Is Brent Harvey Still Married, Articles F

Typically we see around a 95% survival rate. Statistical analysis by Chi-square demonstrates a significant difference (p=0.021) between clinical pregnancy rates of the two groups accordingly. Some evidence suggests a hatching blastocyst is more likely to split into twins although other studies have found no significant increase. Imagine taking a snowball and ripping pieces off of it the snowball itself gets smaller as each piece is removed. This is crucial information to understanding embryo grading! In the reproductive system, embryos and eggs naturally have a protective protein shell called the zona pellucida (ZP). Some clinics will discard these embryos, and its important to check with your clinic what their policy is on this. This stage is followed by blastocyst hatching and implantation. Why do embryos in IVF fail to implant or miscarry? First letter (A to C)- Inner cell mass (ICM) quality. Why do embryos arrest, or stop developing, and dont become blastocysts? 0000002341 00000 n Secondary outcomes were similar between groups: BPR (74.1% versus 72.9%, respectively, OR 1.1; 95% CI: 0.7-1.6), LBR (55.0% versus 50.0%, OR 0.8; 95% CI: 0.6-1.1) and EPL rate (18.9% versus 22.9%, respectively, OR 0.8; 95% CI: 0.5-1.2). This cavity collects water and allows for the embryo to expand as it takes in more water. Some might keep it simple and call them a 5, because its hatching. Purple columns show live birth success rates for day 3 transfers The skin of the balloon is made up of the trophectoderm cells that surround a cavity called the blastocoel, which is filled with water. I guess I'm trying to figure out how much the success rates decrease when the blast is a 4 instead of a 5. 0000058651 00000 n exciting. Before reading this please be aware that these success rates are based on large groups of women who were all treated in similar ways, at the same clinic (usually), with similar backgrounds (baseline characteristics, such as age, BMI, diagnosis, etc.). Embryo grading and success rates is a huge topic, as it will cover an embryos development, why embryos are graded, cleavage stage (day 3) embryo grading, blastocyst stage (day 5) grading, and look at different examples of these grades with wonderful pictures that have been donated to me by my supporters! Thanks everyone! All rights reserved. No symptoms whatsoever. Good luck! That's great. I'm assuming they froze it that way, since it was only defrosted for a few hours before they transferred. think twice before sharing personal details, foster a friendly and supportive environment, remove fake accounts, spam and misinformation, delete posts that violate our community guidelines, reviewed by our medical review board and team of experts. My first transfer was hatching / fresh and resulted in a single healthy baby. Read more about : Does ICSI Increase the Chances of Twins? According to Goto et al. Cent European J Urol. High quality day 5 blastocyst stage IVF embryoBlastocyst grading. We know thats a less than satisfying answer, but it does mean you shouldnt lose hope. You can see that the success rates for day 7 embryos are acceptable from the data above. If youre still confused after all of this and you want some extra help to understand your picture, I offer a service where I record a video and go over your picture for a fee. Without the protection of the zona, an FH embryo could be vulnerable to trauma during the transfer procedure. There is fair evidence that nonfully hatched euploid blastocysts have a higher chance of implantation than fully hatched euploid blastocysts. Researchers are now looking into another factor that could impact embryo assessment: metabolomics. Again, your day 5 embryos are typically graded according to a number followed by two letters. During ICSI, a single sperm is injected into an egg to fertilize. This isnt really a stage for an embryos development, but is when the egg is fertilized, or combined with sperm, as a part of IVF. Ploidy rate by blastocyst hatching status (fresh and FET cycles considered together). Study question: We have broken down the system we use for grading blastocyst success at ORM in the following chart: NUMBER: The degree of the expansion of the embryo's cavity, ranging from 2-6. Nov 20, 2013 at 7:38 PM. Usually around day 5 or so, the blastocyst forms. Heres a handy quick guide to help you put it all together: As mentioned, some clinics might use D in addition to ABC, while others may use A-F. Others may use grade I in place of A or use a + or - sign where an A+ would be a perfect grade. could make it more difficult for the embryo to hatch and implant. The ICM actually becomes the fetus, while the trophectoderm becomes the placenta! For women under age 35, the percentage of embryo transfers that "stick" (implantation rate) is almost 50%. These develop into the placenta and other tissues that your body needs for the pregnancy. Before First letter: Grade of ICM, which develops into the fetus, Second letter: Grade of TE, which develops into the placenta and other supporting cells. Research shows that 8 is best. Blastocysts in this analysis were all tested for aneuploidy, by NextGen Sequencing. 0000080636 00000 n Day 7 embryos work check your clinics policy on discarding them. Mine was basically fully hatched at thaw and stuck nicely! Therefore, we should expect success rates to be higher in this selected population as compared to the rates in unselected patients. Because of inconsistencies in grading cleavage stage embryos, in 2007 the Society for Assisted Reproductive Technology (SART) began requesting its US clinic members to report data in a specific way (Racowsky et al. After adjusting for age, BMI, endometrial thickness at the LH surge and oocytes retrieved in a logistic regression (LR) model, the hatching status remained not associated with IR (P > 0.05). Racowsky C, et al. Oocyte, embryo and blastocyst cryopreservation in ART: systematic review and meta-analysis comparing slow-freezing versus vitrification to produce evidence for the development of global guidance. On Day 6 the BB one changed to 6BA (it hatched!) Some embryos arrest because they cant switch from the stored maternal egg factors to the embryos genome, while others have metabolic issues. In other words, these statistics arent meant to be accurate for you personally. Of the 464 Ex/HgBl, 60.56% developed a gestational sac, while 105 CHBl (49.53%) had developed a gestational sac at the 7-week ultrasound (p=0.007). Group Owners uphold the core values of the brand by reporting content that violates the community guidelines. You can appreciate this by taking another look at the picture above and noticing how the ICM (around 9 oclock) is pretty hard to make out when the embryo is collapsed. What determines the embryos expansion? 9 between the rate of good-quality blastocysts (per D2 embryo) cultured under 5% O2 (good-quality blastocyst rate = 16%) and under 20% O2 (good . There are a few techniques that can be used to perform AH and the most popular technique is by the aid of a laser. Good quality (3BB) and poor quality (<3BB) were evaluated: Awadalla et al. Everything You Need to Know About Hatching Blastocysts, Fertility Help Hub. Ill explain the way I learned when I was an embryologist. Here are the two below the plane of focus: And heres the one thats above the plane of focus: Heres the original image blown up a bit, see if you can now see the 8 cells! Thank you to Wijnland for their expertise and detailed explanation of hatching blastocysts and assisted hatching during fertility treatment. Methods are provided for the non-invasive imaging of embryos to determine whether they are euploid or aneuploid. Craciunas et al. Embryos reach day 5 of development but havent hatched. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Federal government websites often end in .gov or .mil. Create an account or log in to participate. 4 = fully expanded cavity 100%. 0000003407 00000 n All my embryos were CCS tested too, CCS and PGD are very similar. This sometimes occurs when cells divide. Careers. FOIA trailer Please select a reason for escalating this post to the WTE moderators: Connect with our community members by starting a discussion. 0000080481 00000 n 10/10/2018 15:08. (2018) found live birth rates from day 7 embryos were about half of day 5 and day 6 (~25% vs ~45%) with no differences in low birth weight, malformations or early neonatal death. They want to see that each cell has a nucleus and that the cells are of equal size. 0000004090 00000 n This discussion is archived and locked for posting. Additionally, the study was limited to patients that developed high-quality blastocysts suitable for biopsy. Embryo grading is one step in a journey that may often seem endless. In humans, blastocyst stage of development occurs during the first and second week following fertilization(GAweek 3 and 4) and is described initially as Carnegie stage 3. Whats the Infertility Journey Like for Non-Carrying Partners? Lets dive in. eCollection 2022. 0000057970 00000 n My first FET (chemical pregnancy) was a 5 day embryo. (The size of the cake doesnt change when you slice it, but the number of pieces does.). 2: Blastocystthe blastocele is greater than or equal to half of the volume of the embryo. How many embryos do you have on ice? Hatching may not always take place but it is a necessary step towards implantation and pregnancy. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Copyright 2021. 0000005048 00000 n How many failed embryo transfers is too many? Wider implications of the findings: After the fertilised egg undergoes embryo culture for 2-6 days, it is . Biochemical pregnancy rate (BPR), implantation rate (IR), live birth rate (LBR) and early pregnancy loss (EPL) rate are similar in FH and NFH single euploid blastocyst embryo transfers. These develop into the fetus. Consult with your doctor before making any treatment changes. :). Remember that fertility treatment add-ons usually come at an additional cost so youll need to speak with your fertility doctor to understand if assisted hatching is right for you. Assisted hatching is safe and doesnt cause damage to the embryo. This process usually takes a few days. Last cycle we had a 4AB and 4AB/C put back without success so hoping for better luck with . On Day 5 there were three CCs and one BB. 0000014143 00000 n I think they said it increases their success rate. Theres still a lot going on here that researchers arent sure about. <]>> I know they perform assisted hatching on all the embryos before freezing them at the clinic I use. I transferred 2 in December- one fully hatched- in the picture i thought it was 3 embryos but it was the fully hatched embryo, the shell, and the 2nd embryo. Well talk more about why embryos arrest in the next section, but first lets discuss how often a day 3 embryo progresses into a blastocyst, or blastocyst conversion as its called. How compacted a morula becomes through this merging process is important for morula embryo grading. (2018) found that day 5 embryos performed better than day 6 regardless of grade (29.6% live birth vs 17.0%). You can think of them as birthday cakes divided into slices. This is good as a general guide, but newer research is showing that embryos with more than 8 cells have comparable success rates to 8-cell embryos. At day 3, embryologists use a high-power microscope to take a look at the morphology (a fancy word for structure) of the embryo. If youre having trouble getting pregnant, you might be considering IVF as a next step. We avoid using tertiary references. We strive to provide you with a high quality community experience. Theres a lot of research that has shown that embryos across all grades are able to lead to healthy births. I get into this in more detail in the post Genetic analysis of arrested embryos reveals 3 distinct types. More than 70 weedy seadragons have hatched at Birch Aquarium in La Jolla after a first-of-its kind egg transfer in the public eye. %PDF-1.7 % See this image and copyright information in PMC. The blastocyst continues to develop until it reaches the hatching stage. RESULTS: Of 698 FET's, 426 involved exclusively Day 5 embryos, 249 Day 6 and 23 Day 7. Use of this site is subject to our terms of use and privacy policy. (2019)states It is estimated that embryos account for one-third ofimplantationfailures, while suboptimal endometrial receptivity and altered embryoendometrial dialogue are responsible for the remaining two-thirds. Curious if that is a good sign or no? IVF pregnancy with fully hatched embryo. 2021 Mar 18;36(4):929-940. doi: 10.1093/humrep/deab014. Bouillon et al. Cleavage stage embryos with uneven cell size have lower implantation and pregnancy rates (Hardarson et al. Wijnland emphasizes that additional treatments like assisted hatching should only be offered to cases that meet the criteria so assisted hatching isnt suitable for every patient going through IVF. 0000031408 00000 n CCS Success (2007-2020) As pioneers of blastocyst CCS, our expertise spans . This is usually after an embryo is frozen with one grade, and then gets a different grade after it was thawed. 0000009510 00000 n Giulia et al. These fast growing embryos are growing a bit faster because they have more than 8 cells on day 3. In the second study there was a reduction in success rates, so this suggests the hatched embryo is more fragile. National collection of embryo morphology data into society for assisted reproductive technology clinic outcomes reporting system: Associations among day 3 cell number, fragmentation and blastomere asymmetry, and live birth rate. Morbeck (2017) did a review of 8 studies that drew conclusions based on whether the ICM, trophectoderm, or expansion were the most predictive for implantation: This is the kind of thing that should be deferred to the clinic. Ferreux L, Bourdon M, Sallem A, Santulli P, Barraud-Lange V, Le Foll N, Maignien C, Chapron C, de Ziegler D, Wolf JP, Pocate-Cheriet K. Hum Reprod. In cases where preimplantation genetic screening (PGS) or now known as preimplantation genetic testing for aneuploidy (PGT-A), assisted hatching is one of the techniques used by laboratories prior to biopsy to optimize the biopsy procedure. D is for extremely poor ICMs. From health conditions to hormonal imbalances, it can seem that there are so many possible causes of infertility. 4920 N Central Ave #2C, Chicago, IL 60630 Bookshelf This would be described as a hatching blastocyst with the highest quality ICM cells (first letter) and the highest quality TE cells (second letter). Periodic lab work and ultrasounds are done to monitor egg growth over the next 10 days. If you remember from my earlier section on blastocyst grading, the expansion, ICM and trophectoderm are the three features that are graded. Good Luck!!!! 0000031706 00000 n Embryologists can have a different opinion on what makes the qualities of these features good, fair or poor. If you feel a message or content violates these standards and would like to request its removal please submit the following information and our moderating team will respond shortly. Instead, the embryo just starts to grow out of the hole and the zona stays thick. After adjusting for age, BMI, endometrial thickness at the LH surge and oocytes retrieved in an LR model, the hatching status was not shown to be associated with implantation (P > 0.05). Some clinics dont even use the ABC system and have numbers, while others include D as part of their grading system or a + and system. Need help understanding your day 3 embryo grade and picture? Its kind of like the way youd make a good snowball. James et al. Embryo grading is very subjective, and not all embryos will grade embryos the same. The babies began hatching Feb. 26 and continued through March 2, according to the aquarium, which is at UC San Diego's Scripps Institution of Oceanography. Assisted hatching (AH) is one of these add-ons and was first suggested in the 1980s. In this grading method, three scores are given for three different . Bethesda, MD 20894, Web Policies Now you want to know how embryo grade impacts pregnancy success, right? Day 3 Embryo Blastocyst Example In other words is a 5BB better than a 3AA? Disclaimer: Any studies presented here may be contradicted by other studies. (2020) found that good prognosis women who transferred up to 3 euploid embryos (one at a time, for a total of three transfers) had a cumulative live birth rates of 92.6% by the third transfer. Theres likely more differences between clinics, because they may have different ways of training their embryologists, but even embryologists from the same clinic may have different opinions on grades. Mine cooking in there is a 6 day blast that hatched the morning of the thaw and was transferred by itself. At Fertility Centers of New England our laboratory scoring uses a descriptive expansion EB, B, or EXB (early blastocyst, blastocyst, expanded blastocyst) and cell composition listed as a numerical score 1-4, with a score of 1 being best. Your embryo (now called a blastocyst) is hard at work dividing and building up the number of cells. The pregnancy rate per cycle and implantation rate per transferred embryo was 42.1% and 19.4%, respectively, in the blastocyst group compared to 23.6% and 8.6%, respectively, when embryos were transferred on day 2. I was so sure it would work first go round for me, since didn't have any history of fertility issues and was young (30). (2011). Of course, the slow embryos that had blastocyst formation by day 6 and went on to expand, hatch, implant and make babies were strong and healthy all along just slower starters. In fact, its fairly common for transfers of good quality embryos to result in implantation failure. Embryos that have 8 cells on day 3 are dividing faster than embryos with 6 cells on day 3. A blastocyst is kind of like a water balloon. The result is a fertilized egg, sometimes called a zygote. Trophectoderm (TE) score, or quality - range A - C (A being the best) So the least advanced blastocyst would be 1CC, and the most would be 6AA. Naturally, implantation takes place approximately 7 days after fertilization but during IVF, the implantation process starts immediately after embryo transfer and implantation occurs 2-3 days hereafter. acog.org/news/news-releases/2016/08/increased-success-and-safety-in-assisted-reproductive-technology-by-using-elective-single-embryo-transfer, ncbi.nlm.nih.gov/pmc/articles/PMC5987494/, The 30-Day Guide to IVF Success: Diet, Chemicals, Sex, and More, Everything You Need to Know About Artificial Insemination, Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT, Signs Your Embryo Transfer May Have Been Successful, How Fertility Treatment May Affect Your Mental Health. Do the reproductive outcomes from the transfer of fully hatched (FH) blastocysts differ from those of not fully hatched (NFH) blastocysts? 4 studies showed the trophectodermwas predictive. 2019;72(3):296-301. doi: 10.5173/ceju.2019.1900. Some of the cells form the inner cell mass (ICM). Thats why its important to keep your eye on the goal. 1994. 0000003634 00000 n The nurse didn't make it clear to me. and transmitted securely. Your post will be hidden and deleted by moderators. This means that doctors can now transfer a single blastocyst with a good chance of success. But the first three failed cycles proved me otherwise. 2 = small cavity filling a third of the embryo. (2022), which looks at the % of mature eggs that go on to form blastocysts: You can read the full study in my post Age-specific blastocyst conversion rates and other IVF outcomes in good prognosis women. 0000013788 00000 n In the video Ill also spend some time going over the parts of an embryo, embryo development and how grading works, using plenty of pictures to make sense of it all. The usual way is by using the Gardner system, as I explained above. Instead of air, the embryo is filled with water and gets bigger, or expands, over time. Racowsky et al. Since the zona is gone, some worry that these embryos are more exposed and more fragile. Members of our FHH community (download the free app here) often reach out to us seeking clarification on fertility treatment. IVF; blastocyst hatching; comprehensive chromosomal screening; implantation; preimplantation genetic screening; trophectoderm biopsy. (847) 662-1818, 3800 Highland Avenue Suite 110 Downers Grove, IL 60515 2005-2023Everyday Health, Inc., a Ziff Davis company. What is the pregnancy success rate for frozen blastocyst embryo transfer in 32 yrs old woman? The amount of fragmentation (given as a percentage), How similar in size each cell is (symmetry), Fair/poor quality embryos: 11% live birth rate. Learn more about, Twins & Multiples: Your Tentative Time Table. Hatching blastocyst with average number of cells in ICM, even trophectoderm layer. Here are some pictures of day 5 embryos (blastocysts) and their grades. Your embryo is super strong and continued to do its thing after the thaw. %%EOF may be contradicted by other studies. Day 3 embryos are graded 1 to 4 (or 5) depending on the lab protocol with 1 being the highest grade. If youre looking for positive signs after an embryo transfer to indicate that you successfully became pregnant, there are several notable ones. Finally, well go over why embryo grading doesnt tell us everything. IVF can be a tough road, but it's not one you need to walk alone. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Artificial insemination delivers sperm directly to the cervix or uterus to achieve pregnancy. During the early blastocyst stage the blastocoel is simply growing in size. The statistics covered in this guide are highly dependent on maternal age, specifically the age of female at the time of egg retrieval. x. Advertisement | page continues below. Input your search keywords and press Enter. This would be described as a hatching blastocyst with the highest quality ICM cells (first letter) and the highest quality TE cells (second letter). Implantation rates also decline with female age due to a rising chance of chromosomal abnormality. Short Protocol. An official website of the United States government. We see significantly higher blastocyst implantation and pregnancy rates as compared to what we see with day 3 embryos. Cytoplasmic pitting has a negative influence on implantation outcome. Poor quality embryos work check your clinics policy on discarding them, Blastocyst embryo grading (Day 5 grading), Variability in expansion embryo grades by clinic or embryologist, ICM and trophectoderm grading for early blastocysts, Embryo compaction may make embryo grading difficult, How blastocyst embryo grades are reported, Day 5 (blastocyst) embryo grades and pictures. Hatching Blastocyst. This information, however, is not intended as medical advice nor is the advice tailored to any specific person or condition and it should not take the place of talking with your doctor or health visitor generally and, specifically, when you are trying to get pregnant. The sperms DNA is still highly compacted and decondensation needs to occur, as well as steps involved in reprogramming the embryos DNA so that genes involved in embryo development are activated. Thankfully, there is no variability in a 6. 0000034981 00000 n When an embryo struggles to develop into a hatched blastocyst, assisted hatching can be a viable fertility treatment add-on for suitable patients. The Author 2016. Assisted hatching is usually performed on either Days 3, 4 or 5 of embryo development. Generally early blasts have a lower success rate compared to expanded blasts, which have a lower success rate compared to hatching blasts. and more of your hatching-blastocyst questions. Chi-square analysis also demonstrated a significant difference between these two groups with regards to both rates of positive -HCG and the presence of a gestational sac. Expansions of 3 and 4 are also variable. Depending on how developed the blastocyst is, it can be called an early blastocyst, an expanded blastocyst or a hatching blastocyst. Eventually the embryo gets so large that it hatches or breaks free from its zona andthe sticky trophectoderm cells stick to the lining of the uterus to begin implantation and a pregnancy! Whats more important for an embryos grade: Expansion, ICM, or trophectoderm? Yes, avoiding a Robertsonian Translocation, but also couldn't get pregnant spontaneously (so have an unopened new pack of birth control I don't really care for in the bathroom taunting me). In the fresh transfer group, IR was similar between NFH and FH cycles (53.7% versus 55.3%, P = 0.99, odds ratio (OR) 0.9; 95% confidence interval (CI) 0.6-1.5). (2011)show that SARTs parameters (0%, <10%, 10-25%, >25% fragmentation) correlate well with live birth rates. Think of this as studying the chemical fingerprints left behind by processes that happen in the cell. He second pgd transfer attempt was nearly fully hatched and is a singleton. 0000031917 00000 n Some think it may be a way for the blastocyst to help the hatching process. This educational content is not medical or diagnostic advice. Alikani et al. Well also cover a bunch of research that goes over success rates for these embryos so you can get a general feel for how these embryos perform after transfer. These strings connect the ICM and the trophectoderm cells, and its not clear what their function is. Alternatively, frozen eggs can be thawed and fertilized, and the day the eggs are thawed will be day 0. Transferred one perfect 6AA fully hatched blastocyst - BFN! November 2013. Good luck! Group Owners uphold the core values of the brand by reporting content that violates the community guidelines. Live birth rate following frozen-thawed blastocyst transfer is higher with blastocysts expanded on Day 5 than on Day 6. STUDY DESIGN, SIZE, DURATION Retrospective cohort study. I have more information on this below. You can check it out in my post Predicting how many day 3 embryos make it to blastocyst. The retrospective study included 808 patients who underwent 808 cycles performed between September 2013 and July 2015 at a private academic IVF center. They also examine how many eggs people get with increasing age, the number that are mature, the number that fertilize, etc. I do know that my embryos were tested for the translocation and chromosome errors in general though as a few random errors were found in some embryos each time. A Grade 1 embryo has just started to take in fluid and show signs of expansion and is still in the early stages. Group Black's collective includes Essence, The Shade Room and Naturally Curly. Overall Blastocyst Quality, Trophectoderm Grade, and Inner Cell Mass Grade Predict Pregnancy Outcome in Euploid Blastocyst Transfer Cycles. (2000)found that the highest rate of blastocyst conversion was with day 3 embryos with 7-9 cells and <15% fragmentation (~35%-40%). FET #2 - June 2017. Studies of blastocyst collapse in different species of mammals have found that most blastocysts, that experience consecutive weak contractions, hatch successfully whereas those that exhibit strong contractions or collapse, fail to hatch. So in a 1/4 theres 4 cells. Participants/materials, setting, method: The https:// ensures that you are connecting to the Its used as a way to rank embryos for transfer, with the better quality embryos having a higher chance of implanting compared to the lower quality embryos. Design: Retrospective analysis in a private reproductive technology program. Every effort is made to provide accurate and up-to-date information. T32 GM007280/GM/NIGMS NIH HHS/United States, NCI CPTC Antibody Characterization Program. Zhu et al. I havent found too much research on it but Kirienko et al. Bad? ): But this doesnt mean that an embryos grade will dictate whether or not the embryo will implant. 5-day blastocyst implantation timeline Successful implantation of the blastocyst in the uterus is necessary for the fetus to grow. The first step of the IVF process is stimulating your ovaries to produce multiple mature eggs, using fertility medication. The educational health content on What To Expect is reviewed by our medical review board and team of experts to be up-to-date and in line with the latest evidence-based medical information and accepted health guidelines, including the medically reviewed What to Expect books by Heidi Murkoff. The views expressed in community are solely the opinions of participants, and do not reflect those of What to Expect. Scientific evidence suggests slightly improved chances of clinical pregnancy rates and with increased medical advances, a clearer understanding of the benefits of assisted hatching can be reached. Please enable it to take advantage of the complete set of features! The hole is in the middle and you can see where its squeezing out: In this case the embryo was likely assisted hatched to prepare for PGT-A, because the zona is still thick. Hum Reprod. We found no evidence of altered IR or other clinical outcomes in the transfer of FH euploid embryos. A blastocyst is a Day 5 embryo yet to fully understand what a hatching blastocyst is, we need to explain the early development of an embryo. Du et al. Transferred two each time Last cycle resulted in miscarriage at 8 weeks due to trisomy. Results: Of 676 euploid embryos included in this analysis, 464 were expanded or hatching (Ex/HgBl) and 212 were completely hatched (CHBl) at the time of transfer. The rubber skin of the balloon is like the cells of the trophectoderm and the golf ball is the ICM. Embryos with 7 or more cells on day 3 tend to have the best live birth rates based on this study, while embryos with 6 or fewer cells are predicted to do a bit worse.