During an in vitro fertilization (IVF) cycle, after the eggs are retrieved they are fertilized in a lab, where they grow for up to 6 days. Under the supervision of an embryologist, there is a range of growth milestones that good quality embryos are expected to reach and decisions are made based on what milestones are achieved and when. Here is a guide to what is happening in the IVF lab day-by-day and what you should know about each stage.
Day 0 in the IVF Lab - Egg Retrieval and Fertilization
The day of the egg retrieval procedure is considered Day 0. On this day you will have your eggs removed by your doctor under anesthesia and the embryologist will fertilize them. Fertilization with your partner's (or donor) sperm is done using either standard insemination or intracytoplasmic sperm injection (ICSI). Standard insemination occurs when the eggs and sperm are placed together and fertilization happens naturally. ICSI is a procedure where the embryologist injects a single sperm into each egg. (For more insight, read An Intro to Intracytoplasmic Sperm Injection (ICSI).) You should know in advance which method of insemination is going to be used.
If ICSI is the chosen method of fertilization, the embryologist will know at the time of injection how many eggs of the retrieved eggs are mature. Only the mature eggs will be injected with sperm because immature eggs do not fertilize. If standard insemination is being used, the sperm is placed with all of the eggs and we will only know how many were mature the next morning when we check for fertilization.
On Day 0 we know:
- The number of eggs that have been retrieved
- Possibly how many of the retrieved eggs are mature (If ICSI is performed)
- The quality of the sperm
For the most part, all eggs look the same at this stage and they are not graded.
Day 1 in the IVF Lab - Number of Eggs Fertilized Known
On Day 1 the eggs are checked for fertilization. The embryologists look at the eggs in the morning and can see which have fertilized by the presence of 2 round spheres in the middle of the egg. One of these is the genetic material from the egg and one is from the sperm. These 2 circles are known as pronuclei. All humans are a single cell for the first 24 hours of their life! It is likely that your embryologist or nurse will call you sometime during the day to tell you the number of eggs that fertilized. Fertilized eggs are also known as zygotes and they all look the same. The embryos are not graded on this day.
On Day 1 we know:
- The number of the mature eggs that have fertilized.
- On average 75% of the mature eggs will fertilize.
Day 2 in the IVF Lab - Embryo Divides
On Day 2 the embryos start to divide and should have 2-4 cells. The embryo itself does not grow bigger; the single cell that was the fertilized egg divides to become 2 cells and then 4 cells with each cell being half the size of its predecessor.
On Day 3 we know:
- How many cells the embryos have
- If the embryos are of good appearance up to this point
- An average of 95% of fertilized eggs will grow to the Day 3 stage
- The appearance on Day 3 does not tell us how many embryos will continue to grow
Day 4 in the IVF Lab - From Cleavage Stage to Blastocyst
Day 4 is a transformation day where the embryos are in between the cleavage stage and blastocyst stage. We usually do not look at the embryos on this day, but if we did we would see that some of them would be making the transition from a multi-celled embryo with clear cell outlines to what is called a morula which is the stage before an embryo becomes a blastocyst. Sometimes embryos do not reach the morula stage until Day 5.
Day 5 in the IVF Lab - Blastocysts are Graded and Transferred or Frozen
On Day 5, embryos that have continued to grow to become blastocysts will have formed a fluid-filled cavity in the center of the embryo surrounded by a flat layer of cells called the trophectoderm (the part that makes the placenta). These embryos should also have a clump of cells called the inner cell mass (the part that makes the baby). Blastocyst embryos have a more complicated grading system based on 3 factors:
- The size of the embryo - based on the degree of expansion of the cavity (graded 2-6)
- Appearance of the inner cell mass cells (graded A-C)
- Appearance of the trophectoderm layer of cells (graded A-C)
Therefore an embryo with a grade of 4AA would be classed as a good quality embryo. Anything with a B grade is classed as average and a C grade would be quite poor quality.
Embryo grading is not an exact science and it just helps us to get an overall picture of the appearance of an embryo. Grading helps the embryologist to choose which embryo to transfer within your group of embryos.
Try not to over analyze the exact grade of your embryos as we have seen babies born from all grades of viable embryos.
On Day 5 we know:
- The number of embryos that have continued to grow and the quality of these embryos.
- On average, only half of all Day 3 embryos will continue to grow to the blastocyst stage and the other half will stop growing after Day 3. Embryos usually stop growing because there is something wrong with their chromosomes. If an embryo stops growing in the lab it would most likely not have made a baby if we had transferred it.
- Not all embryos grow at the same rate. Some will grow faster and be ready for transfer or freezing by Day 5 and some will need another day’s growth to get to an advanced stage. This is a normal growth pattern.
- The best embryos are either transferred or frozen on Day 5 according to your clinic's policy. In general, pregnancy rates are better when blastocyst stage embryos are transferred rather than Day 2-3 stage embryos.
Any embryos that are frozen are kept in the lab storage tanks until you need them. Any remaining slower growing embryos are kept in the lab overnight and there may or may not be more embryos to freeze Day 6.
Day 6 in the IVF lab - Final Number of Embryos Known
On Day 6 we know the final number of embryos suitable for freezing. Day 6 is the final day in the lab for the embryos at most clinics. The embryologists will assess the remaining embryos and if they have continued to grow overnight they will freeze all that are of good quality. Embryos that have not made a blastocyst by this day are not viable and will not be frozen. Most labs do not grow embryos longer than Day 6 because they need to either be frozen or to be in a uterus after Day 6.
If you choose to undergo chromosome screening on your embryos, a single cell called a blastomere can be taken from each embryo on Day 3, or a small group of 4 to 5 cells can be taken at the blastocyst stage around Day 5/6. This is called embryo biopsy and is done before the embryos are frozen.
Chromosome screening allows us to select and thaw only genetically normal embryos for transfer in a frozen embryo transfer cycle. This type of screening is recommended for women who have had multiple failed IVF cycles or are of advanced maternal age (38 or older). The pregnancy rates are very good for all ages of women when the embryos have been screened before transfer.
Hopefully, this has provided you with some insight as to what is happening in the lab when embryos are created, typical growth patterns that embryos undergo, and the kind of information you can expect to receive while undergoing this process.