This is a guest blog post by Carole C. Wegner, PhD, HCLD featured on Fertility Within Reach (“FWR”) blog, a nonprofit organization that focuses on educating the infertility community on how to advocate for access to family-building benefits, including infertility treatment. Davina, the co-founder of FWR, believes that when individuals are armed with information and best-practice suggestions, they become their own best advocate to ensure their family-building needs are met and reproductive health is preserved. Davina’s personal experience of becoming a self-advocate came to benefit her in all areas of life, and inspired her to help others achieve the same feeling of empowerment. She says, “Using my voice and taking steps to advocate for myself leaves me feeling empowered and hopeful. Empowerment is contagious.” FWR recognizes that self-advocacy does not come naturally to everyone, so they provide step-by-step instructions, a strategic approach and supportive materials to empower individuals to effectively communicate with doctors, legislators, insurers and employers (all core groups that can have a major impact on your fertility journey).
In vitro-fertilization (IVF) procedures require effective collaboration and good communication between physicians, nursing staff and lab staff for each patient’s case. What happens in the lab is critically important for the success of the IVF procedure and clearly requires excellent communication among the IVF team members but to optimize both successful outcomes and patient satisfaction, effective communication between the lab and the patient is also essential.
Increasingly, IVF lab personnel (technicians or the lab director) are responsible for communicating directly with patients to convey updates on how the case is going. Over several days, patients will receive a fertilization report and then embryo progress reports on the number and quality of embryos available for transfer or freezing. Frequently, patient communication occurs over the phone but patients may also have a face-to-face conversation with their embryologist just prior to the transfer as decisions are made regarding how many and which embryos should be transferred. Unfortunately, unlike their clinical colleagues, lab staff are not typically trained in effective communication with their patients and some lab staff are uncomfortable with this role, especially if English is a second language for them. As a patient, you should know it is fine to ask for clarification if you don’t understand. Most embryologists are happy to explain the work they love to their patients. Here are some tips for better communication.
Make sure that your contact numbers are correct and current so that the lab can easily reach you when they have a lab update for you. Eggs are checked for fertilization and embryos are checked for their progression early in the morning at many centers. However, the time set aside for call backs will vary from lab to lab. Ask your clinic when you can expect a call from the lab and make sure that you provide the best contact number for calls at that time.
Ask your lab person to define any jargon you don’t understand. Sometimes lab staff forget that terms like blastocyst, morula, 2PN, zona pellucida and assisted hatching aren’t lay terms and use them without explanation when speaking with patients. It is perfectly fine to ask embryologists to slow down and explain what they mean.
You may be surprised that the number of fertilized eggs are less than the number of eggs recovered at the retrieval but this is normal. It is rare that every egg that is retrieved becomes fertilized and grows to a high quality embryo that can be transferred or cryopreserved. Eggs vary in their maturity and embryos vary in their genetic quality, both of these factors explain the attrition or loss rate that is common from the beginning to the end of an IVF cycle. It is appropriate to ask for an accounting of your eggs and embryos as the case goes on. Embryologists are responsible for this accounting in their daily work so they will have this information.
If the lab gives you a number or combination of numbers and letters (an embryo score) or “grade” for each embryo, make sure that they explain what the score means in terms of how likely it is that the embryo will continue to divide or implant if transferred. Keep in mind that an embryo score is a somewhat subjective ranking based on visual criteria for how fast the embryo grows and whether it looks “pretty”. Scoring systems vary between centers. If you are confused, don’t hesitate to ask your embryologist what the score means.
Specifically, the embryo score is based on several visual assessments made under the microscope such as:
- Is the embryo’s growth rate and stage of development appropriate for the time in culture? A beautiful 2-cell embryo is stage appropriate on day 2. By day 3, this same embryo-if unchanged in appearance- would be considered lagging and possibly dead.
- Are the cells in the embryo even and free of fragmentation? Embryos that have same sized cells without fragmentation receive better scores than embryos that have unevenly shaped cells or have fragmented cells. Fragments are pieces of dead cells that do not have a nucleus and will not continue to divide. Sometimes it is difficult to distinguish between small cells and large fragments which can produce a inaccurate embryo score.
Whatever the score, the thing you really want to know from your lab contact is: Do you expect that these embryos are likely to continue growing in culture or if transferred, are they likely to implant, based on your experience with similar embryos? Keep in mind that expectations are not 100% reliable; embryos surprise and disappoint us with their implantation capability all the time. However, the embryologist’s experience is useful to realistically set expectations and to understand decision points as the case progresses.
Patients may also get a call from the lab when the time comes to decide how many and which excess embryos will be frozen. Typically, embryos must reach “freezing criteria” in order to be cryopreserved. Over time, embryologists realized that freezing all embryos- even poor progressing or poor scoring embryos– is not helpful toward the patient’s goal of achieving pregnancy. Programs devised their own minimal standards (freezing criteria) for which embryos are apparently healthy enough to survive freezing and thawing in order to optimize the patient’s chances for success in a future frozen embryo transfer cycle.
Carole C. Wegner, PhD, HCLD blog Fertility Lab Insider is written for patients and the public and describes what happens behind the IVF lab door. Some previous posts that may be helpful background for a better dialogue with your IVF team include: