Chapter 4

b. ICM morphology

  • <p><strong>Figure 364</strong></p><p>Hatching blastocyst (Grade 5:1:1) with two separate ICMs that appear to be connected to each other at the 2 o'clock position in this view. One ICM appears to be smaller than the other and is beginning to herniate through a breach in the ZP at the 4 o'clock position along with several TE cells. The blastocyst was transferred and failed to implant.</p>

    Figure 364

    Hatching blastocyst (Grade 5:1:1) with two separate ICMs that appear to be connected to each other at the 2 o'clock position in this view. One ICM appears to be smaller than the other and is beginning to herniate through a breach in the ZP at the 4 o'clock position along with several TE cells. The blastocyst was transferred and failed to implant.

  • <p><strong>Figure 363</strong></p><p>Expanded blastocyst (Grade 4:1:1) with two distinct ICMs at the 7 and 11 o'clock positions in this view. Both ICMs are of reasonable size and compact.</p>

    Figure 363

    Expanded blastocyst (Grade 4:1:1) with two distinct ICMs at the 7 and 11 o'clock positions in this view. Both ICMs are of reasonable size and compact.

  • <p><strong>Figure 362</strong></p><p>Blastocyst (Grade 3:1:1) with a crescent-shaped ICM at the 10 o'clock position in this view. The blastocyst was transferred but the outcome is unknown.</p>

    Figure 362

    Blastocyst (Grade 3:1:1) with a crescent-shaped ICM at the 10 o'clock position in this view. The blastocyst was transferred but the outcome is unknown.

  • <p><strong>Figure 360</strong></p><p>Hatching blastocyst (Grade 5:1:1) with a compact crescent-shaped ICM flattened to the TE at the 9 o'clock position in this view. There is a large amount of TE herniating from a breach in the ZP at the 3 o'clock position and a second smaller site of herniation at the 6 o'clock position. The blastocyst developed following ICSI and so the breach in the ZP at the 6 o'clock position may be a result of the injection site. This blastocyst did not result in a pregnancy following transfer.</p>

    Figure 360

    Hatching blastocyst (Grade 5:1:1) with a compact crescent-shaped ICM flattened to the TE at the 9 o'clock position in this view. There is a large amount of TE herniating from a breach in the ZP at the 3 o'clock position and a second smaller site of herniation at the 6 o'clock position. The blastocyst developed following ICSI and so the breach in the ZP at the 6 o'clock position may be a result of the injection site. This blastocyst did not result in a pregnancy following transfer.

  • <p><strong>Figure 361</strong></p><p>Hatching blastocyst (Grade 5:1:1) showing a large crescent-shaped ICM at the 12 o'clock position in this view. The blastocyst was transferred and implanted.</p>

    Figure 361

    Hatching blastocyst (Grade 5:1:1) showing a large crescent-shaped ICM at the 12 o'clock position in this view. The blastocyst was transferred and implanted.

  • <p><strong>Figure 359</strong></p><p>Expanded blastocyst (Grade 4:1:1) with a large stellate ICM present at the base of the blastocyst in this view. The blastocyst was transferred and implanted.</p>

    Figure 359

    Expanded blastocyst (Grade 4:1:1) with a large stellate ICM present at the base of the blastocyst in this view. The blastocyst was transferred and implanted.

  • <p><strong>Figure 358</strong></p><p>Hatching blastocyst (Grade 5:1:2) with a large stellate ICM present at the base of the blastocyst in this view. The ICM seems to be connected to the TE cells with short triangular cytoplasmic strings or bridges. The blastocyst was transferred but failed to implant.</p>

    Figure 358

    Hatching blastocyst (Grade 5:1:2) with a large stellate ICM present at the base of the blastocyst in this view. The ICM seems to be connected to the TE cells with short triangular cytoplasmic strings or bridges. The blastocyst was transferred but failed to implant.

  • <p><strong>Figure 357</strong></p><p>Expanded blastocyst (Grade 4:1:1) with a large stellate ICM flattened at the base of the blastocyst in this view. The blastocyst was transferred and implanted.</p>

    Figure 357

    Expanded blastocyst (Grade 4:1:1) with a large stellate ICM flattened at the base of the blastocyst in this view. The blastocyst was transferred and implanted.

  • <p><strong>Figure 356</strong></p><p>Blastocyst (Grade 3:1:1) showing a very large, mushroom-shaped ICM at the 10 o'clock position in this view and made up of many cells that are tightly compacted. The blastocyst was transferred and resulted in the delivery of a healthy girl.</p>

    Figure 356

    Blastocyst (Grade 3:1:1) showing a very large, mushroom-shaped ICM at the 10 o'clock position in this view and made up of many cells that are tightly compacted. The blastocyst was transferred and resulted in the delivery of a healthy girl.

  • <p><strong>Figure 355</strong></p><p>Expanded blastocyst (Grade 4:2:1) with a small, mushroom-shaped compact ICM. There is some cellular debris present in the space between the ZP and the TE at the 10–12 o'clock positions. The blastocyst was transferred but the outcome is unknown.</p>

    Figure 355

    Expanded blastocyst (Grade 4:2:1) with a small, mushroom-shaped compact ICM. There is some cellular debris present in the space between the ZP and the TE at the 10–12 o'clock positions. The blastocyst was transferred but the outcome is unknown.

  • <p><strong>Figure 354</strong></p><p>Good quality expanded blastocyst (Grade 4:1:1) with a large mushroom-shaped ICM. There appears to be cytoplasmic strings extending from the ICM to the TE. The blastocyst was transferred and implanted.</p>

    Figure 354

    Good quality expanded blastocyst (Grade 4:1:1) with a large mushroom-shaped ICM. There appears to be cytoplasmic strings extending from the ICM to the TE. The blastocyst was transferred and implanted.

  • <p><strong>Figure 353</strong></p><p>Hatching blastocyst (Grade 4:3:1) with no clearly identifiable ICM but a TE that is made up of many cells forming a cohesive epithelium. Dark, degenerate cells are present toward the 3 o′clock position in this view.</p>

    Figure 353

    Hatching blastocyst (Grade 4:3:1) with no clearly identifiable ICM but a TE that is made up of many cells forming a cohesive epithelium. Dark, degenerate cells are present toward the 3 o′clock position in this view.

  • <p><strong>Figure 352</strong></p><p>Expanded blastocyst (Grade 4:3:3) with no clearly identifiable ICM. TE is made up of a few, sparse cells that do not form a cohesive epithelium.</p>

    Figure 352

    Expanded blastocyst (Grade 4:3:3) with no clearly identifiable ICM. TE is made up of a few, sparse cells that do not form a cohesive epithelium.

  • <p><strong>Figure 351</strong></p><p>Blastocyst (Grade 3:3:3) with no clearly identifiable ICM and sparse TE that does not form a cohesive epithelium.</p>

    Figure 351

    Blastocyst (Grade 3:3:3) with no clearly identifiable ICM and sparse TE that does not form a cohesive epithelium.

  • <p><strong>Figure 350</strong></p><p>Blastocyst (Grade 3:3:2) with no clearly identifiable ICM and with TE cells that in places are quite large and stretch over great distances to reach the next cell.</p>

    Figure 350

    Blastocyst (Grade 3:3:2) with no clearly identifiable ICM and with TE cells that in places are quite large and stretch over great distances to reach the next cell.

  • <p><strong>Figure 349</strong></p><p>Hatching blastocyst (Grade 5:2: 1) showing a compact ICM toward the 1 o′clock position in this view. The ICM is very small and made up of few cells relative to the size of the blastocyst. There are a few small, dark degenerative foci in the TE cells. The blastocyst was transferred but failed to implant.</p>

    Figure 349

    Hatching blastocyst (Grade 5:2: 1) showing a compact ICM toward the 1 o′clock position in this view. The ICM is very small and made up of few cells relative to the size of the blastocyst. There are a few small, dark degenerative foci in the TE cells. The blastocyst was transferred but failed to implant.

  • <p><strong>Figure 347</strong></p><p>Blastocyst (Grade 3:2:1) showing a compact ICM at the 5 o'clock position in this view. The ICM is very small and made up of only a few cells. The blastocyst was transferred but the outcome is unknown.</p>

    Figure 347

    Blastocyst (Grade 3:2:1) showing a compact ICM at the 5 o'clock position in this view. The ICM is very small and made up of only a few cells. The blastocyst was transferred but the outcome is unknown.

  • <p><strong>Figure 348</strong></p><p>Hatching blastocyst (Grade 5:2:1) showing a compact ICM at the 8 o′clock position in this view. The ICM is small and flattened and made up of few cells relative to the size of the blastocyst. The blastocyst was transferred but the outcome is unknown.</p>

    Figure 348

    Hatching blastocyst (Grade 5:2:1) showing a compact ICM at the 8 o′clock position in this view. The ICM is small and flattened and made up of few cells relative to the size of the blastocyst. The blastocyst was transferred but the outcome is unknown.

  • <p><strong>Figure 344</strong></p><p>Blastocyst (Grade 3:1:1) showing a very large, mushroom-shaped ICM at the 10 o′clock position in this view. The ICM is made up of many cells that are tightly compacted. The blastocyst was transferred and resulted in the delivery of a healthy girl.</p>

    Figure 344

    Blastocyst (Grade 3:1:1) showing a very large, mushroom-shaped ICM at the 10 o′clock position in this view. The ICM is made up of many cells that are tightly compacted. The blastocyst was transferred and resulted in the delivery of a healthy girl.

  • <p><strong>Figure 346</strong></p><p>Blastocyst (Grade 3:2:1) showing a compact ICM at the 11 o'clock position in this view. The ICM is small relative to the diameter of the blastocyst and probably made up of few cells. The blastocyst was transferred but failed to implant.</p>

    Figure 346

    Blastocyst (Grade 3:2:1) showing a compact ICM at the 11 o'clock position in this view. The ICM is small relative to the diameter of the blastocyst and probably made up of few cells. The blastocyst was transferred but failed to implant.

  • <p><strong>Figure 345</strong></p><p>Hatching blastocyst (Grade 5:1:1) showing a large ICM at the base of the blastocyst in this view. The ICM is made up of many cells that are tightly compacted. The blastocyst was transferred but the outcome is unknown.</p>

    Figure 345

    Hatching blastocyst (Grade 5:1:1) showing a large ICM at the base of the blastocyst in this view. The ICM is made up of many cells that are tightly compacted. The blastocyst was transferred but the outcome is unknown.

  • <p><strong>Figure 342</strong></p><p>Expanded blastocyst (Grade 4:1:1) showing a large ICM at the 4 o'clock position in this view. The ICM is made up of many cells and is very compact. The blastocyst was transferred but the outcome is unknown.</p>

    Figure 342

    Expanded blastocyst (Grade 4:1:1) showing a large ICM at the 4 o'clock position in this view. The ICM is made up of many cells and is very compact. The blastocyst was transferred but the outcome is unknown.

  • <p><strong>Figure 343</strong></p><p>Expanded blastocyst (Grade 4:1:1) showing a large ICM at the base of the blastocyst in this view. The ICM is made up of many cells that are tightly compacted. The blastocyst was transferred but the outcome is unknown.</p>

    Figure 343

    Expanded blastocyst (Grade 4:1:1) showing a large ICM at the base of the blastocyst in this view. The ICM is made up of many cells that are tightly compacted. The blastocyst was transferred but the outcome is unknown.