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Blastocyst vs. Early Embryo Transfer: Pros and Cons
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Virtually all physicians who provide assisted reproductive services are highly motivated to optimize IVF success rates. Achievement of this lofty objective is marred by the inability of conventional microscopic grading, to reliably select those embryos that will successfully implant into the uterine lining. This unfortunate reality often prompts IVF practitioners and clinics to transfer multiple embryos at a time. While such practice indeed does increase IVF pregnancy rates, it comes at a high cost since it all too often results in high order multiple pregnancies (triplets or greater), placing the newborn babies at severe risk of life threatening prematurity-related complications, devastating families and leaving society to foot the bill.
It has long been recognized that as embryos progress developmentally during the first 5-6 days following fertilization, many of those of “poorer quality” succumb along the way. It follows that a much higher percentage of embryos that survive to the fifth or sixth day post-fertilization is likely to be of “good quality” than would be the case by day two or three. IVF researchers applied this principle in an attempt to achieve high pregnancy rates without increasing the risk of high order multiples. They did so by challenging embryos to progress to their most advanced pre-implantation stage of development (i.e. the blastocyst stage) by day five or six post-fertilization and then selecting only one or two such “better quality” embryos for transfer.
The concept of blastocyst transfer (BT) is not new to the field of Assisted Reproduction. In fact, reports of human pregnancies following BT date back to the early 90’s. However the ability to consistently produce a high percentage of blastocysts from cultured embryos is a relatively recent development.
The freshly fertilized egg before it starts to cleave (divide) is called a zygote. After the first 24 hours, (Day 1) the embryo has divided into 2 cells. By Day 2 the embryo has 4 cells (blastomeres) and by the third day, there should be between 6 and 9 cells. Up to that point, embryonic development is under the control of maternal genes in the egg. Around the 8 cell stage the embryo’s own genes (embryonic genome) begin to take over control of development. By the fourth day the embryo has between 16 and 32 cells. At this point it looks like a mulberry and is called a morula. Until the morula stage all the embryo’s cells are the same and are totipotential (i.e. they have the ability to ultimately develop into any tissue or organ type). By day 5 post-fertilization, differentiation of the embryo begins. A fluid-filled cavity (blastocele) forms in the center of the conglomerate of blastomeres. This blastocele will eventually become the amniotic sac and the fluid surrounding the conceptus in the uterus. The cells around the outside of the morula develop into the trophectoderm, which will eventually form the placenta and fetal membranes, while the cells on the inside of the morula aggregate and group together to form the inner cell mass, which ultimately develops into the fetus. This complex creation is now called a blastocyst. As the blastocele fills with fluid, the blastocyst expands, its walls thin out and it eventually breaks through (hatches) its envelopment (zona pellucida). The trophectoderm then begins to invade the uterine lining (implantation) by the 6th to 8th after ovulation or egg retrieval (when IVF is performed).
Human embryos are very fastidious. They have specific metabolic requirements in order to survive. The earliest type of artificial embryo culture media developed for IVF purposes was relatively simple in composition and could only support limited embryonic development in the Petri dish and incubator. Thus, the majority of embryos cultured in such media could only survive to the third day whereupon their development would arrest. Subsequent improvements in media composition allowed for more reliable embryo development to the third day… which became and remained the standard time at which embryos were transferred for more than two decades.
Starting in the mid-1990s, researchers in Australia, Scandinavia and in the USA simultaneously developed a new generation of culture media that can support the growth of embryos to the fifth or sixth day. This development was based on the recognition that the metabolic needs of the early embryo changes as it progresses in development, much in the same way as happens in natural conception as the embryo journeys through the Fallopian tube to the uterus. These so-called “sequential culture systems” are improved embryo culturing methods designed to simulate what happens in the reproductive tract during natural conception. They involve sequentially changing the media environment as embryo development progresses. Approximately 35-40% of “good quality” day-3 embryos (comprising 6-9 cells with minimal/no fragmentation) can be grown to the blastocyst stage using such advanced culturing methods.
It is important to note that in spite of the introduction of specialized sequential culture systems and other new techniques, at best 35-40% of “good quality” embryos develop into blastocysts (even in younger women who produce the best quality eggs). However, since blastocysts are more likely to implant than are day-2 or day-3 “good quality embryos”, the transfer of but a few good quality blastocysts yields better IVF success rates than would be the case following the transfer of a higher quantity of early embryos. Moreover, by transferring fewer blastocysts, the fertility clinic can substantially reduce the risk of high order multiple pregnancies.
The presumption that early embryos would be better off in the uterus than would be the case in an incubator in an IVF laboratory is erroneous. This fact was established conclusively through a study we recently performed and published on in the journal Fertility and Sterility in 2007. This research involved genetically testing each of a large number of eggs sequentially, using comparative genomic hybridization (CGH); first, prior to fertilization, and then twice more in turn (on day 2 and day 3). We then followed each of the resulting embryos in culture to day 5-6 to see if they would develop into blastocysts. The study revealed that a high percentage of the embryos that developed to blastocysts had originated from chromosomally normal (euploid) embryos and were thus “competent” (highly likely to develop into normal babies) while with few exceptions, those that did not develop into blastocysts were almost invariably chromosomally abnormal (aneuploid) and were thus “incompetent”. We concluded that since the uterine environment is no more favorable than the Petri dish in terms of embryo development, there is no advantage in transferring embryos to the uterus earlier than the blastocyst stage.
The use of CGH to select the most competent embryos for transfer, requires that they first be grown to blastocysts whereupon they be cryopreserved (frozen) for days or weeks until the results of CGH testing are available. Thereupon, one or two euploid (“competent”) embryos are transferred to the uterus. This modified application involving CGH selection of the “best” blastocysts to transfer has further enhanced the efficiency of IVF, markedly increased the baby rate per embryo transferred, reduced the miscarriage rate, and minimized the occurrence of chromosomal birth defects.
It is my personal opinion that with few exceptions, blastocyst transfer should be performed preferentially in IVF. Other than convenience and easing pressure on doctor and/or patient, there is in my view seldom any advantage in transferring embryos on day 2 or day 3. After all, we have demonstrated conclusively that embryos failing to survive to the blastocyst stage are almost certainly (aneuploid) “incompetent,” and are thus unable to propagate normal pregnancies anyway.
163 Responses to “Blastocyst vs. Early Embryo Transfer: Pros and Cons”
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Ask Our DoctorsA Question
Is there a threshold number of embryos that you require in order to choose a 5 day transfer, over a 3?
Does age of patient factor into your decision?
Thanks!
I prefer blast transfers accross the board. However women with <4, 6-9 cell embryos by day 3 can just as well do day 3 transfers.
Geoff Sher
Do you feel a blastocyst has a higher propensity to result in a viable pregnancy even if it was a slower growing embryo? For example, would you consider a blastocyst with no fragmentation a good option for transfer, even if it was only 4 cells on day 3? Does the rate of growth affect the viability, or growth rate a non-issue because it made it to blast stage regardless? Thank you for your time!
I am scheduled for an interval transfer, 1 emb on day 3 and 1 emb on day 5. What are your thoughts on this method?
I had my EC yesterday, as of today 8 eggs fertilized, seven of which are of good quality.
If the embryo makes a good quality blastocyst by day 6 npost-fertilization,regardless of its cleavage on day 3, it has a chance of making a baby.
I do NOT believe in traversing the cervix twice in one cycle of IVF. The risk of introducing infection is too great. Thus I am against "interval transfers".
Geoff Sher
Hello!
I'm a 26 yr old with primary infertility due to my husbands extremely poor sperm count and motility. It's my first IVF w/ICSI cycle and I produced 16 eggs out of which 14 were fertelized. Now it's day 5 and I'm going to have a blastocyst transfer in a few hours..my embriologist is quite optimistic and has told has that we have 4 healthy good blasts available, 1 of them has completed the blastocyst formation and the other 3 shall do so in a few more hours. She suggests we shall transfer all 4 of them..
Plz can u shed some light about the prospects of implantation in this case and explain why she said the 3 would be completing blastocyst stage in a couple of hours is that okay? Also wat are the chances of multiples I'd love to have twins..finally she told me the remaining 10 fertelized eggs are slow growing if they become glass tomorrow i.e day 6 then they'll inform us and freeze them otherwise they'll be disposed off.. can't they be preserved?
Thanx in advance!
At 26 I would respectfully suggest no more than 2 blastocysts be transferred. The remainder can be vitrified and banked.
I agree with your RE that if they are blastulating already (even if they are in the early stage now) they can be transferred and allowed to develop further in the ut6erus.
Good luck!
Geoff Sher
Hello again and thanks!
Well I eventually ended up transferring all 4 as the embryologist had suggested as I'm already willing for multiples..
What do you suggest are the odds of implantation especially multiples here and could you briefly explain the factors favoring implantation like is it more dependent on patient's age / acceptance capacity of uterus or the egg/blast quality eventually?
Waiting for 10 more days to have a preg. test seems like a lifetime, any signs of implantation for an early heads up ??
best regards!
The issue is embryo competence (is it chromosomally normal) and yes that is influenced by age (see applicable articles elsewhere on this blog). The other issue is uterine receptivity as it pertains to lining thickness, absence of surface lesions in the uterine cavity and immunologic integrity7 of the endometrium.
Good luck!
Geoff Sher
hi, my wife 35 and i 36 have just retrieve 12 eggs,9 were matured.on day 1,our doctor said 7 were good and today day 2 only 4 still compentent.we will wait for the 4 to reach blastocyct which is 3 more days from now.we're little edgy that none might reach day 5,if this happens why could it be and base on your wide experince is it best to wait for day 5.a little backgrd,the daignose for our infertility was my low sperm count,in day1,5,8,10,12 all bloodtest e2,lh+ultrasound her lining was perfect,all showed well.my wife was on burselne for 2week then fsh 225iu for 12days.is the 12eggs retrieve normal and what would you say a good day 5 quantity for her age?and what the odds in our case that blastocycts produce take home baby.your articles are by far the in the web.thanks
First, embryos that do not make it to blastocyst (day 5-6b post fertilization) are almost always abnormal and would not have been worthy of transfer earlier on, anyway.
Second, it is not possible to comment further on the stimulation or response without having much more information.
I suggest that you call 800-780-7437 and set up a free medical telephone consultation with me to discuss in detail. Be sure to forward all medical records in advance thereof.
Good luck!
Geoff Sher
hello again doctor sher,
i made a previous comment and now after more than two week we got a taste of failed ivf.we were able to transfer 3blast but after 1week post transfer my wife had brownish discharge that turn out to her period.together with our doctor with reviewed the cycle and everything was well in the 12 harvest 9 matured 3 reach blast nothing to freeze.my wife confined herself to bed-couch-bed-couch after transfer.is there a way to increase implantation on our 2nd ivf?in your wide experience what could be the reason for failure of ivf after transfering 3blast grade1,grade2,grade1-?
thanks
I would need a lot more information to comment fully. However, it could be that in spite of appearance microscopically, these blastocysts were actually chromosomally abnormal. That is not uncommon. Read up elsewhere in this blog on "embryo selection" and you will understand better what I mean. It is also possible that the problem lies with implantation. Read up elsewhere on this site, on this as well.
Feel free to call 800-780-7437 if you wish to discuss.
Geoff Sher
Hello Dr. Sher,
This is my first attempt at IVF. I have PCOS and my husband is normal. I'm 32 years old and my husband is 35. I just completed my transfer yesterday and they said I had 2 morula's transferred, on of which was progressing more than the other. I have never heard of a morula and wondered what the odds of conceiving are with a morula? Also will the morula become a blastocyst, if so how soon? Do you know of any literature I could read about this? Thanks so much for your help on this I wasn't given much info on this during my procedure.
Kindest Regards
DR.Sher
Im in the process of IVF and im 29 and the reason for ivf is my tubes were closed and i had them open and got a tubel this march so know im doing IVF im on day 5 i had 13 eggs 6 were good 4 fertelized today day 5 they wanted to wait till day 6 cause they were only at 11am at 33 cells but he said that they he was not happy 100% with the quilty off eggs what do you think my chances are of a good day 6 transfer if it was slow and what amount of cells by day 6 if not 100 would you say would be ok for a transfer thanks
It should be an expanded blastocyst by day 6. Hard to say but there is a chance that it could develop to thnat point within 24hrs.
I will be holding thumbs for you.
Geoff Sher
Hi there Dr Sher,
I had 10 eggs collected from one ovary and 7 fertilised, however due to the risk of OHSS , my clinic froze 6 good quality embryos on day 2. I'm just wondering what are the chances of a day 2 frozen embryo reaching blastocyst? Would you advise this or just go with transfer on day 2 once thawed? I believe 2 will be thawed at a time.
Thanks
Michelle
Survival of embryos post-thaw, depends on embryo quality, the timing of the freezing and the method of freezing.
1)Embryo quality is determined by the age of the woman, the method of ovarian stimulation and the lab quality.
2)With regard to the timing of freezing; I am in favor of early freezing because embryos that do not survive to blastocyst in the lab are almost always abnormal anyway. So who are we kidding by freezing prior to day 5-6 (blastocyst).
c). The method of freezing is also very important. Ultrarapid freezing by vitrification rather than slow conventional freezing does not harm embryos. Slow freezing does (see the article I wrote on vitrification elsewhere on this site).
In your case, the dye has already been cast so I would advise thawing the day 2's and transferring those that upon prolonged culturte make it to good quality blastocysts.
Geoff Sher
Hi, me and hubby are both 31 years old with unexplained infertility… I just had a transfer of a single embryo (in canada its the law to have only one.. My doc said) anyway he sais that it was the only one out of 4 to have made it to early blastocyst stage… I had 17 retrieved 8 mature 4 fertilized … 4 7 cells at day 2 and now only 1 early blastocyst !!! What are my chances of conceiving??? Is it very bad?? Please help… Thanks
Dear Dr Sher,
I am a 42 year-old woman with no fertility issues except the intrinsic decrease of fertility (and eggs quality) due to my age, but my spouse (which I met 4 years ago) has a very low sperm count and mobility (he was operated for a varicocele in his mid 30s, and the varicocele is likely to have reformed given the semen analysis – apparently his sperm count is at 5% of the fertility threshold, and if he were to be operated again, it would only increase the sperm count to 15% of the fertility threshold)So the IVF was the only alternative for us to try to have a baby (after 2 years of trying by the natural way and given my ovarian reserve…). I went through a first IVF cycle back in January 2011 and it failed (out of 9 mature eggs that got fertilized after ovarian stimulation and eggs punction, only 2 embryos were relatively "good enough" to be transfered on day 3.) I am now at day 8 after the embryo transfer of my 2nd IVF attempt, waiting for the pregnancy test in 4 days (this time I took DHEA and CoQ10 for 3 months before the IVF cycle, and I also had acupuncture treatments – after the punction of my eggs, out of 10 mature eggs, 6 got fertilized and at day 3, only 3 embryos were good enough to be transfered, with one of very good quality according to the embryologist)In the meantime, not knowing the issue of the procedure, I can't help thinking of my future in case of a failure: I live in Quebec and since August of 2010, the government has been funding IVF treatments (up to 3 cycles), but the fertility clinic where I am treated doesn't proceed with IVF for women that are 43 and older; I am not sure if they do blastocyst transfer. After the failure of my first IVF, my gynecologist had told me that the doctors at the clinic were reluctant about going further in the process with me, given the poor quality of the embryos produced (and because it is the government that pays, the clinic wants to keep the success rate as high as possible), but my gynecologist insisted that I had at least a second attempt, and here I am. Now, in case of a failure of my 2nd IVF, should I try to consult another clinic and ask if it is possible in my case to get embryos that reach the blastocyst stage before the transfer? I don't care about having to pay (money is not an issue). Do you think that something could be done to increase the fertility of my spouse? I thank-you in advance if you take the time to read this message
Julie
Thank you for this communication.
First, as this article (above) points out, there is no good reason NOT to allow all embryos to reach blastocyst before being transferred because those that do not make it to blastocyst will almost never develop into a baby, anyway.
Please read the blog on "varicoceles" and you will note that when the sperm count is low, surgery rarely helps. I see no point in a repeat attempt. This having been said, ICSI can still propagate good embryos.
Your age is a factor along with your apparent diminished ovarian reserve. However, it is essential to implement a "strategic" protocol of stimulation (see the article: "An Individualized Approach to Ovarian Stimulation for IVF" which I posted on November 22nd on this site for details).
I advise against taking DHEA because it is a male hormone that metabolizes to testosterone in the ovaries (and elsewhere) . The last thing you need is increased ovarian te3stosterone production.
I invite you to call 800-780-7437 and set up a free medical telephone consultation with me to discuss.
Geoff Sher
Dear Dr Sher
I am 39 year old who had a miscarriage at 10 weeks at age 35 and an ectopic a few months ago. We decided to pursue IVF because of my age, prior loses, and my husband was diagnosed with varicoceles (he is 35 years old) . My initial day 3 IVF testing indicated I had a slightly high FSH at 11.9 and low AMH at .73. I had my first IVF cycle in July where I was given 350 units of Follsitem 2x a day with low dose HCG daily. I started to take Ganerilex on day 5 of stimulation. I had a total of 7 follicles and only 6 grew and I ended up with 4 eggs at retrieval. All 4 fertilized through ICSI (we did because of my husband’s condition. He is due to get a procedure to improve his sperm morphology in November). All 4 made it to day 5 – all with even division of cells with minimal fragmentation. One turned into blast on day 5 (grade 3BB) and the others I was told stop developing at that point. We decided to freeze the one blast and do another cycle since we had meds left and given my poor response. We also wanted to try to get more blasts as we wanted to do genetic testing and wanted a few more embryos to make it cost effective. I am about to start my 2nd cycle on Sept. 16th. This time I am going to be on 450 follistem 2x a day, the low lose HCG and my dr. is also adding cholmide. Do you think I will respond any better on this protocol?
Also, my doctor is really pushing genetic testing on us because of my age and I am just not sure what to do. If we have another cycle like our first and we only end up with 1 or 2 blasts I may just say transfer one in and hope for the best. I read that if an embryo makes it to blast there is still about a 20% chance its abnormal and that goes up to about 35% for a woman around my age. So in my mind we have about 70% chance or so that the embryo is healthy. Do you agree with those stats? Given my situation with a blast 3BB frozen.. do you think genetic testing is necessary on that one as well as any others I may get of equal or better quality with this round? I would appreciate your insight!
Hi Dr. I recently got pregnant via IVF with 2 embryos transferred on day 3. They were only 4 cell embryos. I am not sure of their quality. I had a positive pregnancy test and my bhcg levels doubled over a 48hour period. However on my first scan yday at 6-7 weeks there was 1 sac that was only at 5 week size but no heartbeat. There is a v good blood supply. My doctor wants to rescan on saturday to see if anything has changed. He reckons its 50-50 but i think he is only saying that. My question is was i doomed from the start with the 4 cell embryos? I am 38 and have DOF, this was the first time i ever had eggs retrieved (3 previous poor response IVFs). I have autoimmune issues – rheum arthritis and previous thyroid problem
Hi He3llen,
So sorry but this might well not turn out the way you would wish. 4 cell embryos on day 3 can (but rarely do) make it. The other issue is the method of ovarian stimulation used (which can and does impact egg/embryo competency). Finally, before doing anything more, it is essential to thoroughly assess the immune component.
Might I recommend that you go to the home page on this site, find a “search bar” in the upper right hand column and type in the following subjects into the bar and it will take you to all the relevant articles I posted there.
1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
2. “Agonist/Antagonist Conversion Protocol”
3. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
4. “IVF success: Factors that influence outcome”
5. “A Stepwise Approach to IVF At SIRM” (Posted on March 9th, 2012)
6. Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
You might also consider calling 800-780-7437 or 702-699-7437 to set up a telephone consultation with me (which is free if you reside in the U.S.A or in Canada) so we might discuss your case in detail.
Geoff Sher
Thanks for your reply. I was on a mild stimulation cycle (75iu then upped to 150iu gonal F) with no bcp or down regging. High doses of gonal F and down regging seems to switch my system off. I also took clexane, prednisolone, intralipids. 2 follicles, eggs were quite difficult to retrieve/wash
Got it: Sounds as if the protocol of stimulation and treatment was OK.
Geoff Sher
I had a five day transfer they put two morulas back on day five. There is not much information about morulas, is it possible that by putting them back it gives them a greater chance to continue to blast stage?
It will not improve there chances simply by having put them in the uterus. If they are going to make blastocysts in the uterus they would have done so in the Petri dish 1 day later.
Geoff Sher
Oh and I am 42 my husband is 34, we used donor eggs from a 31 year old woman.
Dr. Sher,
I am preparing for my 3rd FET in January. My last 2 FET’s results in pregnancy, but I miscarried a singleton at 12 weeks and twins at 5 weeks and 6 1/2 weeks. We are going to thaw my 4 embryos I have left to do CCS testing for any chromosomal abnormalities. All 4 embryos are Day 6 blastocysts. My embryos will be thawed and tested the evening before the transfer and then 2 healthy embryos will be selected for transfer and any remaining will be refroze.I have a 6AA, 5BA, 3BB, 3BB left. My concern is that by the time of transfer they will almost be day 7 blasts. I’m feeling anxious and concerned that taking the extra time to thaw and test my remaining embryos might lower my chances of getting pregnant and carrying a baby to term. Perhaps some of my anxiety is the loss of the 3 babies earlier this year, I just want to make sure what I am doing is what’s best. I would love a second opinion. I have a good friend who went to you and now has twins that are a year old. She has nothing but great things to say about you. Thank you.
Respectfully, I would differ. I would do not see the point in thawing and then biopsying the 2 day 6 blastocysts. My view is that freezing and thawing embryos is stressful enough, why add the additional stress of a biopsy to the mix. Bear is mind that karyotyping only selects the good embryo(s) it does nothing to improve them. So I would argue that…why not thaw and transfer them both and if one of the two is “competent” it it will have a good chance of taking.
Good luck!
Geoff Sher
Hi Dr. Sher. I am a 43 year old woman who just did her 8th IVF cycle. I recently had my ER and got 14 eggs of which 9 fertilized with the possibility of a 10th fertilizing. I was given the choice to do either a 3 day or 5 day transfer. I plan on putting 6 back and freezing the rest if they make it. In your opinion is it best to do a 3 day or 5 day transfer?
I would caution you about replacing so many embryos, but unquestionably blastocyst transfer is ideal because embryos that fail to make it to the blastocyst stage are almost always abnormal (chromosomally) and thus “incompetent”. So putting them back earlier would have no benefit.
Geoff Sher
I am 31 and my husband is 35. We have been trying to get pregnant for 3 years. We have tried IUI 3 times unsuccessfully and just completed our first IVF cycle. I had 12 eggs, 10 fertilized, 8 made it through day 4 with little fragmentation but on day 5 we only had 2 at the morula stage, which were transferred. None were viable for cryo. I am only day 4 post transfer and was wondering if the odds that the morula will not take are so high, then why did they do the transfer anyway?? Also, if this is not successful, do you have any ideas as to other testing that could be performed next time? The nurse kept telling me they were not expecting this given my age (that I would have ‘bad’ eggs)… Thoughts? Thanks again for your time.
You still have a good chance because the morulae could have progressed to blastocyst by day 6 in the uterus. There is also the issue of implantation dysfunction which could explain failed IUI’s. Do you have any degree of endometriosis.Please go to http://www.IVFauthority.com and to the home page find the “search bar” in the right hand column. Type in the following subjects into the bar and it will take you to all the relevant articles I posted there.
“An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
“Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
“Agonist/Antagonist Conversion Protocol”
“Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
“Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
“Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
“IVF success: Factors that influence outcome”
Feel free anytime to call 800-780-7437 or 702-699-7437 to arrange a telephone or Skype consultation (free of charge to those who reside in the United States or Canada). While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.
Geoff Sher
Hi,
During our first IVF treatment, we have 20 embryos and out of which 12 are fertilized and 7 become embryos. Two is having grade range of 0 to 2 and 3 are having grade 3 and the last 2 are having grade 4 in Day 3.
Range 0 is worse and 5 is the best.
Two having grade 0 to 2 are discarded. 3 having grade 3 are frozen and the last 2 having grade 4 is used for embryo transfer in Day 3.
However, our first IVF attempt failed. Now, we are left with 3 grade 3 embryo for our 2nd IVF attempt.
Hence based on your experience, do you have a higher chance strategy for success rate?
Should we thaw all 3 embryos and see whether they can grow to day 5 and then embryo transfer taking the risk that at least 1 or more will still survive till day 5?
OR if at least 2 pass day 4, we should perform the transfer and frozen back the last one at day 4.
Should we only thaw 2 embryos and then perform embryo transfer if reach day 4 or day 5
OR thaw 1 at a time and see whether it can reach day 5 so that we have two more embryo as backup
Also, is there any other way to improve the uterus lining before IVF so that the embryos can attach firmly although we have been given the progesterone pills till day 17.
My age is 37 and husband 40 years old.
Thanks in advance for your advice.
Cheers
Sky TAN
There are so many issues that need explanation before I can address future IVF attempts and while helpful, the information you provide here is insufficient. The good news is that you seem to be a “good responder” to gonadotropin stimulation so that it is possible that a change in the protocol for ovarian stimulation is needed.
Please go to the home page of t his blog, http://www.IVFauthority.com and when you get there please find a “search bar” in the right hand column. Type in the following subjects into the bar and it will take you to all the relevant articles I posted there.
“An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
“Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
“Agonist/Antagonist Conversion Protocol”
“Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
“IVF success: Factors that influence outcome”
If you wish to discuss your case in detail call 800-780-7437 or 702-699-7437 to arrange a telephone or Skype consultation (free of charge to those who reside in the United States or Canada). While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.
Geoff Sher
We are doing a donor cycle. Egg retrieval was yesterday. We received 5 eggs, and we were told today that all 5 fertilized. Do you recommend a day 3 or day 5 transfer? With only 5 eggs I am leaning towards a day 3 transfer because we can’t afford another cycle. How many embryos do you recommend transferring? The donor is 26.
In my opinion, embryos that do not make it to blastocyst will almost certainly not propagate a viable pregnancy. I would aim at transferring 2 blastocysts. Unless you take all embryos to blastocyst you will not know which embryo(s) are potentially “competent”, and the alternative of taking a chance by transferring all would pose a risk of a high order multiple (triplets or greater)…. which is undesirable.
Geoff Sher
Thank you for your help with this. Do you think we are likely to get 2 blastocysts when we only have 5 eggs? We did a shared donor cycle.
I’m 43 and my husband is 40. We recently did a transfer of 4 morulas and an 8-cell on day 5. I feel like they should of been blast at that point. The morulas were graded a 3 (4 being the best) and the 8-cell a 4. Is there a chance of any of these guys im planting
Yes…because morulae on day 4 often make blastocysts on day 6…and that is still OK!
Geoff Sher
We recently did a transfer of 5 embryos. I was bloated right after retrieval which dissapeared and came back a couple a days after transfer. I’ve very bloated and my stomach is hard. I’m not constipated. I look like I’m 6 months pregnant. Could this be a side effect from the progesterone? It’s a very uncomfortable feeling.
It is possibly a progesterone effect associated with pregnancy…perhaps!!
Good luck!
Geoff Sher
I’ve been bothered by something my fertility specialist said to me and hoping you can offer an opinion. During my last IVF cycle a previously frozen 3 day embryo was thawed and with a 3 day embryo from the fresh cycle both were allowed to continue growing in the lab. On day 5, the fresh embryo had made it to blast stage, the thawed embryo was a morula. The embryologist commented that the thawed embryo being slightly behind was as he had expected. My fertility doctor later commented that the morula had likely missed the implantation window and had had no chance of implantation.
I’m extremely bothered by these two comments taken together. If they had known that the thawed embryo would grow slower why was it not thawed earlier? If they had known that it was growing too slowly to “catch” the implantation window in my uterus why was it transferred?
It seems to me a waste of an embryo! Worse I now have no frozen embryos and a fresh cycle is almost 4 times the cost of a frozen cycle. Without any other consideration that morula was at least worth a lot of money!
Is there a reason it was transferred? Is it likely to have “missed” the implantation window? If the embryologist expected it to grow slower than the fresh embryo should he have thawed it on day 2 instead of day 3?
Thank you!
I do not think that the slower development of one will affect pregnancy generating potential. If it has the potential it will reach blastocyst in the uterus and if it is viable will propagate a pregnancy.
Try not to stress out over this.
Geoff Sher
Hello, I just found this site, very interesting. I am now 40. I was previously married had 2 children, normal pregnancies, normal labor and delivery , both healthy boys. I had my tubal ligation because we were happy with the 2 boys. Sadly my husband passed away of cancer at age 37. I was lucky to fall in love a few years later. My now husband did not have any children and thought it would be nice to have a child together .We decided to try to reverse my tubes, only one was attached and that was very poor and kept blocking up. We decided this year in Feb to try IVF. We did the injections, sorry can not remember what they were called, anyway I had 14 eggs retrieved , 10 fertilized but only 7 made it to 5 day blastocyst stage. I had 2 embies transferred on day 5. I got pregnant and 1 embie took. I had spotting right from implantation. at 5 weeks I had my 1st bleed, had u/s ,saw strong heartbeat and no reason for bleed. the bleed stopped that day but continued to have brown spotting. At 8 weeks I had another big bleed, went for u/s baby fine and saw a small tear in placenta , but they were not concerned? The bleeding was on and off, at 10 weeks had huge bleed, passed fist size clot, went to u/s and saw healthy baby but saw SCH. Oh, I also had a polyp ,very small removed just before IVF treatment started. I bled everyday like I was on my 2nd day of my period .Never any cramping. At 14 weeks had massive bleed again, passed very large clot but baby still was great with strong hb. The SCH was about 5×7. At 18 weeks my water broke, went to ER and 7 hours later I still was not cramping nor dilated. Doc could not get u/s till morning ,he said he was almost positive it was not my water but that the placenta moved and let go of the clot and all was well…. I knew different, in the morning I had the u/s which should I had complete rupture and no water left .Baby still strong heartbeat. We waited till 20 weeks to see if my water would fill back up but no such luck .Aug 7th I was induced, 5 hours of lab to deliver my baby son sleeping. One of the hardest things I have had to endure in my life. 4 months later we decided to try again ,had special u/s to check my lining , no lesions, polyps or anything .I started taking Estrace to thicken my lining to a triple lining which I got and Monday 26th we had 3 thawed embryos transferred 2 blast and 1 morula. I am on day 5 and have been a little crampy lately. I guess my big question is what caused the SCH , I asked my docs and they say it is a fluke .Also baby was fine and placenta was tested and normal. If we get pregnant this time what are my chances of getting a SCH again? I am so freaked out that this will happen again. Never a good time to loose a baby but at 20 weeks was very hard. Hope to hear back soon
Thanks Tracy
Hi Tracy,
So sorry to hear about your ordeal. Subchorionic bleeding occurs quite commonly, and is totally unpredictable. In some cases it happens when there is a chromosomal embryo abnormality. Was the baby you lost tested chromosomally?
There are usually no warning signs either.
Wish I could be of more help.
Good luck! and please keep me in the loop.
Geoff Sher
We never had the baby tested, He looked so perfect, he always measured for growth exactly where he should be, all his organs on u/s was normal, but no we did not have him tested, our hearts were so shattered, holding him in our arms was so hard to give him up. We had him cremated and brought his ashes home with us. I guess we should have had him tested but just at that time could not bare the thought of “something” hurting him..even though he was already gone.The placenta was sent away and that came back normal, would any chromosomal abnormality not have shown up in the placenta results?
I had my trasfer on monday 26th and I have no spotting unlike last time I was already spotting on day 3 after transfer and never stopped. Is this a good sign do you think ? I can sort of understand if the embryo was abnormal and started to detach, how can the baby still develop and always measured totally normal? Is SCH usally caused by an abnormal embryo or was it or could have been an implanting issue or just a fluke?
I am a little nervous of all 3 embies taking but I know god only will give me what I can handle!!
Thank you so very much for repling to me, you have no idea how much we have tried to figure out what casued this and if it was something I did to casue it. I never was told to go on bed rest, or montitored after huge bleeds, was alwasy just told by my doc that you may lose the baby and just have to wait and see. It was hard because everytime I asked a question about the SCH I basically got shrugged shoulders and was told, can not tell you, not sure, just have to take day by day. Because I have had SCH am I at a higher risk to get it again or is just a fluke?
My heart truly goes out to you and I do understand.
However, I want you to know thatt I have had many patients who had SCH’s and went on to deliver a healthy baby. In fact I am the godfather of one. The causes is not necessarily a defective embryo. In fact most go on to a healthy birth. You need to trust and go forward. Before you do the FET however, get tested for thrombophilia and also I suggest a full autoimmune and alloimmue assessment. Go to the home page of http://www.IVFauthority.com and read the articles I posted there in May 2011 on “immunologic implantation dysfunction” and then the one on “thrombophilia”.
I wish you G-d speed and a peaceful holiday season.
Geoff Sher
Good Morning, We already did the FET on Nov 26th. I am due for my period on This sat 8th, so figured I can do a HPT by Wed. So far the only different thing with this embryo transfer is that I have no bleeding at all. Last time 3 days past trasfer I was spotting and as mentioned only spirled out of control from there. I will defiently look up this informantion you mentioned and if I do get a positive result should I still get those tests you suggest, or would it be too late ? Thank you for giving me the hope that we may be lucky this time around if we get pregnant!! I will for sure keep you posted in that area!!
Thank you again for corresponding with me, I truly and 100% appreciate it.
I would still do the tests.
Good luck!
Geoff Sher
Just wanted to say at 5 am this morning I could not wait any longer and did a HPT, it showed Negative. We had the FET Nov 26th, was it too early to do a HPT 7 days past trasnfer of 5 day blasts and 1 morula ? Such a let down !! What a emotional rollercoaster ride!! I am going to get the tests done you suggested also. is there any hope I may still have a positive chance and just rsted too early ? I had cramping 3-5 days past transfer.
Too early for the HPT. Get a blood test done a few 4-5) days from now.
Good luck!
Geoff Sher
Hello Dr.Sher, I wanted to let you know I had my blood test yesterday and confirmed what my HPT did, negative. Hard to take because they put 3 , blasts in me and not one took. I would have been happy with even just one!! We only have 2 blastocycts left. We will try again in Jan. I will be asking my IVF doctor about the tests you suggested. Just puzzled on why not even one took? I understand they can have abnormalities in them, but all 3?? heart breaking. If our next 2 do not take, we are done. We will continue on with our lives and will be happy with that. We gave it everything we had. I stopped my progesterone and Estrace yesterday. I was due for my period on Sat ,8th but still have not gotten it, I guess the progesterone delays it ? Is Jan too fast to try another IVF cycle ? Or should I have a couple of periods 1st ?
Hi Tracy! So sorry!
I would also be concerned about an implantation dysfunction….possibly immunologic. All this should be investigated before you go again. Feel free to call 800-780-7437 if you wish to talk tro me about your case.
Geoff Sher
Is this just a blood test to find out about this ? I am waiting to hear back from my IVF Doctor. Let’s say I have this is there something I can do to prevent this? I can not remember what it was called but I did have a sonohystogram u/s I think is called, before we did this transfer ,where they put a tube into my uterus and put fluid to check my intire lining to make sure no lesions ,polyps etc, everything looked perfect. If I have this should we not even consider doing the alst transfer ? is this something that develops with age, because I had 2 healthy pregnacies when i was younger with no complications at all ? But then did have the SCH and lost the baby at 20 weeks this Aug
Hi Dr.Sher, Letting you know we have a phone call appointment on the Dec 20th with our IVF clinic doctor. I will let you know how that goes. I do have a question, when I was pregnant this year from IVF transfer and lost baby at 20 weeks due to SCH from the very beginning,(rupture of memebranes) IF I was tested for implantation dysfunction….possibly immunologic during that pregnancy would there have been a chance the pregnacy would have been saved with medicine IF I tested positive? Also is there any specific questions I should ask the IVF doctor ? I just want to know I can ask every possible question before we do our last and final transfer with our last 2 blasts. If this fails we have no embryos left. I have been trying to figure out why no doctors suggested any of these tests you mentioned ot me and allowing me to go ahead with another transfer of 3 embies. I know once the transfer is done it is in gods hands. It just has been a long 4 yrs of negatives!! thank you agian for all your resposes to me. I look forward to hearing back from you.
Have a great day
Hi Tracy,
There are many things that need to be discussed that I could not possibly cover them all here. I am not even sure your doctor will be open to doing the following (which I feel is important) 1. a full immunologic profile i.e., NK activity-the K562 target cell test, immunophenotype, antiphospholipid antibodies, antithyroglobulin/antimicrosomal antibodies and DQ alpha and HLA …all on you and DQ alpha and HLA on your husband (these should be done at Reprosource in Boston). 2. Also on you, a full thrombophilia panel.
Then there is the exclusion of uterine surface lesions in your uterus bu sonohysterogram and/or hysteroscopy. Also, what was the quality of your uterine lining at hCG (thickness?
Good lucK,
Geoff Sher
Hello ,they did a sonohysterogram u/s on me on Nov23 and she said everything looked awesome, I had the triple layer lining no lesions, or nothing, her words were a perfect lining, she said my lining was ready for the fET but they wanted me on progesterone for at least 6 days that was needed for a FET. I was told to go on the 26th for the FET .All this testing I can do here right? Is it just blood work ? How come I was able to have my 2 children with no complications? Is this something that is developed with age?
Sounds right! Glad about the lining and yes, this probably developed over time. Let us talk anytime.
Geoff Sher
I am 32 my husband is 27. We have no fertility problems besides I had a tuba ligation in 02. I had 34 eggs retrieved and 20 fertilized. I had 1AA eggs and I was wondering what does that mean and is that good? My dr said since my eggs were in such good quality to only put one egg. Do you think this will lessen my chance of pregnecy by not putting to like I was going to? I’m day 2 dpt 5 day . Thank you in advance for your opinion:)
Hello Dr.Sher, wanted to let you know I had my phone call with the IVF doctor today and he said no need for the tests =( He said that unfortunetly it is only a 50/50 chance of embryos implanting . He said IF I get pregnant this time he wants to put me on a injection called Fragment ? Is this for not allowing blood clots to form ? He said I would have to take it my entire pregnacy. Also I told him we only have 2 embies left and this is our last shot, he said my last 2 look amazing, one is a full blast and the other one is ready to hatch , is that good ? I really hope this happens. I know it is in god’s hands but knowing this is being our last shot has me a little nervous. I will remain positive and try not to worry about it too much as I know stress is not good either. He said my lining was good, I think he said it was 1.5 it was at the top but was ok. He also said once I get my period I will start Estrace and then on day 3 do a regualr u/s to check my lining and then another one on day 10, if good I would then start progesterone. My thick lining …would that have maybe made a difference in implanting or not implanting? can a lining be too thick for embies to implant ? thanks again for all you have done, really it means the world to be able to chat with you. God sends amazing people to this earth for a reason, your reason I feel is to help all of us with answering our unknown questions.
I wish you the very best!
No there is no such thing as a “too thick lining” unless it is shown histologically to be pathologically abnormal.
Geoff Sher
Hello,
Dr Sher
I have an upcoming IVF cycle which will be probably my last one with my OE. I have some concerns about CCS vs PBT.
In my first 2 IVF we did a D3 transfer, as the RE felt that embies would not make it to D5. We did our last cycle in one of the best clinics in USA (CCRM). There are no known issues with both of us. In our 3rd cycle(with CCS) out of 14 matured eggs only 8 fertilized but none made it to D5. Though on the embryologist recommendation we pushed some slow growing embies to D7 & got them tested. All the 3 embies came back as abnormal.My RE is of opinion that since the embies do not make it to D5 they will not make babies. I suggested to him that we do polar body testing with our upcoming cycle but he is of opinion that it will not help to get me pregnant, to which i agree. But the reason i wanted to get PBT is to make sure that it is an egg issue & not sperm issue before pursuing donor egg route. He says that 95% times it is always egg issue and as there are no known issues with my husband’s sperms.
What would you suggest – shud i still do PBT on my eggs or just allow my embies to grow to D5 and get them CCS tested?
Embryos that do not reach blastocyst by day 5-6 are virtually always chromosomally incompetent. Putting embryos back earlier for fear that they won’t make it to blastocyst does not help. If they do not make it in the imcubator they will not make it in the uterus either…so who are we kidding.
PB biopsy is a reliable method of assessing potential to propagate viable, competent embryos and can help discern between an egg vs sperm problem. So this is something worth you considering.
Good luck!
Geoff Sher
Thank you Dr Sher for your prompt response.
My RE is against us doing PBT. He says that its not gonna be helpful. As all my husband’s tests are normal he thinks its definitely an egg issue. So I do not know what to do. What would u suggest?
I guess I have nothing to add in view of your statement
Geoff Sher
I think Dr Sher is probably the best RE in the world, and am so sorry I live thousands of miles away from his clinics. I have lost sleep over serious fertility issues (Dr Sher knows what I refer to) but ladies, he is the BEST! I have never heard so much wisdom as the words in his books articles and blogs.
Thank you for your comments, however,exaggerated and overstated they might be.
G-d bless !
Geoff Sher
Dear Dr. Sher,
I am 39 years old and myself and my husband also 39 have two healthy children together age 20 and 15. My husband and I are undergoing IVF with ICSI in the spring because my husband had a vasectomy after our son was born (aged 24) and we regretted it later on. He had reversal and although numbers are ok motility is an issue. All my blood tests are normal and I am ovulating every month and my AMH is 9.4. I am waiting until the spring because I am dieting to get my BMI to under 30 to increase my chances of implantation (presently 31.7) My question is what are my chances of getting pregnant with one blast transferred? (this is what they recommend at the clinic)or do you suggest transferring 2 blasts?
Also I am considering doing the HCG diet to get my weight down fast, but I am a little concerned that this might affect me in a negative way or interfere with my hormones before going on an IVF protocol, I read on one website that it is the ideal diet to do before IVF, is this true. I would really appreciate your opinion on both questions.
Thank you.
G O’Brien – Ireland
Each blast would yield about a 15-20% chance of a baby but if you vitrify all left-over expanded blastocyst, the freezing would not reduce the subsequent viability of these. So you can transfer one at a time and prevent multiples (by and large) without reducing the overall success rate.
I am not a protagonist of the hCG diet but provided you discontinue a month or so before the IVF cycle it should do no harm.
Happy hew year.
Geoff Sher
Dear Dr. Sher,
I am doing a natural cycle FET and have 2 day-6 blasts to be returned. I have been asked to monitor ovulation using OPKs. I was wondering how the exact transfer date is calculated in such a case. Is the first day of a positive ovulation test counted as day 0? As per the ovulation test kit, ovulation can occur 24-48 hours after the initial LH surge. Does this mean that the day of the first positive test is -1? Also how critical is timing to an FET? Can a day 6 blast be returned on day 5 or day 7 after ovulation with the same success rate as a transfer exactly 6 days past ovulation?
Thank You,
Yes, the day of the surge is day zero. Usually the ET is done on day 5 or 6 regardless of whether it is a 5 day or 6 day blastocyst. I personally do not do NC FET’s, preferring hormonal replacement cycles which I believe to be more successful because it allows easier setting of the window of implantation.
Please go to http://www.IVFauthority.com and when you get to the home page find the “search bar” in the right hand column. Type in the following subjects into the bar and it will take you to all the relevant articles I posted there.
“Frozen embryo transfer (FET)”
“Embryo Vitrification.
Good luck!
Geoff Sher
Dear Dr.,
I am 37 yrs and had my 3rd attempt with ICSI + LAH; transferred 3 embryos on day 3 (8 cells with grade 1 and 6 cels with grade 2).
What are my chances of pregnancy; my beta is on 16 jan 2013. This 2ww is killing me.
Thank you in advance.
I would say that on average the chance is about 30%. But alas, as you know, pregnancy rates can vary widely depending on the clinic you are attending. Also, the transfer of cleaved embryos rather than blastocysts makes predictability even less reliable.
Good luck!
Geoff Sher
Hi Dr.,
Thank you for having this forum. I am in Las Vegas and planning on visiting the fertility Center here.
I am 42 and have no problem getting pregnant. It is maintaining the pregnancy past 6 weeks that is the issue. I have had 2 miscarriages in the last 2 years. Assuming chromosomal abnoramlities due to age. Anyway, in your professional opinion, is the status of my ovarian reserve rapidly decreasing day to day? Do we have 6 months to decide if IVF is really for us or am I increasing the risks of losing what I already might have in there? Haven’t done ovarian reserve testing yet because we want to do it when we are commited to the process. Have you had personal success with 42 year old transfers using their own eggs? My hub is 36 with no issues that we are aware of.
Hi Juliette,
I look forward to visiting with here at our Las Vegas center at your convenience.
Indeed at 42Y, time is a critical factor as far as your ovarian reserve is concerned as it can diminish very rapidly.
Please go to the home page of this blog, http://www.IVFauthority.com . When you get there, look for a “search bar” in the upper right hand corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles I posted there.
1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
3. “Agonist/Antagonist Conversion Protocol”
4. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
5. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
6.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
8. “IVF success: Factors that influence outcome”
9. “Staggered IVF”
10.“Embryo Banking”
11. Embryo Selection: The critical factor in IVF”
Please make sure that you read items 9-12 carefully so we can discuss these further as they pertain to your opportunity. Also, consider calling SIRM-Las Vegas at 702-699-7437 and arrange to come in for a consultation ASAP.
Sincerely,
Geoff Sher
Dear Dr. Sher,
I have been through 5 inseminations with frozen donor sperm, three of the last medicated (clomiphene). All my tests have been good and I have been told that it is not normal that I have not become pregnant yet. My Dr. has doubts about whether it has been implantation issues or if there is an issue with my tubes (my Dr. has put forth the possibility that they are slow to spill), even though my HSG report states everything is fine. We are doing IVF now in February, short antagonist protocol, and as it will be in a foreign clinic it will be a 2-day embryo transfer. I am 34 years old and will turn 35 in a couple of months after this IVF. We are wondering if we should transfer one or two 2-day embryos. We would much rather have a singleton and later try again for the second child, but at the same time it has been such a long and costly process already, that I don’t know if it wouldn’t be better to take the risk of having twins, specially because I am not sure if I am emotionally able to try again if this IVF fails as well. Thank you. Kind Regards, Rita
You have to decide whether to transfer one or two day 2 embryos. I would go with two.
I do almost exclusively blastocyst transfers because embryos that do not make it to day 5 (blastocysts) are almost always abnormal anyway and should not be transferred as they would not have propagated a live birth anyway had they been transferred earlier on.
Geoff Sher
Hi Dr.Sher, Just wanted to update you, today we had our final FET. 2 embyros were transferred ,one blast and the other was ready to hatch, AA embyro, he told us the embryologist did assisting hatching on the one. He said the embryos looked perfect. When does a embryo at that stage implant if it is going too? The doctor said the other embryo was a blast and perfect and was just before the hatching stage also. My linning was perect, triple layer. I am on Estrace and projesterone. All we can do is hope and pray and we know it is now in god’s hands and hope for the positive result in 2 weeks!!
Sounds good Tracy. The blast should start attaching within 24-48 hrs.
Keep us in the loop!
Geoff Sher
Hi Dr.Sher, I feel like I am a bucket full of unknown questions!! One quick one, having the 2 embryos transferred on Monday 21st, some mild cramping yesterday and last night and today I feel like I have a slight burning/ heavy feeling inside my tummy. Almost like when you rub A 535 ointment on and you get that warm burning sensation, only mine is insdie my uterus area. I know it all comes down to we have to wait and see in 2 weeks for the pregnancy test, but are these feelings normal after a transfer, AND if so is it a good sign?
Tracy,
I understand your apprehension, but thease are all very subjective symptoms. Only time will tell.
Good luck and G-d bless!
Geoff Sher
Dear Dr Sher,
I have just finished my 4th round of ivf. Two of the cycles resulted in ectopic pregnancies. I lost my left fallopian tube during the previous cycle late last year. I had my embryo transfer for this cycle yesterday but am concerned as on the day of transfer I only had 2 late stage morula one was a very early blast so difficult to grade. My question is, can I get a pregnancy from such a low grade blast. And if so how likely am I to have another ectopic pregnancy. I normally go to 5 day transfer with much better qualityembryos so feel very anxious and disappointed this time.
Would really appreciate your thoughts
Thank you
Kim
An early blast on day 5 will often make a good one (in the incubator or in the uterus by day 6. So indeed, you can still be successful.
Good luck!
Geoff Sher
Hi Dr.Sher, Ok so my last chat with you I mentioned on Mon Jan 21st I had the FET, one was blast and the other had assisting hatching. I mentioned on 23rd I was having like a burning sensation in my uterus. Friday 25th around dinner time I went pee and on my toilet paper there was a penny size of faint pink blood. that was it, no more no less. Could this be from implantation spotting 5 days past the transfer? I am a little bit scared as we lost our little boy at 20 weeks from the SCH. I hope if we are postive that it is not the start of another SCH. Last pregnacy I was bleeding alot more by now also. thanks Dr.Sher for any advise
This is probably unrelated to implantation, unrelated to a threat to this cycle and likely to be quite innocuous. I can understand your concern but try to “wind down”.
Good luck!
Geoff Sher
thanks dr.Sher. I just have to wait to do the test and hope for a big Ol Positive.I have notcied some changes with my body, lower back ache, tender breasts, but these are also things I get just before my period. I wish there was a majic camera to look inside now to see if impalntaiton took!! one could wish right! thanks again Dr.Sher, you truly are all of our life savior!!
Thank you Tracy!
Geoff Sher
Hi Dr.Sher, Well letting you know I had a blood test yesterday (4 days early) but It is confirmed I am positve!! YAY!!! my count was 120, my 2 week waiting period really is not till feb 4th, but because I started spotting more and past a dime size clot I took my HPT and was positive, so went in for the blood work. after that little clot, i have had no more spotting at all. The doctor said it could have been one of the embryos that did not take, is that possible ? I go back tomorrow for another Beta check to make sure counts are doubling. Because I had a sCH and lost the baby at 20 weeks ,they are putting me on starting today fragment injections, just to prevent or try to prevent any develpoment of clots. I am a little scared of this needle, it will not harm the baby will it? I was told I will most likely have to take it right through my whole pregnancy. I just worry it will thin my blood too much and make the baby disconnect from my lining? Sorry if I sound silly but just never had to be on a blood thinner before. Thanks Tracy
Hi Tracy,
Sounds promising. Please keep us in the loop!
Eager to receive good news.
Geoff Sher
Hi Dr. Sher,
I’m interested in your thoughts on delayed blastulation – there seems to be little info around on this issue. This is my 1st ICSI cycle for severe male factor infertility. I’m 35 and have an AMH in the bottom 25th percentile for my age – otherwise no other detectable problems. I did a long down reg cycle with 200IU FSH. 6 eggs retrieved – all mature, 5 fertilised, of which there were x4 8-10 cell embryos at day 3. Transfer was planned for the morning of day 5, but on day 5 all 4 were still at the morula stage (of which only one was starting to cavitate). I questioned the lab about delaying until day 6 to ensure only a blast would be implanted, but they preferred to proceed to implantation with the 2 best morula as they felt they could clearly select the best 2 at that stage, although they were pessimistic about success. On day 6 both remaining morula had become blasts, but they weren’t satisfied enough with the quality to proceed to storage (they didn’t report their grade, but one was still at an early stage and the other had a good ICM but imperfect trophoectoderm) so they were discarded. I’m still awaiting the outcome of this cycle, although I’m also pessimistic and am directing my thoughts towards optimising the next cycle.
- Any thoughts on the causes of delayed blastulation? Sperm/egg factors?? Culture factors?? (The “lab” is interestingly located in a converted house.)
- Are the rates of success lower with embryos that become blasts at day 6 vs day 5?
Thanks for your thoughts.
In my opinion, delay to day 6 is not problematic, but any delay in reaching full expansion and cellularity beyond this, is associated with dismal results.
Geoff Sher
Hi Dr Sher
I have been reading your blog and thought it is ver helpful. I am 38 yrs old and hubby is 55. We have a 7 yr old and 2 other pregnancies where I experienced intrauterine demise at 12 weeks and 6 weeks. I underwent full immunologic testing and found out I positive ANA. I started stims last January 23 and ER last Feb3. We were able to collect 11 eggs, 9 mature and injected (ICSI) all 9 fertized. Embryologist suggested to wait for day 5 blastocyst transfer which we did. We transferred 2 very high grade blastocyst and I am on my 9th day post transfer and I got bloated stomach gas and mild cramps on day 6 post gtransfer and still experiencing bloated ness until today. Is this normal? Went to see my OB and she said its as expected. I have no lower abdomen cramping, no spotting etc. I have been eating lots of protein and drinking Gatorade but the uncomfortable feeling is still there.
Thanks!
GL
This could be an early sign of implantation. If it is, I hope this time you keep the pregnancy. My concern is that you might not have all the relevant immune tests done (you need: A K-562 test for NK cell activation, a full APA panel, Reproductive Immunophenotype (RIP), and Antithyroglobulin/antimicrosomal antibodies. You and your husband should be tested for DQ alpha and HLA matching) and that you are experiencing secondary immunologic implantation dysfunction. Equally important is where the testing was done because in my opinion there are only about 3 or 4 reproductive immunology reference laboratories in the United States that can do these tests adequately. I use Reprosource in Boston, MA and Reproductive Immunology Associates (RIA) in Van Nuys, CA.
Go to the home page of http://www.IVFauthority.com, find the search b ar in the upper right and type in “Immunologic Implantation Dysfunction” and click. Let it take you to two articles I posted in May of 2011 (PARTS 1 & 2). Then later, after the outcome of this cycle is conclusive, and should the need arise, call 800-780-7437 and set up a Skype (or phone), free consultation with me.
Geoff Sher
Hi Dr Sher,
I am about to embark on IVF #3 after 3 years of trying with/without help. I’m nearly 35, regular cycles and did first 2 rounds of IVF down regulated where all but one of 17 Grade A fertilised Day 3 embryos made it to blast stage.
After IVF#2, I had a lap which revealed Stage 3 endo which was all removed, but 6 months of natural trying has proven futile.
My FS doesn’t think it’s a sperm issue – we’ve has the assay and caryotyping done, but I’m not feeling happy about using the same drug regimen and failing again.
Do you know what could make embryos that showed no fragmentation and looked “perfect” spontaneously arrest in such large percentages? Most of our embryos (90%) are fertilising and all are making it to day 3 looking perfect and then arresting between 3 and 5.
There’s no other diagnostics I’m aware of that we can try, so I’m looking for a new regimen, or some ideas to run by the FS.
More info below:
TTC#1 since Aug 2010
Me 34 DH 34
First FS visit Oct 2011, all usual tests A-OK
Hysteroscopy/Polypectomy Dec 2011
IVF#1 May 2012 BFN (1 blast transfer, 7 arrested day 5)
Genetic testing all clear July 2012
IVF#2 Aug 2012 CANCELLED OHSS (9 fertilised, all arrested after day 3)
Laparoscopy Oct 2012, asymptomatic endo (Stage 3) removed
Trying naturally until April 2013
Sorry, I meant to say all but one ARRESTED between day 3 and 5. So 1/17 made to blast stage.
Hi Dr Sher
After I have written to last feb 17, I was hospitalized for late onset OHSS. Had water in my peritoneal cavity and enlarged ovaries. IMO doctor injected me with pruloton and pregnyl 4 days after ET (feb 12) then I felt bloated and gassy feb 14. Could this late ohss be caused by the pregnyl? My tummy is so big it measured 90cm up until today and I still feel a lot of discomfort. I am going to have my beta HCG on Friday (feb 22). I am a bit confused as to why I have ohss when I only had 11 eggs retrieved. Had no problems whatsoever after ER even ith pregnyl shot on that day.
Cn u pls advise what could have caused this? Will this eventually go away?
Thanks
GL
Hi GL,
You are correct, 11 follicles could not have produced this effect. Even 20 follicles should not have. You must have had many more. Remember, the number of eggs harvested is often not a true reflection of the total # present. In very high responders,especially with certain stimulation protocols ( also when the type/timing/ dosage of hCG is off) poor quality eggs frequently remained trapped in the follicles and do not come free at aspiration. Often times this will erroneously be referred to as “empty follicle” which just is not the case (see below). I would bet that this happened to you…….Good news is that it is avoidable through well timed “coasting” (see below).
If you are not to conceive in this cycle, the progressive symptoms you are experiencing will start to ameliorate. If you you do conceive, fanned on by rising hCG levels, they will get much worse and last for about 4-5 weeks before abating rapidly (often overnight)…and this could be a problem.
Discuss this with your RE and if this cycle does not work out for you, feel free to call 800-780-7437 or 702-699-7437 to arrange a telephone or Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail.. While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.
In the meanwhile, go to the home page of this blog, (www.IVFauthority.com). When you get there look for a “search bar” in the upper right hand column. Then type in the following subjects into the bar, click and this will take you to all the relevant articles I posted there.
1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
2. “Severe Ovarian Hyperstimulation Syndrome (OHSS)”
3. “Prolonged Coasting”
4. “Empty Follicle Syndrome”
5. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
6. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
7.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
Sincerely,
Geoff Sher
P.S. Pregnyl/Profasi/Novarel/Ovidrel are all hCG
Hi dr sher
I am 43 years old and my husband is 51. We are doing our 2nd ivf. My first was a disaster 4 eggs retrieved none made it to day 1.
My second is a lot better. I retrieve 12 9 made it to day 1. . My question is do you think I should do css at day 5? I am just worried about abnormalities but at the same time worried that none of my embryos will be normal.
Any thoughts would be appreciated.
Many thanks
Yes! I would recommend CGH embryo testing. We prefer metaphase CGH on Day 3 but array CGH on Day 5 is fine too. At your age however, you should be considering embryo banking very seriously, in my opinion…see below.
Please go to the home page of this blog, (www.IVFauthority.com). When you get there look for a “search bar” in the upper right hand column. Then type in the following subjects into the bar, click and this will take you to all the relevant articles I posted there.
1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
3. “Agonist/Antagonist Conversion Protocol”
4. Factors that influence outcome”
5. “Staggered IVF”
6.“Embryo Banking”
11. “Egg Donation”
At any time when you are not in-cycle elsewhere, consider calling 800-780-7437 or 702-699-7437 to arrange a telephone or Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail.. While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.
Geoff Sher
Dear Dr Sher,
I am doing ivf with icsi at the end of the month and I had a HyCoSy test today on day 8 of my cycle and my endometrium measured 10.3mm, the sonographer said it was a bit thick for the time of my cycle and asked me was I on progesterone, which I am not. When I went back to work I was puzzled but then wondered if this was caused by me doing the hcg diet? I did the diet for 2 weeks taking 175iu’s of HCG daily but stopped doing the diet on day 1 of my cycle and never recommenced. If this is not the cause then what do you think it could be? I am very worried that it may mean there is something else wrong with me or that it may effect my ivf treatment, should I wait another month before commencing it?
thank you,
Gail
dear doctor
i am awaitiong my third ivf cycle 2 fresh and this will be my first FET. first ivf 2eggs 3 day trasfer faild af came before pregnancy bloods 2nd icis due to husbands low motility 1 very good blastocyst was replaced on day 6 and have 2 blast frozen so i have done day 3 and day 6 blast tranfer and both times have resulted in the same outcome af beofre preg bloods do you think a FET could be better for me less stim drugs as i am only 27 and the aggs i have replaced have been good quality
thank you
Not necessarily. If I were you I would be at least trying to exclude an implantation dysfunction before doing an FET.Please go to the home page of this blog, (www.IVFauthority.com). When you get there look for a “search bar” in the upper right hand column. Then type in the following subjects into the bar, click and this will take you to all the relevant articles I posted there.
1. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
2. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
3. “FET”
4. “IVF success: Factors that influence outcome”
If you feel the need, please call 800-780-7437 or 702-699-7437 to arrange a telephone or Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail.
Geoff Sher
Dr sher
thank you ever so much fr reply the thing is i have had lots of blood work and i have had numerouse procedures laprascopy and had cameras in to have a look around and also a few months ago had womb biopsy and all come back fine is there other things they can do to check for these immune problems my clinic have not mentioned anything to me about this after both of my fresh cycles i become ill both times and had to be on tablets to stop ohss but have had symptoms of this both times or maybe the progesterone has a bad effect on me? also at my clinic after they put eggs back they have you leave within 5-10 minutes could this effect the outcome and is there anything that could be done to help implantation alot of women talk about pineapple core and aspirin are these just old wives tales. thank you so much for replying brilliant to speak to someone with so mich experience
It is a pity that I do not have the opportunity to help because I think I might well be able to.
Geoff Sher
Dr Sher
after reading your posts on immune disfunction my mum has a history of lupus but she has 7 children and 2 of my sisters have already given me 4 nieces all natural so could this still be a factor and does a womb biopsy show if i have any of these immune disfunctions your post are very interesting easy to understand and very informative shame i live in the uk or i would most definitely use your clinic
Thank you for your kind felicitations.
Not everyone with autoimmune disease or a family history thereof has activated uterine NK cells. A blood K-562 target cell test is the most important…not a biopsy. You should contact Reprosource in Boston, MA.
Good luck!
Geoff Sher
I have been reading your blog and I’m new at all this. I am 39 and my husband is 42. Neither one of us can have of our own so we are on a embryo donation list. Our name is now at the top of the list and we are overwhelmed with information being thrown at us. First we have to make our decision on the donor. Not sure what to look at to make the decision. We have an appointment with our doctor on the nineteenth but are in somewhat of a race to pick our donor because there are two other couples along with us. The donor we are looking at has a cell stage of 1 D6 & 2 D7 blasts. Is this good or not good? Any help we could get would be greatly appreciated.
Some programs have their own grading systems and II am not familiar with thisa one.
Sorry! However, if the “D6 and D7″ means they only made it to blastocyst on days 6 or 7 post-fertilization, then I would have reservations.
Geoff Sher
Hi I had Egg collection yesterday and I did egg sharing so had 17 eggs i got 9 and my match got 8. 5 fertilized for me. Do you think there is a chance they will make it to day 5. Or is there a chance they will all not make it? I am 29 and this is my first IVF I have pcos and my husband is fine
Indeed, at least 2-4 should make blastocyst if they were mature (M2′s) and your partner has good sperm.
Geoff Sher
Thank you Geoff that has made me feel better now my clinic has booked me in for a day 3 transfer but they said they will call me in the morning if they think they will make day 5. Also do you think transferring 2 will give me a better chance of getting pregnant?
Hi,
I am almost 40 with PCOS, no male problem, had 3IUI with one early miscarriage and 3IVFs, first 2 unsuccessful and last one we had 5 blastocysts. One was transferred and identical twin pregnancy was lost at 24 weeks. I had bleeding from 20 weeks and some back pain. Babies were normal but did not survive. I am heartbroken but still willing to try FET. What are the chances for fet to work for us, for 1 embryo to split again ? Should we transfer 2? What can we do, test to prevent another preterm loss? I am thinking preventative cerclage, but dr recommended only cervix scans..
Thank you very much in advance.
Age is a factor that impacts egg/embryo competency. Depending on the method of freezing, the skill of the doctor in doing ET and whether there are or are not other mitigating factors such as immune implantation dysfunction, the chance at 40 with a double blastocyst FET should be about 25-30%.
Geoff Sher
800-780-7437
I am 42 awaiting transfer. I was suppose to go in for day 5 transfer this am, they called and said that they wanted to push it back to 6 day transfer. 10 eggs, 6 fertilized….today 4 morula, 1 9 cell, 1 starting to deteriorate. They stated they wanted to give them a little more time to select the best. They will transfer 3 because of my age. Our first attemp, we had 3 fertilize (from 6eggs) and they did well until day 5. We were trying to do PGD but got a call day 5 that they didn’t think they would make freeze following pgd, so they transferred them. Outcome negative beta. Should I be concerned again, or if they were really tanking would they have transferred them today?
Also, dx with unexplained fertility. I have a 3 yo daughter conceived naturally. Just a little more info:) thank you.
Copy!
Geoff Sher
I concur with your clinic’s strategy.
Geoff Sher
Are the success rates for day 6 lower than day 5 transfer? Is the uterine lining too mature/old for implantation to occur following day 6 transfer. 3 progressed to blast the next day (day6) and they transferred them. Unfortunately, all fair quality. Thank you.
They are slightly lower but pregnancies do occur.
Geoff Sher
Another question…would you have recommended freezing the day 6 blasts or would you have just done a fresh transfer? Thanks again!
Either or…would not affect outcome provided the freezing was done by vitrification.
Geoff Sher
Is the uterine lining still ok by then for implantation following 6 days? Thank you.
Yes!
Geoff Sher
Hi Dr Sher, you kindly answered a few questions for me last year when I had a miscarriage. We have now moved onto Donor egg treatment. ET should hopefully take place early April. What would be your recommendation on blastocyst transfer when using DE? My clinic can do 3 or 5 day transfer with a 60 v 65% success rate (I thought blast transfer would have been much higher). Do you have a rule of thumb based on the number of embryos or do you always go for blasts?
The point is that the baby rate per embryo transferred is significantly higher with blastocyst transfers than with day-3. This is because blastocysts are much more likely to be chromosomally normal and thus “competent”. Since embryos that fail to develop into blastocysts are almost always aneuploid (chromosomally abnormal and “incompetent”, you do not want them anyway. What this means is that you do not have to transfer as many blastocysts at a time (no more than 2) as would be needed to get the same baby rate…thus avoiding the risk of high-order multiple pregnancies.
Geoff Sher
Dear Dr Sher,
I am 42 year old, my husband and I have a 4.5 year old daughter naturally conceived. I have a mind Hashimoto desease and am currently substibuted by Euthyrox 125. We went through our 1st IVF attempt in December last year. Short protocol, 11 eggs, 5 fertilized eggs and 3 transferred on Day 3. None of them made it to pregnancy. Our 2nd IVF attempt was under a long protocole, I had 10 eggs, 7 mature, and only 2 fertilized under IMSI. Doctors cannot explain such a low fertilization rate other than by my thyroid disorder (substituted nevertheless). Furthermore, 2 eggs made it compacted morula on day 5 and the doctors decided to proceed with the transfer. I am taking Aspirin to address the antibody issues and continue with the thyroid substitute. I am currenty on my day 7 after the transfer. Not putting too much hope into what the outcome may be but would be interested to have your thoughts on the reason for such a low fertilization rate given the techniques used and the odds of transferring 2 morulae on day 5. Thank you!
More than likely, the low fertilization rate was a function of declining egg quality which alas is a function of age (the biological clock). In fact at 42, only about 1:10 eggs are normal and eggs that are grossly chromosomally abnormal (aneuploid) often do not fertilize.
Geoff Sher
I am 32 my husband is 31 we have been trying to get pregnant since we got married almost 7 years ago. After trying naturally and ovulation predictor tests never worked we decided to ask my ob for help. I was put on clomid 3 times over a 3 month span. The clomid never worked. We were reffered to a RE and she started with clomid and monitoring, no success. We did injections next with iui and it didn’t take, next round was iui to ivf conversion because my body responded to well had a chemical pregnancy. Next was a fet didn’t stick. None of the embryos got the change to blast they were 8 cell on day3. Fet degraded to 4 cell but tried anyways. Our last cycle was last March 10eggs 5fertilized and two implanted on day 3. My blood test was positive and doubling. After about a week had some minor bleeding but levels started to drop. A few days later bleeding stopped and levels went up. Made it to 6 weeks and lost the pregnancy. Was sad but decided not to give up. December we tried again but at first blood/us check found simple cyst. We waited and started new cycle they changed my meds around from gonal-f to follistim, added baby aspirin, metformin 2x a day and folic acid on top of prenatal vitamin. We started taking ganarelex for 3 days. Day of hcg trigger I had.24follicles ranging from 10-23. Egg retrieval they got 17eggs,12fertilized and they gave me a 2/3/5 day transfer. Got call today we still have 12.embryos ranging from 4 cell to 8 cell and being pushed out until day 5 wed. Never gone this long do you think they will make it to blast stage???
This sounds very much like there is an implantation issue afoot. You are young and a good responder and should not have much difficulty getting pregnant. I can almost definitely help here .
Please go to the home page of this blog, http://www.IVFauthority.com. When you get there, look for a “search bar” in the upper right hand corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.
1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
3. “Agonist/Antagonist Conversion Protocol”
4. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
5. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
6. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
7.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
Pick up the phone and call 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail
Geoff Sher
here.
I am 33 yrs and my husband is 30 yrs and I undergone ivf with icsi today. I had 12 eggs retrived and 9 became mature. Inbetween them only 2 were ready to trznsfer at day 5. 3bb grade and one couldnot grade just after morula.
We dont want twin pregnancy so we transfered only one blastocyst of grade 3bb.
We were confused about set or det?
Is our decision right? What are chances of success for me?
Right decision but as to chances, without knowing the clinic I could not say.
Geoff sher
Thanks for reply. My clinic is fertility center of illinois.
I wanted to confirm with you that is 3bb grade is good for single blastocyst transfer and pregnancy outcome?
I do not know the classification. Each clinic has its own.
Geoff Sher
Hi Dr. Sher!
I really enjoy reading all of these posts and your responses. Quick question. We transferred 1 blast, grade 1AA and we used a donor egg (donor is 24). Our clinic says the success rate with donor egg is 60-70%. Do you agree with those statistics? For background, I am 43, my husband is 38 and we have been trying for 5 years now. We have done 5 IVFs with our OE and got pregnant twice, but m/c. One was too early to tell why, the other was a chromosonal abnormality – Trisomy 9. Just wondering your thoughts on our success rate. I am no 3dp5dt. Thank you!
That quoted success rate is reasonable in the right clinic.
Geoff Sher
I came across your blog while doing some research online — very informative and very helpful. Thank you for taking the time to help those of us who are many, many miles away.
May 7, 2013 had one (1) 6 day, fully hatched 6AA blastocyst with 100% cell survival, transferred. I do not know my estradiol / progesterone levels, but do know that I am on 2cc’s daily progesterone in oil shots, as well as two (2) .01mg Vivelle estradiol dot patches replaced every other day. Embryologist said the embryo thawed nicely and rehydrated very well, quickly swelling back up like a basketball. He and the IVF Dr said we have a very good embryo.
From what I’ve read online, a fully hatched embryo would likely implant sooner, as it did not need to contend with breaking through the zona. I know from reading LOTS if information online, that one cannot actually FEEL the implantation and any signs/symptoms of pregnancy could simply be a side effect of the progesterone shots. Speaking of the shots, what a pain in the tush, literally! One evening I think we may have overheated the oil and the burn and pain when injecting was overwhelming. Immediately after the injection, I became flush, dizzy, nauseous, and faint. It subsided after a few minutes, but I was shaky for a while afterwards. I also had a sharp pain in my abdomen, of course, I am hoping that shock to my system did not cause any harm to my embryo!
The day of the transfer, Tuesday, through Friday, I mainly stayed in bed with my feet elevated. From about the 2nd day post transfer, my symptoms started to form and gradually increased: bloating, gas, sleeplessness, full feeling after eating, breasts becoming fuller, nipple sensitivity, growing areole area, headache and backache first couple of days that subsided, only slight headache from time to time now. May 12, 14, & 16, I took home pregnancy test — all negative. My hcg is scheduled for today, Thursday the 16th, 9 days past transfer — is there any chance the hpts are wrong??
Do you have any insights, any thoughts on my fully hatched embryo and it’s chances of implanting, etc.?
The embryologist noted that there is usually a good response with day5/6 embryos, with day 5 having an 8-10% better result; that is, without knowing the chromosomes. Given the fact that we did PGD/S testing and know my embryo is chromosomally normal, that is in our favor.
Also, I wanted to let you know, one thing that was not taken into consideration, was the fact that I tested positive for 2 cys of C677T, MTHFR homozygous. My previous Advanced Maternal Fetal Medicine Dr mentioned taking lovenox up to 12 weeks, though studies do not support this treatment. He also suggested to take Folgard and baby aspirin. I had mentioned these things to my RE but the only one of these things that we are currently doing is the baby aspirin. I called the RE yesterday to enquire about Folgard. I am awaiting word from their office.
All of this may be mute today, if my HCG comes back negative — but, I’m hoping it will be positive and then these are things that should be considered. I don’t know if they should have been considered PRIOR TO TRANSFER. Without taking PRIOR precautions due to the MTHFR, could this have jeopardized this embryo’s chances of implantation?
Some additional information:
I have previously had three (3) natural pregnancies, all three resulting in miscarriage; this is my first IVF, done with ISCI, assisted hatching and PGS, to determine a normal chromosome embryo, as two of my three miscarriages were determined to be chromosomally abnormal. I am 43 yrs old, first natural pregnancy at age 41, two more in the following year. This IVF round brought 14 follicles, 11 eggs retrieved, 10 fertilized normally, 5 remained at day 3. At day 6, 2 remained and biopsied: 5AB starting to hatch, 6AA fully hatched — 6AA normal embryo, 5AB abnormal. So, after 11 eggs retrieved, only 1 normal, transferred on May 7.
Thank you again, for all your courtesy and information. It is greatly appreciated!
Good luck! The fact that this is (I presume) a CGH-normal embryo is very much in your favor and a HPT is far too insensitive to rely on. The blood test is what is needed. The MTHFR mutation is not relevant so early on.
Implantation is associated with no symptoms.However Lovenox given for thrombophilia should continue throughout pregnancy.
My approach to IVF with own eggs in older IVF is to use a very individualized stimulation protocol, to consider Staggered IVF and banking of CGH-normal blastocysts (see below).
Please go to the home page of this blog, http://www.IVFauthority.com. When you get there, look for a “search bar” in the upper right hand corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.
1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
3. “Agonist/Antagonist Conversion Protocol”
4. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
6.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
7. “IVF success: Factors that influence outcome”
8. “Staggered IVF”
9.“Embryo Banking”
If in the future you feel so inclined, consider calling 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail
Geoff Sher
Sorry for the lengthy email, I just wanted to convey all of the information at once. It is 4am and I sit here researching and researching, after my third hpt comes up negative. I’ve read where women have tested negative on hpts, only to get a positive hcg. …I’m still hoping!!
Thank you Dr Sher!
Indeed! See below!
Geoff Sher
HCG negative.
(((
Hi Dr Sher,
I am 36 year old and become 37 at July. I was told to do day 5 transfer. There were 11 good quality (7/8 cell either I or II graded embryo by day 3). However, we will only know whether there is good quality blastocyst by ET time.
At this point, the clinic is recommending SET. I wonder with my age (36/37), shall i consider SET or DET? After single blastocyst does not gurantee pregnancy.
What would you recommend for my age and situation?
Thanks
Unless you have an alloimmune implantation dysfunction or there is a medical condition that puts you at inordinate risk with twins…I personally would opt for a 2 embryo transfer.
Geoff Sher
Thanks Dr Sher. Yeah, I did 5 day ET today and transferred 1 5AA and 4AB blastocyst. Hope to be pregnant to twins.
The only thing I am concerned is the clinic ask me to get up right after transfer. I thought I shall lay on table for about 20 – 30 min. Besides, The nurse ask me to empty my bladder right after the procedure, and saying because of vallium, they do not want full bladder to cause uterus contraction. I am not sure this is totally fine or due to i am the last patient during Sunday.
What do you think? I am highly hopeful for the high quality DET, and do not want those getup and urinate immediately ruin my chance or fall out my embryos.
Again many thanks,
It should not matter.
Good luck!
Geoff Sher
My husband and I have just recently went through our first IVF cycle after three medicated IUIs. We are still awaiting my Beta test to see if the whole procedure worked. However, Im wondering why after retrieving 16 eggs, 15 of which fertilized normally, we only had two make it to day three. One was a 6 cell and other was morula I was told. I am 29 years old and my husband is 28 years old with a slightly low morphology. ( I was put on an atagonist protocol and suppressed with 2 months of bcp. 75mcg Menopur and 225mcg Gonal-F…Cetrotide followed on day 6.)
I think I could be of help here. However, I cannot comment constructively without details.
Please go to the home page of http://www.IVFauthority.com. When you get there look for a “search bar” in the upper right hand column. Then type in the following subjects into the bar, click and this will take you to all the relevant articles I posted there.
1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
3. “Agonist/Antagonist Conversion Protocol”
4. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
5. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
6. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
7.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
8. “IVF success: Factors that influence outcome”
Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail
Geoff Sher
Dear Dr. Sher,
My husband and I recently completed IVF #1. We transferred 2 day 3 embryos that were graded B+. The reason we did a 3 day transfer was because my doctor was out of town on day 5. I was very frustrated and upset by this. The cycle ended in a negative.
We have 4 day 5 blasts frozen that are graded 3BB. I know this isn’t the best quality. My question is should I do an FET with the ok quality blasts or try another fresh to get better quality? I’m 27 and have PCOS/IR. My husband is fine.
Thanks,
Rebecca
Yes I think you should!
Geoff sher
I’m sorry. In regards to my previous post, you think I should do the FET or do another fresh? I was unclear which one you meant.
Thanks again!
FET!
Geoff Sher
Hi,
I am in the 2ww and had my transfer on Monday. My husband encouraged me to take a test today Friday only 4 days after and it was negative. We used a donor and was told this was the best way to conceive. We got the not so great news that the embryos weren’t doing well and only three were even progressing. They wanted to transfer 2 days earlier than expected as they said they would have a better chance for success. So on monday they took the two best and transferred at the morula I got the call yesterday that the one not transferred made it to blastocyst. What do you think are chances are to having a successful pregnancy?
You did the test too early. Give it until Tuesday next then do another beta hCG. I am not totally pessimistic here.
good luck!
Geoff Sher
Hi. I am a 43 year old women trying for our first child. Had my first retrieval for IVF May 23. My lining was only 6.3 so they fertilized the egg successfully as an 8 cell on day 3. at that time, I was not knowledgeable about the benefits of freezing at day 5 to grow a blast. But, he tells me that since it was my first he wanted to see if my egg was of good quality and didn’t want to run the risk of it not making it to day 5. This month the dr. is recommending another retrieval and to hopefully freeze again. He recommends freezing over a fresh transfer. Your opinion on this? Few questions if you don’t mind. Do I do the retrieval and transfer both the fert and fresh at one time? Or do I try for a retrieval and freeze another one? Do I encourage a 5 day freeze for this one? But then i would need two separate cycles to transfer a 3 day and then a 5 day! And, of course this is only if I can produce a good quality egg again. I’m feeling pretty desperate and scared as my time is of the absolute essence. I’m using a friendly center that is accepting of my age and want to try some avenues before considering a DE. Thank you! Your site has been very helpful in my journey.
Hi Bridget,
Embryos that do not make it to blastocyst are almost always chromosomally abnormal and “incompetent”. Thus who are we kidding when we put embryos back sooner. That is my opinion. It sounds as if you have diminished ovarian reserve and woukld benefit from Staggered IVF, and embryo banking of CGH-normal blastocysts (see below).
Please go to the Home page of this blog, http://www.IVFauthority.com. When you get there, look for the “search bar” in the upper right hand corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.
1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
3. “Agonist/Antagonist Conversion Protocol”
4. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
5.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
6. “Staggered IVF”
10.“Embryo Banking”
11. “Egg Donation”
Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail
Geoff Sher
His, I am 35 and my husband is 39. Our dx is severe male factor, my husband has azoospermia, which has been helped with Clomid. We had 2 failed ivf with testicular sperm ( prior to him starting Clomid) and 1 failed ivf with fresh sperm (count was approx 300 k). All of these failed and all were 3 day transfers due to our horrible fertilization rates (1/8, 2/17, 3/10). Fast forward a year and we just underwent IVF #4 with a new clinic. I had 17 mature eggs of which 10 fertilized. I received our day 3 report today and they said that all 10 look great still ( she said it is normal to see some start to deteriorate by this stage but ours looked great). So we are pushing to blast and I am terrified that none will make it. From what I have read this is when the sperm starts to have an impact so I would think the attrition rate would be much higher with severe mfi than normal. His recent count was approx 1 mil but 0% morphology. What do you think would be a normal attrition rate in a case like this? ( there are seemingly no female issues)
That is not possible to predict, but I can tell you that going tp blastocyst is the right course because embryos that do not make blastocyst are almost invariably chromosomally abnormal and would not make a healthy pregnancy anyway.
Good luck!
Geoff Sher
Doctor Sher
We began the ivf journey a year ago. My husband was diagnostic with severe oligospermia. In our 1st ivf we begin the stims with 350 gonal f and I had antral follicule and the cancel the cycle. 2nd we change to menopour, we got 11 eggs which 8 fertilized/ 4 made it to 2nd day/ only 2 survived to 3rd day transfer. I got pregnant but lost it at 5 weeks. We began with 3rd ivf 3 months after and this time I had menopour 225 and gonal f 225. My left ovary shut down and only produce 1 egg and right ovary 7. In the ET day they got only 4 eggs,3 fertilized and none of them made it to next day. I’m 36 and my husband is 34. Do you think I am poor responder? Do you think I can get a better protocol cause I feel gonal f is not the right medicine for me? Do you think this poor fertilization rate is caused by eggs or my husband bad sperm?
I would need to know your basal AMH and FSH as well as specific details regarding your response to stimulation to answer that question.
Please go to the Home page of this blog, http://www.IVFauthority.com. When you get there, look for the “search bar” in the upper right hand corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.
1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
3. “Agonist/Antagonist Conversion Protocol”
4. “Staggered IVF”
5.“Embryo Banking”
Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail
Geoff Sher
Dear Dr Sher
We are starting our 3rd ICSI cycle. Cycle 1 we had 10 eggs, 100% fertilisation with ICSI, 2 good quality blastocysts transferred, nothing to freeze & ended in chemical pregnancy. Second cycle very similar but took clexane, ended in 5 week miscarriage.
Should we do day 3 array CGH to ensure we are only transferring genetically normal embryos? I will also be taking steroids & intralipids this cycle.
Thanks
Clare
CGH might help but you need to look at the problem comprehensively. Both an embryo issue and an implantation dysfunction could lie at the root of the problem.
Please go to the home page of this blog, http://www.IVFauthority.com. When you get there, look for a “search bar” in the upper right hand corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.
1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
3. “Agonist/Antagonist Conversion Protocol”
4. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
5. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
6. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
7.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
8. “IVF success: Factors that influence outcome”
11.“Array CGH versus Metaphase CGH in IVF Patients: …”
Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail