Your embryos are the most precious thing to you. You work so hard for them, so I want you to know what questions to ask.
That’s why I came up with this brilliant (I’m obviously biased) pneumonic called Embryo DIAMONDS. This is a very simple easy way for you to talk to your doctor so that you are sure to find out every single thing about your embryos and you won’t miss a thing.
I do consults for patients all over the country and world, and what I’m still surprised about are the things that people don’t know that they can ask for, and that’s information about your embryos.
I’m going to go through each of these letters now.
D: Day your embryo was transferred or frozen
D: The first thing is what Day is your embryo. Is it a day two, a day three, a day five? Was it transferred as a day three? Was it frozen as a day five or day six? Very important information for you to know. Why? Because that will guide you as far as the pregnancy chance per embryo. That’s really important for you to know, so that later on you’ll know if your embryos will help you reach my goals.
I: Implantation Rate
The I in DIAMONDS is Implantation rate. Just like diamonds, embryos get scores. You need to know those scores. Those scores, given by your doctor — and every lab is a little bit different. As far as the scores — they will help determine the implantation rate per embryo. Not all embryos are going to be the same, just like not all diamonds are the same. In order for you to know the success rate per embryo and if you have enough embryos for the family size that you want, you really need to know the scores and how they predict your implantation rate.
A: Abnormal Embryos
The next thing is this: Which embryo is abnormal? The thing is that you may not be doing genetic testing on your embryos, so you may not know the answer to this question. But it’s really important to know the power and limitations of genetic testing and make a decision that’s right for you, as far as whether you want to do it or not. For the most part, abnormal embryos, or embryos that don’t have normal chromosomes, cannot turn into a healthy pregnancy. Have a really healthy good discussion with your doctor about this first.
Now the M part. It’s a little bit controversial, but it’s super important for you to have full transparency with your doctor about what is mosaicism. ASRM came out with a statement this Summer, and I was so excited to see it, about how important it is for every fertility clinic to share their protocol for reporting and transferring mosaic embryos with their patients.
Clinics aren’t 100% there yet. I know for a fact, because again I talk to you guys over social media and through the consults that I do, and I see that patients aren’t getting this very important information. Why is this important? Because I have so many healthy babies that have been born from mosaic embryos. Just because an embryo is mosaic doesn’t mean that it will not turn into a healthy pregnancy.
It’s very important for you to do a post-test consult with the genetic testing company that is affiliated with the company that did the testing for you. A post-test consult also with a geneticist that’s not affiliated with that testing company or your clinic and please also talk to your doctor. These are the recommendations that I make for my patients. That’s why I want you to know what’s possible for you as well.
O: Official Reports
Now we get to the O, official reports. I’m so surprised, still to this day, that people don’t know that they can ask for them. They’re not given the reports. When I go through an IVF cycle with my patient, no matter what the outcome, I always do something called a post-IVF consult. During this consult, I am reviewing all of my patient’s official reports with them and giving them copies at the same time. We’re reviewing them and going through them line by line.
Again, you worked so hard for these embryos. It’s extremely important to me for you to learn from the experiences that you’ve had, especially if the experiences didn’t turn into a healthy pregnancy, so that you can be more informed about what your fertility diagnosis is and what you should do from here.
Here are the official reports you may want to consider asking for.
1. Embryology report. This report will have the embryo quality listed. Then you can have that healthy discussion about the implantation rate per embryo based on the quality.
2. Genetic report. You want to know “were my embryos screened for mosaicism”, and do that post-test consult as well with a genetic counselor.
3. Ultrasound reports. If you’re a patient in my practice, after each ultrasound I’m oohing and ahhing over your follicles. Seriously, when I’m doing an ultrasound, I see those eggs as sparkling on the screen. I give my patients their ultrasound reports if they want them. I know that not all clinics do that. I know that not all doctors scan their own patients, and that’s still okay. Asking for your ultrasound reports is one way for you to be more knowledgeable and in control of something that is certainly completely out of our control, and that’s what goes on with our eggs up until they’re retrieved.
4. Simulation Sheet. The next thing you might want to request is your stimulation sheet. With each update, I also hand my patients their stimulation sheet. Sometimes patients are just given an email as to what to do next and they don’t get that complete sheet. Sometimes looking at that sheet can be very helpful as far as learning from your experience and then deciding what you should do next.
5. Semen Analysis. The last but not least thing that you need to know, semen analysis. What was your sperm quality on the day of the egg retrieval? Get that report. It’s very important to have that in writing. When you ask for it, I should tell you that sometimes they say, “Well, I don’t do a complete analysis,” and that’s true, but we do get volume, concentration, motility, and these numbers can sometimes be helpful.
N: Normal Embryos
The N is which embryo is normal. When I say normal, it is very important for me to point out that all we can look at when it comes to embryos and their genetics when we do PGT-A is which embryo has normal chromosomes. We can’t tell you if your baby is going to be normal. Are any of us really normal at the end of the day? I have that discussion with my sister quite a bit. I digress.
My point is PGT can help you determine only if an embryo has normal chromosomes, but not if your baby will truly be what we determine as normal, because certainly we all have our own quirks. We can’t rule out everything, like things related to ADD, ADHD, Autism, and other things like birth defects.
D: Dreams Come True
The second D of DIAMONDS is dreams come true. Before you move on to an embryo transfer, I want you to ask yourself this, “Will the embryos I have right now help me reach my family size goals and fulfill dreams of family?” If the answer is no, take a pause, talk to your doctor, and go back and say, “This is what I want. What is going to take to get that? I’m certainly willing to do it.” Then go on from there.
I hear stories of patients who go through IVF and they do a transfer, and then they’re ready to have a baby two years later, and they wish that they had this information. That’s why I’m giving it to you, so you know what questions to ask and you know exactly how to ask it so that you’re more informed as a fertility patient.
S: Sperm Matters
Of course, I can’t finish this without talking about sperm. As you guys know, you’ve heard me say this before, I feel like we forget that it takes two to tango, and sperm is so important. It’s 50% of the embryo. Each embryo is an egg and a sperm cell. When you ask for the sperm report or semen analysis from your embryology report, it should be there, and you talk to your doctor, you want to ask, “Was the sperm the way you want it to be? Was it good? Next time, should we consider additional procedures? Do we need to do extra testing, like a sperm DNA fragmentation test? Would PICSI or ZyMōt help?” Sometimes we even do testicular extraction or use TESA sperm.
I really hoped you guys learned from my embryo DIAMONDS. Maybe one day I’ll come out with my own jewelry line. For now, I want to keep seeing your embryos sparkle and I want to make sure you guys are as informed as possible. Thank you for listening.
I can’t wait to see you guys in class. If you haven’t joined my Egg Whisperer School, please do. I don’t just try to be funny. I am funny, and I’m way funnier in class, too. Please join me.
Catch more of me and topics like this through The Egg Whisperer Show. Episodes are live-streamed on YouTube, Facebook, Twitter, IGTV and Apple Podcasts on Wednesdays at 7PM PST. Sign up to get my newsletter. Tune in to The Egg Whisperer Show on YouTube. and Sign up for The Egg Whisperer School.