This content is for educational purposes only. It has been reviewed for scientific accuracy, but it does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional regarding medical questions or fertility treatment decisions.
Reviewed for scientific accuracy by: Dr. Mona Bungum
Last reviewed: April 2026
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takes 3 minutes to complete00:00:06 Any embryo that's good enough to freeze or transfer has the potential to give you a baby. I've seen textbook quality embryos that don't result in a pregnancy in a live birth. And I've seen ugly embryos that go on to make gorgeous, healthy babies. Stop worrying about grading, okay? It's not like you're going to be 20% excited or 27% excited, or 37% disappointed. 20% excited or 27% excited, or 37% disappointed. It just doesn't work that way. You're either going to be 100%
00:00:37 pregnant or 0% pregnant. You're either going to be 100% excited or 100% disappointed. There's no middle ground, so stop worrying about grading. I often hear a woman say, well, I've had a four AA blastocyst transferred. It's a perfect embryo. There must be something wrong with me. Well, no. There must be something wrong with me. Well, no. This embryo still could be chromosomally abnormal, or there could be something else going on that we still haven't discovered.
00:01:08 I mean, we have done IVF for the past 40 years, but there's still things about conception that we don't know about. Success rates. They're funky and they're not what they seem. And understanding them is virtually impossible. So let's say clinic reports we have 40% success rates. So let's say clinic reports we have 40% success rates. What does that actually mean? Most people will jump to say, well, that means that we have 40% chance to take home a baby.
00:01:38 But in actual fact, it could mean how many people got a positive pregnancy test per embryo transfer, or how many people got a positive pregnancy test per egg collection. Or maybe how many people got a heartbeat per embryo transfer? Or how many people took home a baby heartbeat per embryo transfer? Or how many people took home a baby after the whole IVF journey, whether it be one cycle or ten cycles. All these numbers mean completely different things, and it's virtually impossible to compare them. Another factor you might come
00:02:15 across a clinic that has quite high success rates, and then you realize most of the patients are 35 years or younger. Right. And then you see another clinic next door that has lower success rates, but you realize they take on older patients harder cases and but you realize they take on older patients harder cases and their clinic is more equipped for that cohort. So if you fall into that category, I would absolutely recommend you go to the clinic with the lowest success rates, but protocols that are
00:02:46 suitable for you rather than the one next door with high success rates. But younger patients. I often hear the phrase conceived naturally or conceived via IVF. Like they're completely different naturally or conceived via IVF. Like they're completely different things, but nature still has a big role to play in your IVF cycle. These clinics are not taking over completely. There's no such thing as embryo staple gun. What these clinics do is they help you jump hurdles.
00:03:18 So if we take conventional IVF, we would put eggs and sperm together in a dish to leave them overnight to fertilize. The sperm now have shorter distance to swim, but there's still some The sperm now have shorter distance to swim, but there's still some swimming that needs to be done. So the analogy I use is swimming marathon, right? So if an marathon, a man usually would have to swim 6 to 7 miles. He now needs to swim five miles a shorter distance. Now both the egg and sperm
00:03:50 providers have a job to hand over the best quality raw materials. So the raw materials are the egg and sperm to the lab. Because if they hand over poor quality eggs or poor, Because if they hand over poor quality eggs or poor, poor quality sperm, the fertilization rate and ultimately the take home baby rate will be compromised no matter how experienced the staff are. So work on your eggs and sperm. Which brings me to the three months prior to your IVF cycle. It's an important time to
00:04:23 optimize your overall health. See if there's any fireworks going off anywhere in your body. Uh, any disbalances or inflammation. going off anywhere in your body. Uh, any disbalances or inflammation. Because the way we work is if there's something else going off, right? Our body is going to de-prioritize reproduction. Reproduction is the last thing on our priority list when it comes to focusing the energy and efforts. Right? And so taking care of the rest of your body is very important
00:04:57 as well to help with ultimately, egg and sperm health for men. as well to help with ultimately, egg and sperm health for men. Uh, men are very lucky. They produce a fresh batch of sperm every 68 to 74 days so they can work on their last batch before the IVF cycle. And what I recommend is during that time, while they're working on their last batch before they produce the sample for IVF is to practice regular ejaculation every 2 to 3 days. Abstaining for five days or longer is not a good idea.
00:05:33 It's a bad environment, not a healthy environment, because sperm crowd themselves and they start producing DNA fragmentation. And that's a big no no. Preimplantation genetic testing has improved a lot in the last decade. It's a more sensitive testing system. And because of that we're picking up many more mosaic embryos now. I'm a very visual person and so are a lot of my clients. I'm a very visual person and so are a lot of my clients. So I have made a model here. This is a model of a blastocyst.
00:06:11 A blastocyst is a day five to day seven embryo in culture. The cells you're seeing here on the outside are called the trophectoderm cells. And when we do embryo biopsies, we take cells from this layer. And these cells go on to form the placenta. I cut a hole in my model and the placenta. I cut a hole in my model and inside you see a clump of cells. Those are called inner cell mass. And those cells go on to form the baby.
00:06:39 Now when we take biopsy of cells for genetic testing, like I have done many times, we take about 5 to 10 cells from the outer layer. As you can see, some of the cells here that have painted blue, they are aneuploid. They have abnormal number of chromosomes, too few or too many. The white ones are euploid, which chromosomes, too few or too many. The white ones are euploid, which is normal number of chromosomes. Now let's say I take cells from this area where majority are blue. The result will come back as
00:07:16 high level mosaic. So most of them are abnormal. If I take a sample from here, this is just one abnormal cell. This can come back as low level mosaic, right? This can come back as low level mosaic, right? If I take cells from, let's say here where there's no abnormal cells, this result will come back as euploid no abnormalities detected. And so as you can see, depending on where I take the sample of cells, the result will come back different. Now a great study has come out and
00:07:53 they were donated many embryos. Blastocysts. And so what they did is they took biopsies from the outer layer, And so what they did is they took biopsies from the outer layer, as you normally do in a live case, as well as the inner cell mass, those cells that go on to form the baby, which we don't touch. Right. What they found is those embryos that came back as low level mosaic from the outer layer 50% of the time, the inner cell mass was absolutely normal, no abnormal cells. And those embryos that came back as
00:08:27 high level mosaic, right from the trophectoderm layer, the inner cell high level mosaic, right from the trophectoderm layer, the inner cell mass was normal 40.2% of the time. So what this tells us is when we take these samples for genetic testing, it's not telling us the whole picture, just the picture of that sample from the outside layer. It's very complicated. Taking home a baby via assisted reproduction can take time. It takes around three IVF cycles reproduction can take time. It takes around three IVF cycles
00:09:03 to have an 80% chance to take home a baby. What that means is you need to transfer all the embryos that are frozen in each of those cycles before you have an 80% chance to take home a baby. It's not a quick fix. So my job is to ensure that those IVF cycles, each one of your rounds, is productive as possible, and that they don't stretch into an eight grueling cycles without any answers. they don't stretch into an eight grueling cycles without any answers. I'm not here to guarantee you a baby, but I'm here to support you and
00:09:37 guide you with clear signs so that you can make progress and get answers sooner rather than later. Staying up to date with scientific advances is a huge part of my job. Fertility doctors are wonderful, but they're also incredibly busy and many of them don't have the time to look through new studies and evolving approaches. time to look through new studies and evolving approaches. And for some of doctors, they have people breathing down their neck to pump out as many cycles as possible. It's sad, but true.
00:10:09 So it's my responsibility to bring out any red flags and make sure they resolve between my client and their doctor. So I recently worked with a couple who were advised by their clinic to transfer 3 to 5 embryos on day three. Now it's a. I haven't heard of such advice in many years. I haven't heard of such advice in many years. It's archaic and frankly, dangerous. The clinic claims that the chance of multiples is low, but there is still a chance,
00:10:41 and there's a lot of complications that come with a multiple pregnancy, both for the mother and the babies. And so advice that they do not transfer so many embryos on day three. I follow the guidelines of the European Society of Human Reproduction and Embryology. They go by the abbreviated name Reproduction and Embryology. They go by the abbreviated name of Ashura. Now they are the gold standard in our field. Ashura brings together leading
00:11:09 fertility specialists, embryologists and research scientists to go through data and publish evidence based best practices in human reproduction. And so those are the guidelines that I follow.
