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Hi Peter

This is not an urgent question, but something which I
would like to understand more about.

I have seen some information on the web about blastocyst transfer (usually takes place ? day 5) and how it is much more effective than day 2 transfer because the embryos that make it to day 5 are more likely to implant (as some will have fallen by the wayside, having proved non-viable in the extra 3 days in the lab).

What is your opinion of this method and is it generally available in the UK?

Any info would be gratefully received!

Thanks
 

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Dear Vicky,

Blastocyst transfer means allowing all of your embryos to grow to day 4/5 in the lab and then selecting one blastocyst for transfer. You are right in saying that if an embryos reaches blastocyst stage in the lab then it is likely to be a good one. It is interesting to note that the first ever test tube baby was a blastocyst.

The technique is useful in those people who have had several unsuccessful IVF/ICSI cycles as it gives the embryologist a better idea as to embryo quality. The drawback is that if none of the embryos reach blastocyst stage then there will be no transfer in that cycle.

The technique is widely available within the UK.

Hope this helps!

Peter

Vicky W said:
Hi Peter

This is not an urgent question, but something which I
would like to understand more about.

I have seen some information on the web about blastocyst transfer (usually takes place ? day 5) and how it is much more effective than day 2 transfer because the embryos that make it to day 5 are more likely to implant (as some will have fallen by the wayside, having proved non-viable in the extra 3 days in the lab).

What is your opinion of this method and is it generally available in the UK?

Any info would be gratefully received!

Thanks
 

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Peter,

Do you know if blast is more sucessful than assisted hatching? I know each clinics success rates differ but just wondered if you had an opinion as I will be having one of these options for my next cycle depending on how many eggs they retrieve. If I produce a good number (that would be a first) then I will have blast - if I dont however then they will consider assisted hatching.

Also can you have more than one blast put back?

Thanks for your time :)

Love

DebsXXX

 

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Dear Debs,

Assisted hatching is usually done on earlier embryos (2-6 cell) and is another technique employed when someone has had several unsuccessful attempts. The mebryo is acytually ready to hatch naturally at the blastocyst stage so there is no great advantage in doing the procudre to a blastocyst. Success rates vary enormously from clinic to clinic but I would say that the two techniques are broadly comparable.

At present the maximum number of embryos we can transfer is 2 so in theory you could have two blastocysts. In practice it usually happens that there is only one good blastocyst to transfer so most people end up having just one.

Hope this helps!

Peter
Debs said:
Peter,

Do you know if blast is more sucessful than assisted hatching? I know each clinics success rates differ but just wondered if you had an opinion as I will be having one of these options for my next cycle depending on how many eggs they retrieve. If I produce a good number (that would be a first) then I will have blast - if I dont however then they will consider assisted hatching.

Also can you have more than one blast put back?

Thanks for your time :)

Love

DebsXXX
 

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Peter

Just a quickie. How many embryos usually get to blastocyst stage in culture? My clinic only freeze at blastocyst stage not embryo stage which worried me as I understood it was quite a low chance. Why is there so many varying ideas in fertility clinics?

Today I found out that 5 of my 9 leftover embies got to blastocyst stage so are in the freezer. As my FSH was 9 I had a higher dose of stims, but I am presuming that my egg quality must be good to get this far.

Hope Catie is doing well now.

Thanks,

Jane
 

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Please see my comments in your text:

Janieb said:
Peter

Just a quickie. How many embryos usually get to blastocyst stage in culture?

It varies from person to person and cycle to cycle.

My clinic only freeze at blastocyst stage not embryo stage which worried me as I understood it was quite a low chance.

It is! See above.
This is an unusual approach which I have not come across before. I would ask them to justify their approach as in my opinion you are missing out on frozen embryos.

Why is there so many varying ideas in fertility clinics?

Becuase no one really knows the right answer and each clinic is trying to optimisie its results.

Today I found out that 5 of my 9 leftover embies got to blastocyst stage so are in the freezer. As my FSH was 9 I had a higher dose of stims, but I am presuming that my egg quality must be good to get this far.

This is very good blastocyst rate, perhaps your clinic do have something here??

Hope Catie is doing well now.

Catie is back to normal now, many thanks for your good wishes

Regards,

Peter

Thanks,

Jane
 

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Peter

Sorry I meant approx generalised percentage of embryos making it to blastocyst, I realise actual numbers don't count here and can vary.

I read that it was as low as 1 in 6 which is about 15%.

Also other reading material says that if an embryo is not going to get to blastocyst in culture it won't either in the uterus. Other say the uterus is the best place. Your view?

I realise my rate is good but I am still trying to get my head around the blastocyst approach.

Thanks again

Jane
 

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Please see my comments in your text:

Janieb said:
Peter

Sorry I meant approx generalised percentage of embryos making it to blastocyst, I realise actual numbers don't count here and can vary.

I read that it was as low as 1 in 6 which is about 15%.

That is about right.

Also other reading material says that if an embryo is not going to get to blastocyst in culture it won't either in the uterus. Other say the uterus is the best place. Your view?

The uterus has got to be the best place for an embryo but by the same token if an embryo reaches blastocsyt in vitro it is probably a good embryo. No one knows the answer to this question at present.

I realise my rate is good but I am still trying to get my head around the blastocyst approach.

There is a move to single embryo transfers to try to reduce the incidence of multiple pregnancies. The best approach to this is baslrocyst transfer but patients must be aware that sometimes they will get no transfer if they opt for this route. The first ever test tube baby was a blastocyst so this is nothing new!!

Regards,

Peter

Thanks again

Jane
 

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Dear Peter

I have recently had a meeting with my doctor to discuss our next ICSI cycle (this will be the 4th). He has recommended letting all the embryos go to blastocyst stage before transfer. Is this usual?
He wants to do this to see if they can survive beyond the compacting stage (that's the furthest we've ever seen our embryos go) as he feels it will give him an idea of my inherent fertility - I'm only 29. (ie if I'm fertile even though I have blocked tubes and DH has poor sperm). Is this a good way of indicating this?

He has warned us that there is a risk that none of the embryos may survive and we may not have any for transfer. Is this a high risk?

Also if they don't survive - what exactly does this tell us and what can be done about it?

Sorry to bombard you with questions but at the time of the meeting I couldn't think what to ask.

Many thanks

Kerry
 

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Hi Peter
I'm in Australia and my clinics practise is to wherever possible go for blastocyst transfer
on my third icsi cycle had 4 fertilised and three made it to blasto, the best one which was expanding was replaced and i got a very painful heavy periodon day of my test (so didn't do it), could this have been a clinical preg, my coordinator thought maybe and this a good sign - your opinion
the two frozen were a little behind transfered blasto, do they have the same survival rate if transfered separately, does replacing two just mean that if one had the energy to create a preg it would have anyway even if it was transfered over two fets, i am hoping they both make it of course, we hope to limit the possibility of twins but don't want to limit our chance of success
thankyou for your time, there is so many questions when your on this rollercoaster
niki in aussie
 

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Please see my comments in your text:

KT said:
Dear Peter

I have recently had a meeting with my doctor to discuss our next ICSI cycle (this will be the 4th). He has recommended letting all the embryos go to blastocyst stage before transfer. Is this usual?
He wants to do this to see if they can survive beyond the compacting stage (that's the furthest we've ever seen our embryos go) as he feels it will give him an idea of my inherent fertility - I'm only 29. (ie if I'm fertile even though I have blocked tubes and DH has poor sperm). Is this a good way of indicating this?

This is a good idea, good blastocysts produce very good pregnancy rates.

He has warned us that there is a risk that none of the embryos may survive and we may not have any for transfer. Is this a high risk?

Depends on the clinic. The clinic I work at in Toronto has a 60% blastocsyt rate but this is exceptionally good.

Also if they don't survive - what exactly does this tell us and what can be done about it?

It really only tells us that blastocyst culture is not a good idea in your case.

Regards,

Peter

Sorry to bombard you with questions but at the time of the meeting I couldn't think what to ask.

Many thanks

Kerry
 

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Please see my comments in your text

niki66 said:
Hi Peter
I'm in Australia and my clinics practise is to wherever possible go for blastocyst transfer

This is good, I work for a clinic in Toronto (markham Fertility Centre) and they get brilliant results from blastocsyt only transfers.

on my third icsi cycle had 4 fertilised and three made it to blasto, the best one which was expanding was replaced and i got a very painful heavy periodon day of my test (so didn't do it), could this have been a clinical preg, my coordinator thought maybe and this a good sign - your opinion

Yes, it is a good sign

the two frozen were a little behind transfered blasto, do they have the same survival rate if transfered separately,

one mebryo at a time is becoming the option of choice, especially in the case of blastocysts.

does replacing two just mean that if one had the energy to create a preg it would have anyway even if it was transfered over two fets, i am hoping they both make it of course, we hope to limit the possibility of twins but don't want to limit our chance of success
thankyou for your time, there is so many questions when your on this rollercoaster

One is the best option, especially with blastocysts as multiple pregnancy needs to be avoided.

Regards,

Peter

niki in aussie
 

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Hi Peter
Ive not spoken to you before but always read your posts and now I too have a question for you if you dont mind.
I had a frozen/thawed blastocyst transfer yesterday and they noticed a couple of hours before transfer that a couple of the cells were darker, is this something to worry about?
we were feeling very positive about the blasto as the pg rates are much higher but now these dark cells are concerning me, any advice on this?

Many thanks
H x
 

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Dear H,

As there are about 120 cells in a blastocyst then two or three dark cells do not really matter. In general a dark cell is an indication that the cell is not as healthy as it could be.

I am delighted to hear that you have opted for blastocyst transfer as I see this as the way forward.

Good luck and think positive!!

Peter

H said:
Hi Peter
Ive not spoken to you before but always read your posts and now I too have a question for you if you dont mind.
I had a frozen/thawed blastocyst transfer yesterday and they noticed a couple of hours before transfer that a couple of the cells were darker, is this something to worry about?
we were feeling very positive about the blasto as the pg rates are much higher but now these dark cells are concerning me, any advice on this?

Many thanks
H x
 

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Peter

I have always been very interested in Blastocysts right from the word go in relation to my IVF treatment. I asked my Nottingham clinic before even starting with them last August and they said they have been doing them but have had mixed results - which I would expect in early stages anyway. I guess what they are trying to say is they do not see themselves at the forefront of this at present. Their general policy is to day 2 transfer but have had good results recently with day 3. My first IVF had no frosties that would have survived and resulted in ectopic (I am 36 with tubal damage) so no suprises there. My 2nd IVF was negative but resulted in 9 frozen embies which is very pleasing. 8 days ago I had 2 put back in on completely natural FET and am waiting to see..... I am on no drugs at all. Whilst still trying to remain positive on this cycle for future reference (whatever the result) what are your thoughts on taking the remaining 7 to blastocyst? The 2 they took out both happened to be 2 cells (there are a couple of 4 cells) and the morning of transfer went to a 4 cell and a 3 cell very quickly so were put back in.
Do you think 7 would be sufficient to try and how much longer would it take to get to blastocyst stage.
Thanks
Tracey
 

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Dear Tracey,

Trying to grow thawed embryos on to blastocyst is a good idea as long as you can accept that none might make it and you may therefore not get a transfer. It would also be sensible to only thaw two at a time just in case you ended up with blastocsyts from everything which is unlikely but possible. Re-freezing of such embryos is probably not a good idea.

I firmly believe that the blastocyst transfer procedure is the best way of ensuring that the best embryos are transferred, otherwise embryo choice for transfer is just guess work.

Hope this helps!

Peter

Tracey S said:
Peter

I have always been very interested in Blastocysts right from the word go in relation to my IVF treatment. I asked my Nottingham clinic before even starting with them last August and they said they have been doing them but have had mixed results - which I would expect in early stages anyway. I guess what they are trying to say is they do not see themselves at the forefront of this at present. Their general policy is to day 2 transfer but have had good results recently with day 3. My first IVF had no frosties that would have survived and resulted in ectopic (I am 36 with tubal damage) so no suprises there. My 2nd IVF was negative but resulted in 9 frozen embies which is very pleasing. 8 days ago I had 2 put back in on completely natural FET and am waiting to see..... I am on no drugs at all. Whilst still trying to remain positive on this cycle for future reference (whatever the result) what are your thoughts on taking the remaining 7 to blastocyst? The 2 they took out both happened to be 2 cells (there are a couple of 4 cells) and the morning of transfer went to a 4 cell and a 3 cell very quickly so were put back in.
Do you think 7 would be sufficient to try and how much longer would it take to get to blastocyst stage.
Thanks
Tracey
 

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Thanks Peter

can I send them out to Torronto??

Tracey
 

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Dea Tracey,,

If you would like to!! It 's a great place to visit!!

Regards,

Peter

quote author=Tracey S link=board=51;threadid=2133;start=0#msg26958 date=1048354259]
Thanks Peter

can I send them out to Torronto??

Tracey
 

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PEter

might have to go out to toronto now as AF started today like clockwork and unlike me I thought it had worked this time!!
Was thinking about your above comments re blasto and was wondering if should try and get the 7 to blasto - two at a time of course as above. Peter would I be still be ok having a natural FET like this month as all mine are day 2 frozen and would take a while to get to blasto wouldn't it - if they didn;t work wouldn't this hold me up?

Thanks - sorry but need to move forward with this.
Tracey
 

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Tracey S said:
PEter

might have to go out to toronto now as AF started today like clockwork and unlike me I thought it had worked this time!!

Sorry to hear that

Was thinking about your above comments re blasto and was wondering if should try and get the 7 to blasto - two at a time of course as above. Peter would I be still be ok having a natural FET like this month as all mine are day 2 frozen and would take a while to get to blasto wouldn't it - if they didn;t work wouldn't this hold me up?

A natural cycle is perfectly OK but you would have to bear in mind that if no blastocysts formed then you would have to wait another month for another go. You also need the advice from your embryologists regarding your embryo quality as if they were not good when frozen then it might be worth thawing more than 2 each time to optimise your chances of a blastocyst. Please also make sure that your embryologists have experience of blastocyst and pregnancies from work, if not take your embryos to someone who has.

Let me know if you go ahead with this as I am very interested.

Peter

Thanks - sorry but need to move forward with this.
Tracey
 
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