How do we select good quality embryos? - Dr. Nirmala T S

Right now we are going with the morphological way of assessing whether the quality of the embryo is good or bad. But we can think about other options also, we generally today have a habit of transferring the embryos on the 2nd day or on the 3rd day. Once the eggs are retrieved from the body. We culture it only for day 2 or day 3. But there are ways that we would extend your culture upto the days 5 or day 6. We call that as a blastocyst culture. Anything that your culture in an external environment in a prolonged period is going through a lot of external environment stress. Second, the embryo carries its own potentiality to develop and grow further. So those embryos are thought to be a better survival ones. So they could stand a better chance of implanting, the other one is sometimes the egg shell could be very hard and that is one of the reasons why the embryo is unable to hatch out of the shell and attach onto the uterus, they go unimplanated. So there are techniques of laser assisted hatching, mechanical hatching, where you create a breech zone on the egg shell so that it cracks out and it attaches on the uterus easily. Yet another way of selecting embryos. So these are the ways of allowing the attaching or the implantation process to become better. The other way that has been though of and lot of research has been going on though we do not have any conclusive evidence is the metabolomics. It is nothing but understanding the fluid in which the embryos or the eggs are cultured to understand the various processes, the various material that are being secreted or utilised by the embryos. So that can give us a better picture whether that embryo is viable metabolically, not just morphologically, by its looks but is it really viable, but this needs larger studies to conclude yet another and the best way to understand that this embryo has the potentiality to implant is ofcourse the very recent technology which is in use which is called as the preimplantation genetics, which is screening, clearly preimplantation genetics screening gives us the genetic profiling of the entire 23 sets of chromosomes is analysed in this particular technique by one of the recent method is called as the next generation sequencing or NGS, as well as the mitochondrial DNA, as well as the mitochondrial disorders also can be understood though we do not have any great understanding of what could be the impact of the mitochondrial problems today, but for sure most of the chromosomal or the genetic disorders are very well understood.so we eliminate the embryos which are genetically chromosomally abnormal and give the uterus back the normal embryo. This would definitely take the pregnancy rate from where we are around 40 to 45%, it can easily go 60 to 62%. This again goes in line with the popular theory which says that whilst the uterus and the receptivity is important for an implantation process, what directs this implantations is a good embryo. So all that you need to do is give the uterus back a normal good embryo and there on it directs to direction and attachment and development of a baby.