Jessica Manns | Understanding IVF: A Deep Dive into Embryology

In this episode of The Mama Making Podcast, host Jessica Lamb chats with embryologist and IVF educator Jessica Manns about what really happens behind the scenes in a fertility clinic. Jessica breaks down the IVF process - from fertilization and genetic testing to embryo transfer - while sharing her own experience with surrogacy and the emotional realities of infertility.

They dive into why education and support are essential for anyone going through IVF, how success rates are evolving, and what hopeful parents should know when navigating their options. This conversation blends science with heart, offering clarity, compassion, and community.

You can connect with Jessica:

• On Instagram at: @explainingivf

This episode is sponsored by Collabs Creative - a digital marketing company supporting makers, creatives, and small business owners with all things digital and design.

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Transcript

Jessica Lamb (00:57)
Hello everyone and welcome to the Mama Making Podcast. If you're new here, I'm your host Jessica. If you're not new, then welcome back. Today I'm very excited to have Jessica Manns on the podcast. Jessica is an embryologist and an IVF infertility educator, and she is helping people learn more about the IVF infertility process and providing support to families going through the journey. Welcome, Jessica. Thanks for being here.

Jessica Manns (01:19)
Welcome, Jessica. Thanks for being here.

Thank you so much for having me. I'm excited to be here. So tell me a little bit more about you.

Jessica Lamb (01:23)
So tell me a little bit more about you, who

you are, where you're from, whatever you're comfortable sharing.

Jessica Manns (01:27)
Absolutely. So like you said, I'm Jessica. I am from Pittsburgh, Pennsylvania. I was born and raised here. I have wanted to be an embryologist actually since high school, which is not the route that a lot of people always take. But I had to do a career research project when I was in high school. And I knew that I was really interested in women's health, but also really interested in biology. And I can kind of remember back in the day, you know, going on to Google and kind of trying to combine the terms and find, you know, women's health.

biology jobs or something, you know, and I stumbled upon IVF, at the time I'm 32, so it's a little bit ago. At the time it wasn't something that was as, it's not, but if you were to Google it now, it would come up right away. It took me a little longer to figure it out at the time. Google wasn't as great back then, I guess, I don't know. either way, I ended up.

Jessica Lamb (02:04)
It's not that long ago.

Yeah, for sure, for sure.

Yeah.

Jessica Manns (02:18)
learning about IVF and embryology and I was so fascinated with it. And from there I started reading more books about it from what was available and I said, this is definitely what I want to do. I want to be an embryologist and nobody knew what that meant but I was happy with the decision and so I started to kind of pursue embryology. At the time I didn't know exactly what you needed to do to be an embryologist so I went to my undergrad and I got a

my bachelor's degree in natural sciences at the University of Pittsburgh. And then I found this really great program at Colorado State University. It was a one year program hands on and you work with basically cow embryos, but you do IVF in the lab there and you take classes. And I got accepted and moved out there and loved the program, learned so much. It's really amazing. And I got my first job out of there in Charlotte, North Carolina. So I started embryology in 2018 in Charlotte, North Carolina at a clinic.

on there called Reach. I loved it.

We did move back home though, my husband and I, in 2022 for personal reasons. And at that point there were no jobs in the area. So I started traveling. So I became a traveling embryologist and traveled to about 15 different clinics since that time. And I've worked in the labs filling in. I've helped design new labs. I've helped do their first cycles. I've helped train. So I've seen a lot. I've done a lot. And that's kind of where I'm at right now. But I'm on a little bit of a break right now because I'm a surfer.

and I will be delivering soon.

Jessica Lamb (03:44)
Yeah, that's so cool to have such a wide range of experience. Obviously it might be nice to have like the regular day-to-day, nine to five, know what to expect. But I imagine if you're like someone who wants to be doing something new, have some new scenery and learn different things about different, how different clinics run and operate. I'm sure that's been kind of cool to get a multitude of experiences.

Jessica Manns (03:53)
Good

It's been amazing. I've met so many people. I've seen really how

differently, labs can operate. They all have the same goal. Everything runs very similarly, but just the different ways that people maybe make their dishes or the different time frames that people have for their procedures. so I've learned a lot and it's actually helped with the growth of my Instagram page, which you were telling everyone about explaining IVF. So I created the page back in 2022 when I was still, I just kind of shifted out of working full time and going into traveling. And I was thinking about a lot of the people that I had

to

talk to while I worked full time. And so many of them were in the process of IVF and didn't know what was happening in the lab. And I kept thinking to myself, you're investing so much time, so much money, so many emotions into the process, and you don't even know what's happening here. So I kind of went online and, you know, at the time there were articles about this is what ICSI is, this is what we do, but I said how great would it be if people could actually see.

what's happening to the eggs inside of the lab. And so with permission, of course, from the lab, I was able to take some videos and post them and it kind of took off from there. And so it turned into an educational platform that I think has really helped a lot of people.

Jessica Lamb (05:19)
Yeah, I can imagine I feel like when I've talked to other moms who have been through IVF They're they like know the terms in the lingo of what's happening, but there's this piece missing of like not fully Understanding what it all looks like so I imagine that is incredibly helpful to help families feel more connected to the process obviously when you're Conceiving naturally there's a whole other thing happening and so I imagine that

parents can feel disconnected from that beginning stage. So I imagine what you're doing has been incredibly helpful for families going through the process, whether they're just starting or redoing a cycle. And I know so much changes in the IVF world as well. I imagine that the content keeps rolling.

Jessica Manns (06:03)
Absolutely, yeah. And not only does it help them, but it's a way for them to show their families too. know, their parents might not understand what is happening, so they could say, watch this video, like this is what's happening in the lab. And I think that it just helps people, even if they're not going through the process, understand what's happening behind the curtain, you know, in the lab.

Jessica Lamb (06:19)
Yeah, that's a great point too, because I feel like families don't always know how to support. They want to and want to say the right things and might not always. But I think having a different perspective or understanding on what's going on can be really helpful to supporting their family member who's going through the process. Yeah, yeah. So can you share for the lay person or someone who hasn't done IVF before, can you explain

Jessica Manns (06:37)
Right, knowledge is power for sure.

Jessica Lamb (06:47)
what embryology is, what it looks like, like what does your day to day look like, and how does it all kind of relate to families doing IVF.

Jessica Manns (06:55)
Absolutely. So embryology really kind of translate to the study of embryos or the biology of embryos. so it's really everything that happens from a time that an egg is retrieved from the ovaries until the time that an embryo is transferred into a uterus. So it's sort of all the steps that happen in between. so basically, when you start the process, the first step is always the egg retrieval. And that means that eggs are actually taken from the ovaries

This is all done via a needle and an ultrasound and it's done by a physician. So it's not the embryologist that's doing that. But the embryologists will find those eggs in the fluid that's aspirated or taken from those follicles. And we'll find the eggs and then we'll place them into a clean dish. And we will make sure that they're cleaned and then we grade them based on their maturity as well. And that's something that is a little complex, but eggs go through maturation or development and we need them

to at a certain point of development in order for them to be fertilized by a sperm. And not every egg that we retrieve is always going to be at that point. Some are immature, maybe some of them don't survive. There are a lot of things that we can see at that point. But what we're hoping for is to get a couple of mature eggs that are able to be fertilized by a sperm if we inseminate them. And from that point, what we do is we actually do the insemination inside of the lab, unless you're freezing your eggs, I should say. You can freeze your eggs before they're inseminated if you would like to. Totally a viable

option to preserve your fertility or for whatever reason you might have for that. But we'll either combine the sperm and eggs into a dish together and leave them overnight in hopes that the sperm will fertilize the egg similar to what happens inside of the fallopian tube in the body. Or we do something called Ixii, which is pretty common. That's where we take one sperm and we inject it into each mature egg. And then we give them a couple of hours to do kind of do their thing to fertilize hopefully. And we'll check them the following day. So whether you do the conventional insemination where you put the sperm and eggs together or you do Ixii.

We'll check them the following day to see if they have signs of fertilization. On average, we expect to see about 50 to 80 % of those eggs fertilized properly, but it really depends on a lot of factors. I say it depends a lot when it comes to the lab, because it really does depend on a lot of factors every step of the way.

If they do fertilize though, we let them grow for a couple of days inside of an incubator. They're in a very specialized fluid that kind of mimics what's going on inside of the body to help them to optimize their development. Then we check on them a few days later to see how they're doing. And from there, we can decide if you want to transfer the embryos, freeze them, maybe do genetic testing on them. And at that point, we can either do a fresh transfer or we can freeze them for a later cycle.

I don't know if I answered your question all the way. I'm sorry. I get carried away sometimes.

Jessica Lamb (09:27)
No, that did. No, that's totally fine. No, that's perfect.

So is there a difference in success rate with the just like the natural way versus like letting them meet each other or doing the insemination?

Jessica Manns (09:40)
That's a great question. So between the conventional IVF, again, putting the sperm and eggs together in addition, it really depends on what is the egg quality like? What is the sperm quality like? What is your history of doing conventional IVF? Has it failed in the past? If so, it's probably not going to do as well as ICSI. If you have a poor sperm sample, it's probably not going to do as well as ICSI.

But there are cases where if there's no sperm quality issues, no egg quality issues, no history of prior failed fertilization with the conventional IVF, there's not a huge difference in success rates between the two. Of course, anything can happen. Sometimes IVF, we find the entire process is actually diagnostic, meaning you might not think that there's a problem, but then in doing IVF, you realize, maybe the sperm sample looks really great, but we didn't realize that there was really high DNA fragmentation in the sperm.

or the eggs maybe, there's a high number of follicles that are developing, but the egg quality is not great. And sometimes you can't see those things until you're actually in the process. But overall, ICSI is the more preferred method only because we know a sperm is going into an egg, where with conventional insemination, you're hoping that the sperm might be able to do what they need to do so that one sperm can fertilize each egg.

Jessica Lamb (10:50)
So would the patient choose what's happening or would the lab choose just based on what everything looks like?

Jessica Manns (10:55)
Patients always have a say in what will happen. And that's something that should be discussed with their doctor before they even start the cycle. A lot of times, clinics will even have you sign a consent saying, I'm choosing to do ICSE. A lot of clinics, I will say, automatically choose ICSE. But if conventional insemination is something you're interested in, just talk to your doctor. Ultimately, it's really up to you. But it's important that you know.

kind of the pros and cons of doing each. But a lot of times it's automatically icky and that's only because it ensures higher success rates.

Jessica Lamb (11:27)
Yeah, I imagine it's more efficient just to go that route as well. So with the genetic testing, what can be tested for? I know a lot of people who have had it and will say, got X amount of eggs and had X amount of embryos, but after genetic testing, we only have this many. What does that look like? What's the process? And then what are you guys able to test for?

Jessica Manns (11:29)
Mm-hmm. Yeah.

Right.

Yeah, that's a really great question. And I'll just do a little bit of backup here just to kind of give a general overview of what we're doing. cells inside of the human body, all of our cells should really have two sets of DNA, one from the egg that created us and one from the sperm that created us. So we have two sets of DNA, and they should be arranged into 23 pairs of chromosomes. So.

We have 22 chromosomes that are for, they're called autosomes and then two are sex chromosomes. XX is female, XY is male. So those are some things that we can test for when we do PGT. The most common form of PGT or pre-implantation genetic testing is called PGTA and that tests for aneuploidy. So that determines, does this embryo have the right number of chromosomes? Does it have 23 pairs or maybe is it missing one from one of those pairs? Does it have an extra pair?

A common example that we think of is Down syndrome, which is also called trisomy 21, in which case the embryo would have three of the 21st set of chromosomes instead of two. And as we know, Down syndrome is not a lethal disease, but it's something that can be tested for. And that's a very good example of what PGTA can test for.

But it can test for any of those missing chromosomes. And it can even now, with the more advanced technology, test for are we missing part of a chromosome? For example, are we only missing 1 fourth of a chromosome? In which case, that would be something maybe called segmental ineuploidy. So what we do in the lab when we test for PGT is we take about five cells from the embryo. And this is normally done on days five, six, or seven, depending on your lab's protocol.

And we're able to take about five cells. And the embryo at that point should have about 150 cells, give or take, depending on its quality. So we're taking a pretty small percentage. But the hope is that that sample that we're taking is representative of the entire embryo. Because as those cells divide, they replicate their DNA. Of course, things can happen in the process. But overall,

all the cells in that embryo should have similar DNA inside of them due to that replication process. So we're able to send a very small percentage of those cells to a genetic testing company. And then we typically freeze the embryos after. Very rarely do we do a fresh transfer because it takes about seven to 10 business days to get those results back. So most of the time, we'll biopsy the embryo, we'll take those five cells, freeze the embryo after, and send the samples to a genetic testing company.

From there, they're able to amplify the DNA inside of those cells. So they're able to make a lot of copies of the DNA, and they'll run the samples through an analyzer, which is able to say, OK, this embryo has the right amount of DNA, but embryo number two has an extra 16th chromosome, or it's missing a 16th chromosome. It can also tell you the gender, or the sex, I should say, of the embryo.

if that's something you want to know as well in certain countries. In some countries you're not allowed to know, but in the United States you're allowed to know the sex of the embryos as well.

And from there, you can decide, you know, is this embryo suitable for transfer or is it not suitable for transfer? But there is a little gray area in the middle too. So that's called mosaicism. And it's probably something that you've heard about. know, someone might say, I have four euploid or genetically normal embryos, two aneuploid or genetically abnormal embryos, but then I have a mosaic embryo. And that's an embryo that has a mixture of both normal and abnormal cells. So that means it's somewhere along the line during that replication.

maybe an error occurred. So maybe the embryo started with the right amount of DNA, but somewhere during the replication process, one of the cells got the wrong amount of DNA. Then that cell with the wrong amount of DNA multiplied, made more cells with the wrong DNA, but the cells with the right DNA multiplied and made cells with the right amount of DNA. So it gets a little sort of a gray area and there are percentages that the company goes off of. So every company is a little bit different, but if they look at the sample and they say,

80 % of the cells in this sample have the right amount of DNA. We call that euploid. But if 80 % of cells in the sample or more have the wrong amount of DNA, then they would consider it aneuploid. But maybe in the middle, somewhere around 20 % to 80 % normal and abnormal would determine the level of mosaicism.

As it gets closer to having more cells that are abnormal, it becomes a higher level mosaic. And as more cells in the sample are normal, it becomes a low level mosaic. And what we're finding is that a lot of low level mosaic embryos, depending on the abnormality, can actually result in healthy live births.

Jessica Lamb (16:14)
That's so interesting. I feel that would be definitely helpful to know going through the process of having a more layman's explanation. I imagine that, like you said, the patients always have a choice and option as to what they want to do. But I imagine that choice can be really challenging at that stage of things where you're like, well, the percentages say this, but

Jessica Manns (16:16)
Yeah.

Jessica Lamb (16:37)
How do clinics kind of navigate that part of things? Or it's like, well, do we keep them? Do we try to transfer them? How does that all work?

Jessica Manns (16:45)
Yeah, that's a really great question. It's something that actually is kind of a hot topic right now. And so what I think a lot of clinics do and what I think is a great idea is if you have questions about your embryos, meaning they're not euploid, they're mosaic or they're aneuploid, and you have questions about transferring them, definitely talk to your doctor. But maybe also consider talking to a genetic counselor. The thing is that some of these abnormalities might be OK for that embryo to live with. They might have high success rates.

that they could be something where the embryo wouldn't survive or if the child survived there could be severe conditions or severe complications, that's the word, severe complications if the child were to survive. so talking with a genetic counselor who has that information, because I know I don't have that information, you if you were to come to me and say, my embryo is 60 % mosaic for negative 15, what does that mean? I wouldn't know. But there are people out there, genetic counselors in particular,

who might say, look at that and say, that is this, this is the percentage of success, this is what could be like the potential complications that could occur. A lot of clinics though don't transfer aneuploid embryos and the reason is because they're very prone to miscarriage, which can then present complications for the person who's pregnant as well. So you figure that early miscarriages are typically due to genetic abnormalities in the embryo.

So most aneuploid embryos that are transferred do result in early miscarriages. And that can result in complications that could prolong the time between doing another transfer. There could be retained tissue from the miscarriage that could prolong the process as well.

It could also cause other pregnancy complications. So a lot of doctors are very hesitant to transfer inupolate embryos because they don't want to risk the carrier or the mother, the person who's carrying the pregnancy, being at risk as well. But again, there are always people that you can talk to. And sometimes people need that closure to say, hey, if you transfer this embryo, there's a really high chance that it won't work. And sometimes that is what they need to just be told that.

Jessica Lamb (18:50)
Yeah, I think things can be so unknown that being like, here's the percentage of how this, like to have a grading of it, I'm sure is helpful. And then obviously talking to a genetic counselor and having them be like, okay, here's what we've got. This is what you're up against. So in terms of the transfer, I know things have changed a ton in IVF where they were putting like a million.

embryos and hoping for the best. And now it's kind of rolled back a little bit. And just the people that I know where there's like one or two put in just to see how it goes. Can you talk to that a little bit more? What does that look like?

Jessica Manns (19:26)
Yeah, absolutely. I know it's so crazy when you kind of think back to not even that long ago when it was normal to put three, four, or five embryos into someone's uterus in hopes that one would implant. And really it has to do with the rapidly evolving technology and advancements that we've had in the field over the last few years. And some of those are prolonged culture. So it used to be that embryos wouldn't survive in the incubator after three days of development. And now we can have them survive really up to about seven

days. way different. A day three embryo versus a day five embryo, there's a lot of change that happens in that time. And so, we know that if an embryo makes it to day five, that it has a better chance of success versus a day three embryo. And the reason for that is a lot of embryos actually stop developing after day three. So, on day three, you might look at an embryo and say, hey, that embryo looks really great. But from there, we tend to see a lot of its progression kind of

fall, decline. And so by day five, you might not always have as many embryos that are available, but they're better quality and they have higher success rates than that day three embryo.

But back in the day, we were only able to go till day three. The PGT at the time was possible with day three embryos, but at that point, the embryo only has about eight cells. So there was higher risk of damage to the embryo. The technology wasn't nearly as good as it is now. To put it into perspective, mosaicism has only been around for maybe not even 10 years at this point. So it's very new. So the technology wasn't as good. And so they would put the three, four embryos in,

chances

of one in planting where we're okay, you know, where now we can do a day five embryo or day six or day seven even if you freeze them and one of them has I think even a higher level or higher chance of success than one or even maybe two day three embryos depending on age and everything. So yeah.

Jessica Lamb (21:15)
Yeah, and that makes sense.

mean, obviously the technology has changed a lot, but if they're not doing that testing to determine how viable it would be, obviously it would make sense to just put as many as you're comfortable. Whereas now you're able to do a lot more informed decision making.

Jessica Manns (21:27)
Yeah.

Right, yeah, mean, when you think about putting all of those embryos in at one time, so many people ended up with twins, triplets, you know? And so we're able to hopefully reduce the number of twins and triplets because even one embryo can split into twins. It does happen, but the more...

the more embryos, the more babies inside of the womb, the higher the risk of complications during the pregnancy or preterm birth, low birth weight. So those are things, again, we try to minimize. And by transferring one embryo, there's a much lower risk of high order multiple pregnancies. And there's a lot more singleton births that are occurring, which is really what we want. Twins are great. There's nothing wrong with that. But again, we have to think about reducing the complications during the pregnancy and during the birth as well for both the person

carrying the babies and the babies themselves.

Jessica Lamb (22:21)
Yeah.

So can you talk a little bit more about the transfer process? What does that look like in the lab? And then also, what does it look like for the person having a transfer?

Jessica Manns (22:31)
Yeah, so there are two types of transfers that we can do in the lab. One is a fresh transfer and one's a frozen. And if you're doing a fresh embryo transfer, that means that the embryo isn't frozen before it's transferred. And this usually occurs during an IVF cycle, a couple of days after a retrieval. And so what we would do is we would look at the embryos on day five. We would pick the best embryo, the one that's developing the most, the one that kind of looks the prettiest. And that's the embryo that we would choose for transfer. If you're doing a frozen embryo transfer,

we would look at what did the embryo look like before we froze it, know, during a previous IVF cycle. Like what day was it frozen? What was its grade? Did we do PGT on it? What are the, you what are the results of the PGT? And we would...

you ultimately, I think, would pick with your doctor. It's really up to the doctor which embryo to transfer. The lab follows suit with what the doctor says. It's very important. We don't kind of pick on our own. We have consents that we follow to make sure we're following the right embryo. So they'll pick the right embryo. We'll make sure that we have the right embryo because they're frozen in liquid nitrogen. So we're able to actually look and find the individual device that we froze that embryo on. So let's say you want to transfer embryo number one. So we would go in.

we would find embryo number one, which is in liquid nitrogen, and we would thaw that embryo. Any other embryos you have frozen would remain frozen in liquid nitrogen. But the one that we're going to thaw, we would place it into a warm thawing medium or fluid, which kind of allows the embryo to start to re-expand and really kind of resumes its development. Because while embryos are frozen, no development occurs. All cellular processes are halted. So it kind of lets the embryo resume its development again.

water renters the cells, it starts to re-expand, we put it into a medium or a fluid that allows it to continue its development. We do that a couple hours before the transfer. Every lab's a little bit different, but a few hours before to make sure it survives the thaw, to make sure it's re-expanding, to make sure it looks good by the time that we transfer it. That's all really important because we don't want to transfer an embryo that didn't survive the thaw or maybe doesn't look very good following the thaw.

But that's what we do beforehand. And then whenever it's time for someone to come in for their transfer, they'll come into the clinic and they'll go back to a room to change. Then they'll go to the operating room. They can bring a support person if they'd like to. Most clinics will allow that, although every clinic's a little different, so it's always good to ask. But usually you can bring a support person back with you, whether that's your partner or a friend or family member.

And you'll get set up on the, kind of just like if you were doing a pelvic exam, you would lay down, you would have your feet in stirrups. Most people are not sedated during the process. It's a pretty quick process, and unless there are any complications, it really only takes a couple of minutes. if you've ever had an IUI done, it's very similar to that in terms of the mechanics of it all. So what we do.

Well, the embryologist or someone will come in and ID you. And you'll usually get a picture of your embryo to take home with you. And they can talk a little bit about how the embryo looks and everything. You should always verify that it's the right embryo, of course. So say you wanted number one. You should make sure that it's you and this is your embryo and we're transferring number one. And there's witnessing that goes on in the lab the whole time too. So after that, the embryologists will go into the lab and they have a transfer catheter. And that's actually what the embryo will get loaded into.

And so they'll take the embryo out of the incubator. They'll ID it, make sure it's right embryo. In some labs, the patient will even get to see the dish. In others, they won't. It just depends. But someone will be there to ID it and say, OK, this is your name, and it's embryo number one. And then whenever the doctor is ready, the embryo will get loaded into the catheter.

and it'll get taken to the OR where you're at and then it will go, the catheter will go through the cervix into the uterus and everything should be seen on an ultrasound screen. So while you're laying there, you should be able to see the catheter coming into the uterus. It sometimes looks like a white line and when everything's in place, the doctor, you know, the doctor will manipulate however.

he or she needs to to have it in the right place and then we'll inject that embryo with a little bit of fluid into the uterus. And sometimes that looks like a bright light on the ultrasound screen and people call it a shooting star. And then the catheter is removed and the embryologist will take it back to inspect it to make sure the embryo doesn't stay retained inside of the catheter. It happens sometimes if it does, the embryo is just reloaded, shouldn't affect success rates. A lot of people get worried about that, but.

The embryo is in fluid the whole time, so it shouldn't affect the success rates of it. And if everything's clear, you are good to go. Your doctor will give you a couple of restrictions, and then normally you will take a blood test about 9 to 11 days later.

Jessica Lamb (26:59)
That's really cool to be able to kind of see it happen. I'm sure like there has to be some kind of like disconnect to how it's all operating. So I think being able to see it is probably so cool for the families.

Jessica Manns (27:11)
Yeah, definitely. and getting the picture too, I think, is really great too. I think that kind of helps to see what the embryo looks like. Sometimes you'll get the ultrasound picture of the flash or that shooting star we were talking about. So that's really nice too, yeah.

Jessica Lamb (27:23)
That's

awesome. So can you talk to the timeline it looks like? So from the time you do the retrieval to through the testing and then up until your transfer, what is the timeline like through that?

Jessica Manns (27:37)
Yeah, absolutely. Before you even do your egg retrieval, there's a process called simulation as well. So that's a little bit out of the lab's scope. But essentially, you inject medications or you take medications that help those eggs inside of your ovaries to develop so that by the time we retrieve them, we have a decent number of mature eggs that we're able to inseminate and hopefully fertilize. So that process can take anywhere from about

It takes about two weeks, give or take. And it depends on how the follicles or the sacs inside of the ovaries that the eggs are in. It depends on how they're growing, how your hormone levels look. But.

your doctor will determine when you're ready for your retrieval. So and again, that could be anywhere from it's like normally anywhere from about 10 to 14 days, just give or take. And the egg retrieval and insemination take place on the same day. So we call that day zero in the lab. Most labs give give embryos up to seven days to develop. So one week inside of the lab. And if embryos are ready on day five, they can be frozen or transferred on day five. If they need another day, we can look at them on day six if they need an additional

day, we can look at them on day seven. I've never worked in a lab that went past day seven. I don't think that that's something that's done. And the reason for that is even embryos that develop on day seven are pretty slow in development. They tend to have lower success rates. They can absolutely be successful. But their development's pretty delayed. And we find that embryos that aren't ready until day seven are often aneuploid or genetically abnormal. And their success rates just aren't as good as embryos that are ready on day five or day six.

That whole process takes about seven days. If you're doing a fresh transfer, that would occur on day five of that IVF cycle. If you're freezing your embryos though, or you're doing PGT, you have to wait until another cycle to do your transfer. So usually there is a cycle in between where you won't do your transfer, but you can do it as early as a cycle after. And that involves more medications, and we typically do the transfer a couple of days after.

when ovulation would occur in that cycle, which doesn't always happen because of the medications. But normally, it would be a couple days after when ovulation would occur, if it were your natural cycle. So normally, it's a couple of, might be like two months before you could do your first transfer. And some people choose to wait longer for any reason. But if that's the case, then.

You would come in for your transfer and again about nine to 11 days later you would do your first blood test to see if implantation occurred. And if it did, then you would go from there with more blood tests and ultrasounds as well.

Jessica Lamb (30:03)
So imagine if it is successful, you're just going through testing for a while just to make sure that everything looks how it should and is developing as it should.

Jessica Manns (30:12)
Yes, there's a lot of monitoring that goes on if you do have a positive blood result. So a lot of times, and again, every clinic's a little bit different, but you'll go in for your first blood test. If it comes back positive or even a lower positive, they'll have you come back normally two days later. And at that point, you want to make sure that the levels are rising appropriately. They might even have you come back a third, maybe even a fourth time, depending on how the levels look. And then from there, you'll schedule your first ultrasound.

occurs between like the fifth and sixth weeks of the pregnancy. Sometimes it's still too early to hear a heartbeat, but you can still see a little gestational sac on the ultrasound. And then you'll come back again maybe in a week or so. And then you'll, at that point, you might be able to hear the heartbeat or you can see the little yolk sac or something too. And then I think it's around nine weeks or so whenever you're released to your OB-GYN.

Jessica Lamb (31:03)
Okay, cool. And then, so if it is unsuccessful and it doesn't implant, what does it look like from there?

Jessica Manns (31:09)
So from there, if you were taking medications for your transfer, so normally that's estrogen and progesterone, you would stop taking those medications and that would induce your period to occur. And at that point, a new menstrual cycle would start. So from there, if you want to proceed with another frozen embryo transfer or another cycle, normally you would come back in.

whenever you're ready to start on usually cycle day three. So the third day of your cycle. might not, not that exact cycle. It could be the following cycle where you would come in and the doctor would just make sure that your ovaries look okay, your uterus looks okay, your blood level, blood hormone levels look okay. And from there decide if you're ready to start another transfer or not.

Jessica Lamb (31:49)
And typically how long do people have to wait until they do their next transfer?

Jessica Manns (31:54)
nor

It really doesn't have to be more than a month or so, but it does depend if your clinic has a wait list, if your doctor has a wait list, if you have personal reasons for waiting, maybe an event coming up or something that you don't want to miss or you don't want to have to be doing medications, maybe a vacation or a wedding or something. you can choose to, I mean, you can wait indefinitely if you want to. But normally, most clinics like to wait a cycle and then when you're ready to come back for your next cycle where everything is sort of balanced out,

hormone levels and everything have balanced out, that's when you can start again.

Jessica Lamb (32:27)
Yeah, I imagine they want you to be as optimal as you can be. Anything else about the process that you think people should know?

Jessica Manns (32:29)
Yeah, yeah, absolutely. Yeah.

The one thing I realized I didn't really talk much about, I was saying that the most common type of that pre-implantation genetic testing, or PGT, is BGTA. And that's looking at the overall kind of chromosomes. But there are two different types as well. They're not as common, and they're reserved for people who really need them. But they're called PGTM and PGTSR. they're used for people who have known.

genetic conditions or they're carriers of genetic conditions. say that me and my husband found out that we're both carriers for the same genetic condition. So maybe cystic fibrosis. We don't have cystic fibrosis, but we both carry it. And we found out that...

You know, there's a 25 % chance that if we have a child together, that child could have cystic fibrosis. There's a 50 % chance that they could carry it. There's a 25 % chance that they could be unaffected by it or not carry it. What a lot of people will do in those situations is something called PGTM, and that's monogenic. So the PGT...

The process is the same with the biopsy and everything. The difference is they're looking to see if that embryo is affected by that condition or a carrier for that gene or if they're unaffected. So that's something else that we can do.

PGTSR is if there's a structural rearrangement of the chromosomes. So maybe one is flipped. Maybe some of them have swapped pieces. And in some cases, they can be OK if they're balanced. In other cases, they could be lethal. And in those cases, if the parent has a known structural rearrangement, we can test the embryos as well to see if they have those rearrangements and how they look and if they're OK to transfer or not. it's something we don't do often, but it is something

something worth mentioning.

Jessica Lamb (34:11)
So do most people, are most people encouraged to do genetic testing prior to even starting the process on themselves just so they have a better idea or do you do people kind of just roll with it and see what happens as they're in the process?

Jessica Manns (34:23)
A lot of clinics will require a karyotype, which looks at the overall chromosomes. And that's where you can tell if there's any abnormalities with the overall chromosomes. And then a lot of clinics will also recommend carrier screening. And that's when you can look to see if you are a carrier for any gene mutations or variants that could cause those genetic conditions in the embryos. Sometimes they'll have one person do it. And if they are positive for anything, they'll only test the partner for those exact

Other times they'll have both people do both just to see. But it is encouraged. And even if you're trying to conceive naturally and you're able to do it.

It doesn't hurt because a lot of people don't know that they're even carriers. I everyone's a carrier for something or so I've been told. Everyone's a carrier for something and you might not even know it. And it's not until you're having issues getting pregnant or until you have a child that has a genetic condition that you realize that you both were carriers for the same thing. And so it's always recommended to do. A lot of IVF clinics do recommend it before you even start any of the treatments. But again, everywhere is a little bit different.

Jessica Lamb (35:22)
Yeah, just makes so much sense though. I imagine going into the process, knowing kind of what you're up against if there is anything. But then also when you said the specific type of embryo when it's transferred, if it's abnormal, will.

typically miscarry anyways. So that makes a lot more sense to me that people who are trying naturally and continue to have miscarriage, that there could be something like that where the genes aren't expressing well and that you're both caring for something or it's just not optimal.

Jessica Manns (35:51)
Right.

Right, no, absolutely. And that's why a lot of people choose to do it. PGT is recommended in some cases, but especially for women who are young when they do their retrievals, the data is a little up and down. Some say that there is no difference in the live birth rates. Others say there is. So it's hard to say, does everyone need PGTA? No, not technically. But it could.

get you a healthy pregnancy faster. So even if you're young, there's still a chance that you could have an aneuploid embryo. And even beautiful embryos are aneuploid or genetically abnormal. So if you don't do the testing, we could say, hey, that's your prettiest embryo. Let's transfer it. It could still be aneuploid. And so a lot of people who don't even necessarily need, per the recommendations, PGTA will do it because they say, I'm already investing so much into this process. Why would I not do the testing and know that I'm transferring a healthy embryo?

that chance of miscarriage or complications or something when I know there's something I can do to have a healthier pregnancy or to minimize my risk of miscarriage.

Jessica Lamb (36:58)
Yeah,

I mean, you might as well go all in if you're able to and have the option.

Jessica Manns (37:01)
able to.

Right, you're already investing so much into the process at that point. you know I always say to each their own, if you don't want to do the testing that's fine, it's just know the pros and cons, know the risks, that's the most important thing going into it.

Jessica Lamb (37:13)
Yeah, I think knowing what's available to you is key to any process of having a child. yeah, having the option to do that and see where you're at and where you're starting at to give you kind of a baseline, I imagine, has to be helpful in moving forward with the whole process.

So I would love to talk a little bit more about outcomes and success metrics. I know that that can be kind of a tricky conversation of figuring out what everyone's success rate is. Can you just give a general on that and your experience?

Jessica Manns (37:40)
Thank

Yeah, no, kind of, yes. And a lot of people hate my answer on this. once again, it just depends on so many things. It's so hard because I don't want to tell someone, oh, your chances of success are 60 % because that's just this ballpark average that we give. Because there really are so many factors that go into it. And so I hate to always give a general, because really in general, it's kind of anywhere from about 50 to 60%.

per IVF cycle. And that means that per cycle, there would be one healthy live birth. That might mean two or three embryo transfers. But from one cycle, if you have multiple embryos that you're able to freeze, there might be that 50 to 60 % chance that one of them will result in a healthy live birth. But there are so many ways to

skew this data to that it makes it really hard to give an exact amount because or an exact success rate because their age is a factor, your reproductive history is a factor, sperm quality is a factor.

Yeah, embryo grade is a factor. PGT status is a factor. There are so many factors that go into it that really it's so hard. I really hate to even say like, maybe about 50 to 60%. And that's why I always tell people if you really do want to know your success rate, ask your clinic what your success rate would be for you based on your age, based on your history, based on your embryo grade, because that's where you're really going to get the best.

estimate for your success rate. So I know it's not the answer that you're probably looking for, but I've really tried to let people know that don't always listen to what you're reading online. There are really good IVF success calculators out there, you know, through the CDC or through SART, and you can definitely look into those. They pull a lot of data from different clinics and everything, so you can certainly look into it, but just know that there are so many factors going into it that really it's so hard to get even an estimated success

right.

Jessica Lamb (39:41)
Yeah, no, I think that's the perfect answer because I mean even just hearing more about the process obviously I know like age and your history and how many miscarriages you've had or whatever it might be That's obviously a factor, but then also hearing how much good is on like the the actual Embryo side of things it's it makes so much sense that like everybody is dealing with a different set of circumstances and genetics

And so I imagine unless you're talking to your doctor who knows exactly what you've got going on, I imagine it's gonna be hard to get a really concrete success rate.

Jessica Manns (40:11)
Yeah.

IVF is not one size fits all. It's actually very unique to each person and so finding a doctor that takes the time to really look at your history and your health and your conditions and your factors, it makes a big difference especially when it comes to trying to figure out your success.

Jessica Lamb (40:32)
Yeah, absolutely. So with a few minutes

left, do you want to chat a little bit about your surrogacy journey and what it has looked like for you on the IVF side?

Jessica Manns (40:41)
Yeah, absolutely.

Yeah, so from the IVF side, I actually had nothing really to do with that process. I was really only involved in the embryo transfer process. I was matched with a great couple through an agency, which I preferred to do instead of doing it myself because I just wanted to know that someone was guiding me through the process, that it was taken care of legally and everything. And it protects both me, the baby, the parents. I wanted to make sure that was all in order. And so when I met them, their embryos had actually already been

created. So they were just frozen and they were waiting for me. And so I went in and I did some medical screening through their clinic and we did some psychological evaluations and paperwork. My husband did some paperwork. He did an evaluation as well. They needed to make sure that I was healthy and kind of looked at my history and everything and

Once I was cleared for that, we kind of got started with the whole transfer process. So I went in for my baseline scan, like that day three, the menstrual cycle scan to make sure everything looked okay. I started taking medications. I did the PIO injections, which were unpleasant, but you know, anyone who's done them knows they're just a necessary evil, I guess. So I did those and we did the transfer. The embryo was great. It was so cool to be on the other side of things.

where I got to actually see the flash on the screen and it was really amazing and then we did our blood test a couple days later. One thing that was kind of interesting was the blood levels didn't necessarily double from the first to the second and so I got a little bit nervous because sometimes knowledge is power but sometimes ignorance is also bliss, you know? And so when they called with my second results I said,

I thought that the numbers were supposed to be higher by now, so naturally my brain was thinking all kinds of things. But then we went back for the third and it did rise and everything ended up working out. And all that is to say that the numbers aren't everything, you know, they're important, but it's hard to not sort of put yourself on a spiral whenever you go online and you say, these numbers should be doubling every, you know, two to three days. And granted, it was only two days and it hadn't doubled. So maybe by the third day it had, but, you read on

online and go down the Google rabbit hole of, yeah, and it's hard. So that was a little bit difficult, but everything worked out. I'll be 34 weeks on Thursday. So we're so excited about it. Yeah.

Jessica Lamb (43:04)
I would love to know what kind of propelled you to do the process. I imagine knowing a little more than the average person was helpful. But what made you feel like this is something I want to do?

Jessica Manns (43:14)
Yeah, it's a good question. You know, it's something that I've kind of always had in my heart, to be honest, and working in IVF and getting to meet, I'm sorry, getting to meet a lot of people who are surrogates or gestational carriers, really, and just seeing, you know, the look on the parents' faces and how happy they are, it really kind of moved me to say, you know, this is something that I really want to do. And so I do have a daughter, she's almost four, and my husband and I both said, you know, we were done building our family.

that's good for us. think having multiple children is great but we are very happy with just having one and I said you know I'm so young and I know that I can have a child so why not

help someone who can't. And he was all for it from the beginning. So having that support was really great. I think I got really lucky because we're both very supportive of each other. And had he not been supportive, I don't know if I would have done it, but he said, hey, if it's what you want to do, then I'm here for you. I got your back. So that kind of propelled me forward. And I applied with an agency.

and I got accepted. I wasn't sure because it's very, very critical. They look at everything. They kind of dig down deep on you. And I'm like, well, maybe they'll find something. I don't know. But they approved me. And so I was able to start the matching process from there. And I felt really comfortable the whole way, which is really great.

Jessica Lamb (44:30)
That's so amazing. think being like called to do something like this is really cool. It's obviously there's going to be some hard parts to it. Obviously the medications and then like pregnancy itself is hard delivery, but I think it's such an incredible gift that you're able to give someone and I'm sure you're helpful to them through the process as well. Cause you are a little bit more intimately aware of what it's all like. Then I think also on the other side, you're able to see it from

Jessica Manns (44:35)
Obviously there's going to be some hard parts to it.

Yeah.

Thank

Yeah.

Jessica Lamb (44:58)
the other side of the coin as the patient kind of know a little bit more about what all goes into it.

Jessica Manns (45:04)
Absolutely. Yes, they're so nice. They always remind me how they said, you know, we're so lucky. What are the chances we ended up with someone who knows so much about the process? And, you know, I critiqued that embryo when I saw it on the screen and I said, OK, that embryo looks good. I know it looks good. So when I saw it, I was like, I'm going to, you know, I'm going to give this a good once over and make sure it looks OK. But yeah, it looks good. And yeah, it's been nice. I've been able to walk them through the whole process. And even, you know, I as an embryologist,

Jessica Lamb (45:18)
Yeah.

Jessica Manns (45:32)
them through the IVF process, the transfer process, but then also having a child myself, I'm able to walk them through the, you know, I feel this but that's normal, you know, or this happened but that's normal.

Yeah, kind of take away some of the fears that people have during a first pregnancy, whether you're carrying the child or not. You you hear, for example, I failed my first glucose test, which I didn't do my first time around, but I did. But I passed the three-hour one. But I said, you know, I failed it, but it's OK. We're going to do another one. But you know, for someone who is the first time in it, they might be freaking out. And I say, it's OK. This happens. And we're going to take it from there. So.

Jessica Lamb (46:07)
Yeah, and I imagine

going through IVF, you're, from the people that I've spoken to, you're just like waiting for the other shoe to drop. And so I imagine like, it's hard to be super invested in a successful transfer when you know that the chances of it continuing might be lower than average. So I imagine being able to, like you said, being armed with knowledge of how the process is going, but then also having had a pregnancy experience already.

Jessica Manns (46:20)
Sure.

Jessica Lamb (46:32)
I'm sure that's been so helpful to the couple.

Jessica Manns (46:35)
Yeah, yeah, absolutely. Any first pregnancy, think, is terrifying on so many levels. But especially, yeah, if you've been through IVF or you know someone who has struggled with getting pregnant or carrying a pregnancy, yeah, I think it's a terrifying, especially that first trimester when you don't really know what's going on inside of your body. And so it really could be terrifying for so many reasons. yes, like you said, you're always, especially with IVF or if you've had a miscarriage in the past or have had trouble getting pregnant, you're just waiting for that shoe to drop.

And unfortunately, it makes sense. It's very valid. It's a valid fear. But I wish there was a way to kind of get rid of that fear. yeah.

Jessica Lamb (47:11)
Yeah, yeah, I think it's a natural, not consequence,

but a natural next thing that you're just like always expecting. But I would love to talk a little bit more about the work you're doing on social media to start sharing more with other people about the process and then offer a little bit more support to those going through it.

Jessica Manns (47:31)
Yeah, absolutely. the social media is actually a little bit twofold right now. it kind of developed into, it's not only educational, but I'm also trying to strengthen the community a little bit more too. Because yeah, there's the whole technical side of IVF. Being in the embryos in the lab, the egg retrieval, the transfer, but there's an emotional side of it as well. And I think anyone who's been through it can agree that it can be a very painstaking and uphill

process and a lot of people

suffer in silence and they don't have support. So what I'm trying to do is, in addition to making the educational content, the posts and the videos of what's going on in the lab, I've also recently started a weekly warrior post. So people share their stories and the goal is to use those stories to remind you, one, you're not alone. Other people are going through this too. And two, if people have found success or not, they're still going, they're fighting through it.

They're showing strength and they're hoping to bring you strength through your journey as well. And then the other thing that I do is a monthly IVF buddy matching. And that's where people from all over the world are able to fill out a quick little Google form. It's totally private. And I'm able to match them based on where they're at in their journeys. Or maybe it's someone who is starting the journey and they want to talk to someone who's found success. Maybe it's someone who lives near them. Maybe it's someone on the other side of the world or someone who's used

donor eggs, someone who's had recurrent pregnancy loss. There are a lot of things that people are looking for and it's a way to connect people and help them again, not feel so isolated on their journeys, remind them that they're not alone and to lean on someone for support and to support someone else.

Jessica Lamb (49:06)
Yeah, that's such incredible work. think, like we've been saying, it's a scary and unknown process to begin with. I know it's super isolating for those who are going through it. So I think having a buddy to kind of, for anywhere in the world going through it, to connect with, I think is incredible.

Jessica Manns (49:21)
Yeah, no, there's definitely not enough support. So I'm always looking for ways, you how can I show support? How can I even educate to show support? You what ways can I empower people to know that they're not alone and they can get through this? And it's a tough journey. And for some, it's temporary, for some it's longer. But, you know, finding any kind of strength in that entire process, I think, is really important.

Jessica Lamb (49:42)
Yeah, for sure. Well, where can people find you? Social media, whatever you want to share.

Jessica Manns (49:46)
I really use Instagram for almost everything. So it's at explaining IVF is my handle. You can email me if you want to, but you can also just send me a message on Instagram and I'm happy to answer any questions that I can or point you in the right direction for resources if you need it. But yeah, definitely check it out. I hope that there's something on there for everybody that they can benefit from.

Jessica Lamb (50:06)
Yeah, absolutely. And we'll put your Instagram handle in the show notes and then also the link for that IVF buddy match as well. Hopefully we can get some people matched up as well.

Jessica Manns (50:14)
Perfect.

I will say the link does change every month. I open it at the beginning of every month and I leave it open for a couple of days, but I close it on purpose because I need to be able to, if not people will keep applying, which is great, but I need to be able to close it at some point.

Jessica Lamb (50:29)
so much for being on. This was amazing to learn more about the IVF process and all the work you're doing on socials.

Jessica Manns (50:36)
Thank you. Thanks for having me. And if you have any questions, please reach out.

Jessica Lamb (50:39)
Absolutely, thanks.