of the most biggest

advancements we've ever had.

Is the clinic going to

monitor you properly?

So I think anyone that's

having treatment should

have at least four scans

during their stimulation journey.

Are you going to have a consultation?

Is it gonna be bespoke care?

Are you going to be,

all of these things that

are really important to you

in that list of questions

that I put together for me,

those are the things that

you need to consider when

choosing a clinic.

Do they freeze average quality embryos?

Are you going to be involved

in that discussion?

Can they do genetic testing

if you need it?

There's so much more to this

than just different clinics

offer different things.

And it really depends on

what your needs and your context is.

So some people need really,

really high level of care.

Other people don't.

I mean, some people don't need it.

It's really, really dependent.

So I would be the first

thing I would say is what's

important is what is important to you.

Yeah.

And I guess some people might know what is,

they might not know what is

important to them.

So they need to have

conversations with lots of

clinics to get a sense of what that is.

Yeah,

lots of clinics actually do open

evenings as well.

If you can tap them up,

lots of them do like a free, like we do,

we do a free open evening

or a free... Where's we for

people that don't know where you work?

Sorry, the Evewell,

I work at the Evewell

Harley Street or the Evewell Hammersmith.

They offer a free

consultation or like an

open evening thing so you can get a feel.

for the doctors and stuff so

yeah that happens in quite

a lot of clinics

So the questions,

and please do come to this

post after this session,

Emma goes into detail as to

why you want to ask these

questions as well.

So the top,

the top ten questions that we

came up with was how will you treat me?

Will you treat me?

Because actually there's also,

there's a lot of cherry

picking that goes on.

And actually some clinics

won't treat certain,

like going back to our lady

earlier with a low AMH,

there are some clinics that

won't touch you with a low

AMH because it affects

their success rate.

So you are more difficult to treat.

So the first question you've got to ask is,

will you treat me?

Yeah.

And then we have,

what are your success rates?

What is your multiple birth rate?

I'm going to talk about that.

Why do I ask what is your

multiple birth rate?

Well, you tell me.

Why do you ask that?

Because if it is really high,

someone is relying on unethical practice.

Your multiple birth rate

should be less than five

percent in this country.

Our multiple birth rate is one point six.

And that's because embryos

sometimes are little

monkeys and split and you

end up with identical twins.

So your multiple birth rate

of clinic can tell you a

lot about their practices.

It should not be that the

HFVA have put a rule on it

that should be under ten percent.

The HFEA is the Human

Fertilization and Embryology Act,

because I know you're

looking at me because I'm

not explaining it.

That's my acronym face.

So when I look at Emma to say,

you just said an acronym

and you need to say what that means.

So it should be under ten percent.

If it's over that,

then someone isn't isn't

practicing ethically.

It's not good.

You know,

twins sound like a great idea

that it's a very complicated pregnancy.

So I just want to get that in there.

Absolutely.

Do you run a seven day service?

And that isn't because about

the culturing embryo.

Sorry, you got me on a roll.

And that's not because of

the whole seven day culture

of blastocysts.

But you should if you are

running a seven day service,

it means that it doesn't

matter what day your egg

collection is to what

treatment you receive.

Yeah.

So just because you have an

egg collection on Tuesday

doesn't mean you shouldn't

be able to have a

blastocyst put back on a Sunday.

That's really important.

Yeah.

How is the embryology team set up?

How much will it cost?

How long will it take?

What do we need to do before we start?

That's a great question.

What support do you offer?

And what can I do to

increase my hour chances?

Yeah.

Check out that post.

It's really good.

I actually, that took me ages.

Yeah.

We worked on that one for a while,

but you know,

those are essential

questions to help people get started.

So do you want to take one?

Yeah, there was actually.

Where was it?

It was here.

This one.

Oh yeah.

From Archness.

Ah, Archna, brilliant,

who I believe has joined us

on a number of our webinars.

So thank you, Archna,

for joining us again.

Appreciate that.

Hello.

Where do you think the

science of embryology is going?

What has the potential?

Is on the verge of moving things on?

Or what's exciting for you?

Great question.

There's quite a lot of

exciting things going on at the moment.

So I think the way we're all

going now is we're starting to understand,

like I think I've done a

couple of posts on this as well,

we're starting to

understand that embryos

haven't read the textbook.

And just because they don't

behave a certain way

doesn't mean they're not viable.

So actually a lot of my work

at the moment is trying to

go into understanding

embryos that maybe before

hadn't been utilized

because we couldn't safely

do it to how we then turn

it around so that we can

safely use embryos.

So what I mean by that is

things like when they don't

look like they fertilize normally,

how can we then test

against them to make sure

that patients can actually utilize them?

Um,

there's a lot of stuff going on with AI,

but not so much AI in regards to, I don't,

I don't think AI will be as

brilliant as everyone thinks it is,

but it will help us as a

team start to have a better

work life balance to have

no mistakes about this

guy's embryology is one of

the most stressful jobs you can do.

You're in a, you know,

you're in a lab for eight

hours a day handling

people's dreams in your hands.

It's, it's, it's brutal,

but it's wonderful, but it's hard.

So AI is definitely going to

be what helps take the edge off our

the repetitiveness of it, I think,

and everything like that.

That's quite exciting.

Yeah, yeah.

And what excites me is a

couple of the genetics

papers coming out of the US

that I think will help us, again,

understand genetic science

a bit more and utilise embryos more.

Fascinating.

Watch this space because I

am at the front of this,

so I'm trying to get massively involved.

There's a thing you probably

can't talk about.

Probably can't talk about.

It's definitely very exciting.

Let's move on from that.

That is a good one.

Thank you for your question, Archana.

Really appreciate that.

Okay, should we take this one here?

No, I don't.

Here.

Oh, this one?

Yeah.

Okay, question from Susie.

Thank you, Susie.

Can you disturb embryos too much?

We've just thawed and

biopsied our remaining three embryos,

then refreeze,

but now debating moving clinics,

therefore disturbing the embryos again.

That is a great question.

So I love the term disturbing embryos.

So we talk about non-disturbing embryos,

especially when we're

culturing them because we

like to keep them in an

incubator where they should be.

So that's why time lapse

again is so brilliant.

You don't have to touch them

for five or six days.

Yeah.

In regards to disturbing

them when you're moving clinics,

they don't actually get

disturbed because if you can imagine,

they are in... I can't explain it,

but it's like a...

It's like a tube and it's

full of liquid nitrogen.

They're immersed in liquid nitrogen.

Essentially,

they have no sense of being moved.

No, so they won't.

Yeah.

So I suppose you have to

accept that the more we do with embryos,

the more risk there is.

If you're doing a risk assessment,

just because you're doing stuff with them,

we're humans and there's definitely that.

But I would say that they

are non-disturbed when you

move them between clinics.

They are kept under liquid

nitrogen the whole time.

We're also really used to doing it.

So it's something that's incredibly safe.

So that wouldn't concern me.

What would concern me is

you're in a clinic,

you feel comfortable to

have them transferred back into you.

I see.

Yeah, great question, Susie.

Hopefully that answers your

question there.

I think that was a follow up

from an earlier question.

Let's see if we can find that.

I might have missed that one.

Let me see.

Oh, there's so many questions coming in.

Thank you very much.

Oh, I might have missed that one.

But right,

let's jump to some of the

questions we had coming in

from Instagram.

So this question from Natalie,

if egg fertilizing ICSI and

defrost successfully,

does that mean implantation

failure is the female issue?

Yeah,

that's an impossible one because I

don't know the age of the embryo,

the age of the egg that

created the embryo.

So an egg can fertilize normally.

It can create a blastocyst.

It can be frozen.

It can then be thawed out.

it can then be put back.

But if the genetics of that

embryo are incorrect,

then it won't implant.

So that's not your implantation issue.

That's the embryo's quality control.

So what I would need to know

about that embryo is was it tested?

There's so many variables

around that embryo.

So no, not necessarily.

So you've got two elements.

When an embryo goes back,

you've got the embryonic

control and then you've got

the female implantation control.

And ultimately,

if the embryo's quality or

genetics blueprint isn't correct,

the quality control

mechanism kicks in and

actually a lot of these

embryos just don't make you pregnant.

It's nature's way.

It's bloody unkind, but it's nature's way.

It makes me think, like,

variables often come up,

and you often use the word variable.

Has any embryologist ever

tried to map out all the

variables and say, you know,

this type of variable has

more impact than this other variable?

Yeah, yeah, we absolutely do.

And you literally map it out.

Could we write that and post about it?

Or is it just too science-y?

Some of it's too science-y,

and some of it's a bit...

it's not noughts and ones, right?

Just because it doesn't work

for someone doesn't mean it

won't work for someone else.

I think one of the variables

that I talk about quite a lot is,

is it day five?

Is it day six?

Is it day seven?

That really,

really correlates to implantation rate.

And I think we've got a

question somewhere about

That OK, somewhere.

But yeah,

so the variables are very much

like that is a really big

variable in embryo

development and means a lot to me.

So when people talk about grade of embryos,

I always say it's what day was it?

Because actually a day and

I'll say this probably time

and time again,

a day five for BC will

still make you pregnant.

far higher rates than a day

seven five aa so it may

look better on paper but it

took longer to get there so

its chance of actually

being able to be in plant

and be a viable pregnancy

is much lower regardless of how it looks

And often,

I think I can gather that folks

get a bit caught up on the

scoring and what scores mean.

What's your caveat to the

audience today around scoring?

Grading.

Grading, sorry, grading.

We're humans.

We pick an embryo out of an incubator,

we look at it and we give it a grade.

And it's something that's

dynamically changing.

So the journey an embryo goes on is,

in my mind, more important than

the number and two letters

we give it at the end.

Because actually how it divides,

how it grows,

when it makes certain milestones,

all of that really

correlates really highly to implantation.

How it looks when an

embryologist looked at it

at nine o'clock in the

morning before it put it in

the freezer is not really

ultimately very scientific.

I can call an embryo a three

BC in the morning and my

colleague might call it a

five AB in the afternoon.

It's a changing entity.

Yeah, I see.

I think...

when embryologists try and

speak to patients about

quality and grade and all of that,

what they actually need is

the full picture of the

context of that embryo.

What did it look like on day one?

How did it get there?

When did it get there?

What movements did it make?

All of these things are really,

really important.

So I always say to patients,

don't fixate on the number

in two letters.

Because it's only part of the information.

And actually for me,

it's one of the smallest

parts of the information.

Because also, I'll be completely honest,

I am such a harsh grader.

and probably because I've

been doing it so long so I

have seen thousands tens of

hundreds of thousands of

embryos so my relationship

with embryos from

experienced eyes you could

argue that maybe I grade

too harshly but then a

junior who is got rose

tints on or something do

you know what I mean so

it's also I think we would

all agree that certain

embryos are good average

and poor I think we would

all put them in the right

buckets if that makes sense

because you're trained to

do because we're trained to

do that but we're not all

going to grade the same way

And I disagree so many times

on embryos that come in

from other clinics and I

thaw them out or I look at

them and I just, for whatever reason,

I just disagree.

Yeah.

And you, and I guess, you know,

I think of it like,

because grading feels like

it's quantitative,

like that there is direct correlation,

but you're kind of saying it isn't.

It's just a bit of an

indicator that helps you

make choices in a lab.

Yeah, actually,

it's more of a language

that we speak to each other.

So it's like if I say

something to one of my

colleagues and I give it a grade,

then my colleagues know

exactly what I mean by that.

It's an indicator.

It definitely correlates to something,

but it becomes a fixation

and there's so much more to it.

Yeah, and you wonder,

because there's quite a lot of,

we've seen quite a lot of

misinformation about grading and that.

Oh, that chart.

The chart.

Don't get anyone on a start on the chart.

Bloody chart.

I mentioned the chart.

It's awful.

It angers me, that chart.

If no one's seen it, it's on my Instagram,

I've pinned it.

It's got a great big red cross on it.

Please go and look, it's awful.

We have contacted the place

where it exists and they're like,

if you can show evidence that it's wrong,

we'll take it down and we're like...

We have plenty of evidence

that this is wrong and they

haven't taken it down.

They get too much traction.

Again, that's the case of Dr. Google,

the misinformation out there.

So this is why we're doing

what we're doing to try and

help clear up some of that

misinformation that's going around.

Just going to do a quick time check.

We've got just under thirty minutes.

Thank you for sticking with us, folks.

Take a little breath.

We've got a few more questions to go.

Thank you so much.

There's so much stuff coming in.

What we are going to do

Do you want one of these two?

That one on the left, good.

One on the left.

So, Georgie on Instagram asks,

can you tell egg quality

just by looking at the egg?

No.

No, you really can't.

Okay, that's a lie.

So if an egg is really dark

and poor and granular and

abnormal looking, then yes,

I can tell you that.

but actually I would say

ninety to ninety five

percent of the eggs all

look the same everyone's

eggs look the same and you

don't really get any

determination of quality

until you start turning

them into embryos and

growing them which is why

light bulb moment I find it

absolutely fascinating that

people think that you can

give people egg freezing

ultimate results on the

other side oh I see because

how how can you do that but

no no no you don't know

what sperm you're going to

put in yeah so when people

come to egg freezing and

they say right those eggs

are really good and you've

got about a fifty percent

chance of any of them

making a blastocyst that

they they don't know who

you're gonna meet and they

don't know what sperm is

going in it so how on earth

can you tell someone that I

find that bonkers

So who's giving that misinformation?

There's lots of places now

that will give you a report

with your egg freezing,

saying that these eggs look

a certain way and therefore

they are going to be

suitable for use in the future.

And they'll and fifty

percent of them are going

to make blastocysts.

But if you meet someone in

the future from an egg

freezing cycle who doesn't

have any sperm or is a really poor,

like a poor male factor,

that is going to impact

ultimately on the embryos

that you can create with those eggs.

Madness.

so yeah so no you can't tell

equality not from visually

sometimes you can see

certain things that might

make us make comments about

them um equally on the flip

side I've seen what

visually looked really poor

quality embryos that went

on to make a twin pregnancy

so I've I've just stopped

trying to guess to be

honest yeah they haven't

eggs haven't read the

textbook either they

haven't read the text they

don't know what they're

meant to look like they

don't know you know I like that line

There's no skincare routine.

I don't know.

It's fascinating.

Absolutely fascinating.

But kind of unfortunate as

well that there's companies

out there that can kind of

give you a bit of false sense of hope or,

you know.

Scare mongering and false reassurance.

Yeah.

You can't do that with eggs.

You just can't.

You cannot know.

You just can't.

It is what it is.

And actually certain

stimulation protocols can

make eggs look a bit funny.

But it doesn't mean they're

not genetically perfect.

So it's, yeah,

it's a lot to do with that as well.

Yeah, I get it.

OK, so another few questions coming in.

Here we go.

And you can point at one, Emma.

We're just having a read

through if there's a bit of

silence on the audio.

This one here from Todd.

Thank you, Todd.

I had embryos retested from

a defunct lab that were abnormal,

but retested by another lab

in twenty twenty four and

three were euploid.

Can I accept this or do I

consider them mosaic now?

Newer tech, question mark.

That's really interesting.

So it depends what the tech was.

So I think this is what I

was saying earlier about

older style technology now

being reverted into the

newer style technology and

then being regraded.

So when you say they were abnormal,

I wonder what the

abnormality was and whether

it was partial abnormality

rather than... So I haven't

got time to get into this.

I wish I did because it's

really complicated.

But the newer tech that

we've been using sort of in

the last three,

four years adds an extra layer of...

certainty to the test

results so I think you need

to probably consider the

fact that they could be

mosaic but most likely no

the older tech just was

incorrect for those

unfamiliar with the term

mosaic what does that mean?

Mosaic means that the embryo

has good and bad cells and

we now know that mosaic

embryos are actually really

quite viable at making

pregnancies without too

much affect I've always

used mosaic embryos I find it

hideously barbaric that people don't.

But they are again,

their success rates is lower.

So it's about making sure

that the patient has

genetic counseling to make

sure they understand the

theoretical risks around

using embryos with an unknown,

completely unknown entity

of genetics in them.

Most labs will offer genetic counselling.

Yeah, most labs will.

Oh,

we've got our own genetic counsellors

that we use.

So NHS as well?

No,

because the NHS don't offer PGTA testing.

So the NHS offer genetic

counselling when you've got

a genetic condition.

But not for PGTA, they won't offer it.

Because they don't offer that service.

But genetic counsellors aren't too bad.

They're about two hundred

pounds for a consultation.

And they're incredible.

The people I work with are brilliant,

brilliant humans.

Yeah.

Got it.

Good question there, Todd.

Thank you for sharing.

OK.

Right.

Let's take this one from...

That's come up a few times today.

Rosie.

OK, so Rosie,

you've asked a great question

that's on everyone's mind.

So the difference between

day five and day six.

Is D six much worse or a bit worse?

A bit worse.

So this is really interesting.

And I think that this is

something that I would love

to highlight a bit more

because when I say,

what day was your embryo on?

And there was a reason I

asked that because the

pregnancy rates between day

five and day six

with euploid embryos,

even with normal embryos, is reduced.

So you get about a six

percent loss between

embryos that were euploid

and biopsied on day five.

So they reached the

blastocyst stage at the textbook time.

Or those that took till day

six to get there.

There's about a six percent

pregnancy change between them.

Now, if that's in euploid embryos,

when you're talking about

unscreened embryos,

so embryos that haven't been PGTA tested,

the difference is actually a bit bigger.

And that's because actually

the longer an embryo takes to grow,

the more likely it is to be

genetically non-viable.

So of my embryos, so for example,

if in a woman that was thirty eight,

for example,

embryos that I test on day five,

the blastocysts that I test on day five,

about forty five percent of

those will come back normal.

OK,

but of the blastocysts I test on day six,

only thirty five percent

will come back as normal

because they've just taken

that much longer to get there.

So that correlates into pregnancy rates,

but equally, and I,

this fascinates me is that

even embryos that take longer to grow,

even when they're genetically normal,

do not give the same pregnancy rates.

So it is a bit worse.

It's not huge, but it,

It needs to be discussed

because you should go into

every embryo transfer,

knowing what your chances

of success are and knowing

your realistic outcome with

the embryos you have in the

freezer so that you can

make informed decisions

about whether you do

another collection or

whether you've got enough

in the freezer to create your family,

for example.

So that's what we talk about quite a lot.

And that's why I try and highlight.

The difference between day five, day six.

Now, day seven is when you said,

is it a bit worse or much worse?

Between day six and day seven,

it's much worse.

Right.

Because anything that's

taken genetically normal or not,

it's not functioning properly.

So its implantation

potential is actually quite small.

Yeah.

And you mentioned,

you said about having

discussions about family.

What do you mean when you say that?

So patients that come to you in a clinic,

having been trying to

conceive for a really long time,

I think we need to accept

the fact that actually by

the time you get there,

and I'm sure anyone on this

podcast will not mind me

saying how desperate you

feel once you walk into a

fertility clinic,

because you've probably

either been through

something really awful

that's left you there,

or you've been trying for

ages and actually you're

just beside yourself.

So all you want to do is get pregnant.

But if you're stood in front

of me at thirty eight,

the most kindest thing I

can do for you is say, right, fine,

we can get you pregnant,

hopefully get you pregnant now.

But if you only create a

couple of embryos and I put

one embryo back and I get you pregnant,

that's brilliant.

But by the time you've had that baby,

you've looked after that

baby and you're ready to have a sibling,

you're going to be nearly forty.

Yeah.

and it's going to be that

much harder to create more

embryos so sometimes the

difficult conversation is

we might just need to pause

for a couple of months

whilst we make sure you've

got enough embryos to

potentially have the family

you dreamed of before this

all got so crap yeah so we

talk about family building

more so than sometimes most

places I would say um I

know some people don't want

to hear it and that's fine

But I've been there.

We've been there.

It's you know,

you do just get this

desperation over you and

you just need sometimes it

takes someone like me to say, well,

what did it all look like

before it all got so awful?

Yeah.

Let's have that chat and

let's see if we can make that happen.

Yeah.

That's good.

I mean,

it's important and you can totally

understand why people just

can get fixated.

I just want this.

I'm not thinking about, you know, a second,

third or fourth sibling like that.

But you will be.

You will be in eighteen months time.

You absolutely will be.

And it's and that's OK.

And that's the conversations

we need to have.

Yeah.

Yeah.

Yeah.

You're never going to be as

young as you are today.

Yeah, it's good to emphasize that point.

Absolutely.

Thank you, Rosie,

for asking that question.

We're going to jump back to

some questions that have

been coming in on Instagram.

Done that, done that.

This one.

We've done that one.

That's those quite good

because that's PGTSR.

So yeah.

Yeah.

Okay.

So Alicia asks,

for anything in particular

when creating embryos, obviously PGTSR,

but curious if anything else.

Oh, no, she's talking about translocation.

So a translocation is

something that some people

have where they have all the chromosomes.

There are forty six chromosomes,

but they're in the wrong order.

OK, so it's called a translocation.

So you actually end up

making eggs and sperm,

what I call as gametes.

Yeah.

With more abnormalities than

normal because everything

gets shifted around the wrong way.

So that's called PGTSR.

There's nothing in particular.

We do always do ICSI with PGTSR.

There's another question

there about PGTM and how long it takes.

So PGTM,

for anyone who is listening to this,

is when we're looking for

an inherited genetic disease,

like things like cystic fibrosis.

And someone asked us,

how long does it all take

in regards to...

How long does it take from

doing the cycle of

treatment to getting to the

embryos being put back?

And what I think is really

interesting is it doesn't

actually matter for me what

genetic testing you're doing.

The process is the same.

I would create embryos,

biopsy them and then send

them to the lab.

It's the testing that's done

in the lab that differs.

But ultimately,

the turnaround time for the

results is always two weeks,

regardless of what you're doing.

Wow.

There you go.

The only thing to say is with PGTM,

you do have to do like a

six-week workup there.

You have to give them like

lots of information about

the patient so they can

make the test quite bespoke.

It's a good reminder,

all these acronyms coming

in and all this terminology.

If it's unfamiliar and it's

like flipping heck, this is overwhelming,

which it can be, right?

Absolutely.

Emma has created a very good

glossary of terms that you can find out.

So if you head over to

emmatheembryologist.com,

I think there's a link at

the top or in the footer

called glossary of terms

it's a post called things

you might hear in an ivf

clinic it's a huge list

quite an overwhelming list

it's in alphabetical order

you know you can do a

keyword search and just get

a bit of clarity on some of

the terminology but if if

there's something on there

that or something you've

heard that's missing

then get in touch with Emma and say, look,

I've heard this thing, whatever it is,

and I don't know what it means.

Send Emma an email.

I might not know.

Yeah, well, we'll find out.

But if I don't know,

then it's probably not in much use.

It should be on Emma's radar.

If it's not on my glossary

and I don't know what it is,

then I will either add it

or I'll tell you it's nonsense.

But you can contact Emma via the website.

So just head over to

emma.embraylogist.com.

Go from there.

We're going to take this one from Emma.

Okay.

Oh, no, we're not.

Oh, yeah, that one.

Okay.

So in one of my egg collections,

my eggs were described as oval shaped.

That egg collection was my

worst yielding round I ever had.

Could it be linked?

And why would my egg be oval?

um it's probably not linked

they do just sometimes come

out a funny shape yeah I

had one embryo once that

developed and made a baby

actually and on day three

it looked like a christmas

tree wow it was like a

really funny shape and they

lined up so like a

christmas tree I've got a

picture of that on my phone

somewhere um no shape

shouldn't really be a

problem why are they oval

shape I have no idea my love

Just happens.

They sometimes do.

It's really interesting, actually,

because most embryos are

just beautifully spherical.

Yeah.

But sometimes you get them

and they are just an unusual shape.

It doesn't normally correlate to anything.

It's just probably a bit like people.

Yeah.

Funny shapes.

It's all funny shapes and sizes.

A hundred percent.

Great question.

I was going to do this one, actually,

as well, because this one's really good.

Okay, this is coming in from Sophie.

Thank you, Sophie,

for asking this question.

We've just done our first round of IVF.

Ten mature eggs collected,

eight fertilised,

seven made it to day five, one frozen.

Which is brilliant.

Amazing.

I was day six... One was a day... Oh,

sorry, misread that.

One was day six CC, not frozen.

Grading was two plus five of

a three plus four AA, one...

times uh five bb three bb

the lettering part of it I

kind of understand but what

gets me is the number all

of them were day five

embryos so I don't get the

number difference any

guidance here so the number

doesn't correlate to the

day the number I think

that's a real misconception

that people think a five is

a five so the number

correlates to how big the

balloon of the embryo is so

imagine when an embryo is

forming it's filling up with fluid

And the reason it's filling

up with fluid is as it's

filling up with fluid,

the cells are dividing.

So the embryo is forcing

itself out of its own shell.

So it gets bigger and bigger

and bigger and bigger until

it makes cracks in the

shell and then it leaves the shell.

So when we talk about

embryos and being blastocysts,

we start with the number one,

which is a very, very early blastocyst.

It then goes to a two, three is full,

but not.

expanded four is expanded

five is hatching six is

hatched yeah so we use the

number to talk about how

advanced the embryo is in

its journey through its

blastocyst space but

nothing to do with nothing

to do with the day no yeah

you can understand that

misconception yeah it's

worth updating the

terminology to avoid that

confusion of I don't know

what else you would choose but

No, because everyone tries, like,

that's been around for so long.

David Gardner did.

It's the Gardner grading system.

Most of us use it.

And when people don't use it,

it really annoys me because, again,

it's the language we speak to each other.

So it's like someone not

speaking that language but

trying to describe the same thing.

I think it sounds like you

need to create the Whitney

grading system.

I haven't got time.

You imagine.

We should.

Don't worry, folks.

I'll get Emma on that.

We're not.

We're not.

This new grading system is

going to be a lot easier to

understand and reduce

ambiguity and anxiety.

Absolutely.

Do you want to pick one from there?

Yeah, let's do it.

Okay.

Top tips to maximise IVF

outcomes with three months prep.

I've seen this do magical

things to people.

So I think first of all,

you need to weigh up

whether you've got three months in you.

OK, so three months.

If you're forty two,

you haven't got you need to

be like if you unless there

is a reason for you to be

waiting three months,

then I think you need to be

cracking on if you are with

age related infertility.

So advancing maternal age.

But if you have,

I've seen some patients

really work hard for three months.

And the three-month prep is

you see a nutritionist,

you make sure you're on all

the supplements.

Obviously,

you cut out all the processed foods,

all the alcohol, everything goes.

You live a bit of a sedentary,

boring life for three months, no doubt.

But I have seen it totally

change people's fertility.

Like, especially it's been, yeah.

You think it's like...

of course physical but also

there's something going on

in someone's like head

where they're like right

I'm getting in the zone now

yeah I think that's that

but also the eggs take

three months to be produced

and so do the sperm so it

correlates to the health of

what you give us in the lab

to what we get to work with

embryologists are wizards

but we can only work with

the quality of what we're given yeah

We can't make stuff better.

We can't reduce the age of the eggs.

We can't take away genetic abnormality.

But I've seen patients go

from only getting like two

or three eggs in a cycle,

then going through a

massive three month

overhaul and getting eight eggs.

You're not gonna be one of

those people that gets twenty eggs,

but if you can give us more eggs,

then we've got more at the

top of the funnel to work with.

So I think there's a lot in it.

I think that especially for male health,

if sperm takes seventy two

days to be produced to the

time they're ejaculated,

I think there's a lot in it.

And you definitely see men

have been really ill three

months ago when they do a sample.

It's really poor because

actually the effect is from

when they were really

poorly three months ago.

So there's yeah,

I think there's a lot in it.

And I think people should, if they can,

invest the time

And actually,

I've seen people do that and

get pregnant naturally.

So I think it's there's

definitely there's some

really good nutritional

experts out there that can

help with all of this.

I wouldn't process to be one of them.

But you've got actually your

friends of the embryologist

on your website.

So Mel Brown's one of my

favorite people on the planet.

She's brilliant.

So do check out.

There's a link on the website.

Just some people that Emma works with,

you know,

in a different part of the world

of fertility that can

support patients that Emma

can't offer or the clinic

that she works at.

So, yeah, do go check them out.

You mentioned about like, you know,

you are wizards,

but you can't change the age of an egg,

for example.

Like, again,

coming back to that question

about the future,

do you think at some point

technology would be able to

reverse the age of an egg?

I mean, that sounds very science fiction,

right?

No, I don't think it does.

And I think there's some

studies going on at the

moment in mice about

bonkers stuff in ovaries

that are making them more able to...

Yeah, no,

I think you're probably onto

something there.

How it's going to come about,

I don't know.

And whether it will come

around in my lifetime, I don't know.

But you've got to remember

that our first IVF baby is

only forty six.

Louise Brown's ninety seventy eight.

She's forty six.

So and if I can even I can't

even tell everyone what's

happened in the last ten years,

that is the way this

landscape has changed so quickly.

um I I would say watch this

space because I think it's

there's stuff like that

coming for sure people are

trying it people are trying

everything it's fascinating

fascinating space

absolutely okay we gotta

just under ten minutes uh

before we wrap up today's ama webinar

that's a nice one uh this

one here yeah what emma

said ah thank you emma for

for sharing your kind words

thank you so much for doing

this you too oh it's our

pleasure it's an absolute

privilege to get to chat

with you today and uh we

are hopeful that these

sessions are helpful and if

of course we won't be able

to get through all of the

questions today that we've

had come through on

instagram and on the live

chat right now and also

when people registered um

But please do keep them coming.

We will use the questions to

help also write some

articles and do some future

posts on Instagram just to

try and address them and

help folks out there.

We do have some more from

the people that registered earlier on.

So should we take this one from Louise?

Yeah.

Okay, so Louise asks,

what sperm selection

methods do you recommend

for a patient with high DNA frag,

forty-nine percent,

and severe oligospermia,

five thousand per milliliter,

caused by late maturation arrest?

Is ICSI sufficient?

What about PICSI, Zymot, IMSI, et cetera?

We've got a couple of

questions around that.

So let's talk about what they are.

So high DNA frag is

something that's been

associated with recurrent miscarriage.

And actually,

you can see it sometimes in embryos,

they really struggle to

develop because an embryo

is driven by the mother's egg,

the maternal egg,

up until late day three.

And then on day four,

the embryo itself switches

on its own genetic control,

which is why when embryos

fail between day three and day five,

they look okay on day three,

and then they they don't

make it to blastocyst stage.

people always say it's the

man it's the man well

actually it's one of two

things it's either the

embryo itself so if the

information isn't correct

so if the embryo is

genetically abnormal it

will also shut down okay so

it might be nothing to do

with the sperm or it could

be to do with the sperm so

we see a lot of embryos

fail and then we find a

male factor so male factor

can come in varying forms

it can be severe which is

what louise is describing

is very severe maturation

arrest is something that's

actually going on with

testicular failure and

unfortunately with certain

parameters around severe male factor,

you never really find out

what's causing it and

there's not much you can do about it.

So your answer for these

cases is to do what you can

to try and get the DNA frag

to reduce as much as possible.

Unfortunately,

a Zymot is quite difficult

to do on low sperm counts.

You can,

but I would also say if you're

going to use a Zymot for high DNA frag,

you need to make sure that

it actually does the job it's meant to do,

which is reduce the DNA frag.

So you then need to get into

conversations about doing a

post-Zymot DNA frag check

to make sure it's not made it any worse.

Otherwise,

it can be quite counterintuitive.

I've used IMSI for years and

saw absolutely no difference.

IMSI is when you look at the

sperm under six thousand

times rather than four

thousand times to see if

you can visually assess it better.

Hand on heart, you can't.

I don't have a lot of

relationship with Pixi.

I've tried it.

I've done trials on it.

I quite like it.

It's very easy to use.

Again,

I've not seen any increase and I've

not seen any studies to suggest.

So I'm a bit of a believer

in evidence based.

I do think there is a place for a Zymote.

I really do.

It's a lovely bit of kit.

It's how you prepare the sperm.

And the idea is that you

you're almost putting it

through a bit of an obstacle course.

So you get the best ones

through this little slide.

But when you are dealing with very,

very severe male factor

that can't be corrected.

So what I will say is some

men have got really high

DNA frag from really bad lifestyles.

Vaping is about the worst

thing you can do for your sperm.

And crack cocaine,

but that's probably not

something for the entire

conversation today.

But vaping, which is now so common,

is one of the worst things

we can do for sperm health.

So things like that,

you can definitely correct, right?

So you can stop vaping and

then it will start to change.

And so there's definitely

things we can do for DNA frag.

But when it's in a situation

like Louise's,

It's incredibly challenging

because you are up against

something that probably

can't ultimately be made better.

So what we need to do is

work with what we've got

and try and do the best we can.

Yeah.

So, yeah.

Thank you for your question, Louise.

We hope that helps.

One of these.

Mm hmm.

From Jody.

Yeah, that's a good one.

Yeah, you want to take that from Jody?

Thank you for this.

Thank you, Jody, for your question.

What is the live birth rate for a five-day,

three-BB embryo that is

tested normal after thawed

biopsy for PGTA and re-frozen,

forty-year-old woman,

one live birth and three failed FETs,

all untested embryos from the same batch?

So the fact that it's been

thawed and refrozen

shouldn't really change its

outcome at all.

If it's handled properly,

you can thaw embryos out

and let them recover and

then biopsy them and then

put them back in the

freezer without too much harm.

My clinical pregnancy rate

from doing that is identical,

whether they've been frozen

once or whether they've

been frozen twice.

They do tolerate it.

I think it's something that

people are scared of, but actually...

You can do it.

It's quite it's as long as

they're handled.

OK, it's really good.

So what's really interesting

about PGTA tested embryos

is the age related success

rates goes away because the

reason that age related

success rates goes down is

because you are making more

abnormal embryos that are

less likely to work.

Once you are dealing with normal embryos,

it doesn't matter how old you are.

Everyone's pregnancy rate

and life birth rate is the same.

Oh, that's fascinating.

That is fascinating.

So at our clinic, for example,

the live birth rate with

PGTA tested day five, I'm presuming.

Let's call this a day five.

A day five embryo is fifty seven percent.

I see.

And it doesn't matter how

old the uterus is.

It's to do with the age.

It's to do with the fact the

age of the egg.

And the reason it's to do

with the age of the egg is

because of the chances of

it being normal.

Yeah.

But once you put normal

embryos back in women.

You get like a plateau of pregnancy rates.

So you normally get pregnant

with euploid embryos around

about the sixty five,

almost seventy percent mark.

There is still miscarriage.

We can't stop miscarriage.

We can't we can't change it.

It's definitely lower.

I think the miscarriage rate

with PGTA tested embryos is

about eleven percent,

whereas in the natural order of things,

it's about twenty five percent,

twenty two percent in natural conception,

one in three, one in four.

So it's definitely lower.

We definitely are negating

the miscarriage cause.

But I think it's really

interesting to say that

actually what I tend to see

is day five live birth

rates with PGTA tested

embryos is about fifty seven,

nearly fifty eight percent.

And then it drops a little

bit with day six to fifty

two because you've got that day five,

day six thing we talked about earlier.

Yeah,

but it's I it gets to the point where

I don't know.

Your age means nothing then,

because as long as we can

get your uterus to function

and we can get aligning and

we can make it prepared, then

Is that related?

You did a post on abnormally

fertilized embryos.

Do you touch on that within that?

No, that's called atypical fertilization.

That's another topic, isn't it?

Yeah, that's something I'm actually doing.

We're doing a presentation

on soon at the conference

because it's a big deal.

Yeah, absolutely.

Thank you, Jodie, for that question.

So Jocelyn,

thirty four with AMH twelve

male factor morphology,

but success fertilization

of four of our eight eggs

collected through IVF.

We had a day three transfer

of two times four cell embryos.

First IVF cycle.

What test considerations

guidance would you suggest

for a future round?

This is going to be a quick

fire round because we're nearly done,

aren't we?

So first of all,

thirty four with an AMH of twelve.

So with an AMH of twelve,

I'd expect you to be

getting more than eight eggs.

I think your stimulation

needs looking at through IVF.

So that's only fifty percent

fertilization without

knowing what the other eggs are.

I think you probably I'm

hoping they did ICSI

because you said they've

got male factor anyway, regardless.

A day three transfer to four cells.

So embryos should be between

five and eight cells on day three.

So unfortunately,

those embryos were quite slow.

I'm hoping you were told that.

What would I consider next?

I'd actually want you to see

someone that I'm hoping the

male fact has been addressed properly,

which would mean a urology referral.

You're only thirty four.

So you have got some time to

do that three months work

and make sure you've seen someone.

you absolutely should be having ICSI.

And given that your embryos

are not getting to the

right place at the right time,

I'd like you to be under

time lapse as well to see

what on earth is going on

and why they're slowing down.

You might need a continuous culture.

You might need to be in a different lab.

I hate to say it,

but we're not all created equal.

Some labs are just better at

culturing embryos than others.

But I think that male factor,

given you're only thirty four,

desperately needs like you

need a urology review.

Someone needs to have a look

at your partner.

Make sure that, you know,

you haven't missed

something that can be changed.

And then I'd look at maybe

getting a second opinion

and getting some stims sorted out,

because with an AMH of

twelve at thirty four,

I'd expect you to be

getting twelve to fifteen eggs.

I see.

Great advice.

Hopefully, Jocelyn,

that can help and give you

some next steps.

So we want to do one more.

Do one more.

Sneak one more in.

Yeah, we have gone over.

So thanks for sticking with us, folks.

Very grateful for you going past the hour.

I know we're breaking the rules here,

but why not?

Which one would you like to

take as a final one?

I can scroll back up if you like.

No, go down that.

But last one was quite good.

This one.

This one from Tony.

OK, so Tony asks,

thank you for this question.

Is there an average number

of untested day five,

six embryos that gives you

a good chance of a live

birth at age thirty seven?

I.e.

how do you know when to stop?

Oh, such a good question.

It's so hard when they're not tested.

And I do understand why

people do and don't test.

So we just have to go with the statistics,

Tony.

So you're a thirty seven.

The chance of each embryo

being normal on day five is around.

I can't remember the numbers.

I think it's fifty two percent, isn't it,

in that age group?

And then on day six,

the chance of an embryo

being normal is about forty six,

forty five.

There's always a drop of

about six or six or seven percent.

So I think you need to look

at it from that.

So if you are.

you know,

banking embryos for the future to

give you a chance of a live birth,

one live birth, I'd say maybe three,

three or four.

If you're looking to create a family,

then unfortunately this is

where PGTA comes into its

own because at least you

know what you've got in the freezer,

probably five or six to be

really sure that you've got

a good shot at three of

those embryos being euploid,

if not hopefully four in this age group.

It's a really tricky one.

And I would also be looking

at the time lapse and the

grades and stuff like that

to see if any of that,

because a lot of that

correlates to the potential

chance of the embryo working.

So you can have that

conversation if your

embryos are under time

lapse with the team to make

sure that they've seen good divisions,

good normality.

How do they look?

All of that.

Great advice for Tony.

Thank you for sharing your question.

Okay, folks, we're gonna wrap up today.

So thank you for being part

of this AMA and thank you

so much for all your questions.

Incredible set of questions.

Apologies that we didn't get

through to all of them,

But they're amazingly helpful.

They're really helpful

because I can start

building posts off these as well.

So there's always a common

theme in a lot of them.

So I can use that to help

build posts that will then

hopefully come as a more

generic posting type thing

that I can start to help.

Yeah.

So for those unfamiliar,

you can follow Emma on Instagram.

So at Emma the Embryologist.

Also do subscribe at

emilyembryologist.com.

You'll get access to the newsletter.

You'll also be able to access our podcast.

So we're going to do a lot more podcasting,

perhaps not as webinars,

but we'll record some conversations.

We'll dive into some deeper topics.

Some of the things that

we've talked about already

on our podcast podcast

We have discussed IVF one on

one just right back to basics.

That was a good one.

We did a whole one on PGT.

We had a discussion around

donor sperm and then also

the Vienna consensus and

choosing a clinic.

For some articles as well,

we mentioned a few already.

So the ten essential

questions to ask during

your consultation.

We've got the glossary.

Emma talks about her

personal story that she's been through.

The role of an embryologist.

That is a really good post.

Bigging up all the brilliant

embryologists out there.

and then the abnormally

fertilized embryo post as

well worth checking out

head over to

emilyembryologist.com for

that do subscribe do sign

up keep the questions

coming keep looking out for

each other we're very

grateful for you being with

us today and we wish you

all well and we'll see you

next time thank you

everyone take care folks bye for now