DE Cycle - Blastocyst Questions

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1 posts on this thread and the last post was on June 12th, 2006 12:41 PM by Dr Smith

LucyLu - June 7th, 2006 5:31 PM

I recently completed a DE cycle that was not successful with a 24-year-old first-time donor. She produced 19 eggs, 18 mature, 15 fertilized (with ICSI), 14 cleaved by day 2, by day 3 there were 4 eight-cell As (A being best), 2 six-cell As, 5 four-cell As and 3 four- cell Bs. By day 5, 2 had made it to blast and 6-7 were still at the morula stage. At the time they were graded (which was very early in the morning on day 5), the 2 blasts were both graded 1AA (on a scale of 1-6, with 6 being fully expanded). These two were transferred on day 5. By day 6, two more had made it to blast (graded 2AA and 3AA) and were frozen. My husband has no male factor problems, and my uterine lining was great. This particular clinic has had DE cycle success rates averaging 65%-68% in 2004 and 2005, respectively, and about 50% with DE FETs.
A few questions:
1.) Is this good embryo production for a donor? Obviously fully expanded blasts would be preferable - do you think that the fact that these were a little slow may have been a problem? Or is the AA score more important?
2.) What do you think of our chances for the FET? I believe that I’ve read in your other posts that day 6 blasts may have slightly lower implantation rates than day 5 blasts. Would this maybe be offset by the fact that they are more expanded than the fresh ones we transferred?
3.)We did the DE cycle at an out of town clinic with a large donor program, with monitoring by my local RE. My chances being equal, we’d prefer to do the FET here for convenience. My local RE does not do a lot of DE cycles. (Both REs have roughly the same annual IVF total volume and similar success rates for non-donor fresh and frozen cycles.) However, my local RE doesn’t do many DE FETs, and performs a lot more day 3 than day 5 transfers. Do you see a lot of variation among labs on the FET success rates? (If so, we’d be more inclined to use my out of town RE because of more experience.)
4.) Finally, just out of curiosity, what is your clinic’s policy on bed rest after transfers? Also, what day does your clinic do betas following day 5 transfers?
Thank you so much. I really value your input and find it unique among the various interent forms I've seen, as it gives valuable information from the perspective of the embryologist instead of just the RE.

Dr Smith - June 12th, 2006 12:41 PM

A1. The embryo "production" from this donor is within the expected, but not super-duper. A "good" donor cycle would result in 2 good quality blastocyst stage embryos for transfer and at least 3 top grade embryos for the freezer.

What people don't realize is that there is a lot of "wastage" in human reproduction. By the time a woman is in her late 20s, nearly half of the eggs are anueploid (abnormal chromosome number). There are estimates coming from the scientific literature to suggest that a significant number of eggs are anueploid from the start (i.e. birth). As a species, humans are very inefficient at reproduction. Evolutionary biolgists believe that this evolved because we invest some much time and energy into our young (much, much more than other species - except other primates). Accordingly, the birth rate for a particular mother needed to be slowed down. In otherwords, there was no advantage to having a litter of human babies because very few (if any) would survive to adulthood without proper care and nurture.

The AA score is more important than the degree of expansion. On the early morning of Day 5, it is appropriate to see blastocyst in the early stages of expansion. So I would not categorize them as "slow". Once intiated, the exapansion process proceeds rapidly.

A2. By Day 6, I would expect full expansion of the blastocoel cavity. Since they were 2-3 instead of 5-6, this is indicative of reduced developmental potential. Although you prgram's over all pregnancy rate for DFET is around 50 (and this is completely respectable), I think your indivdiual chances may be a litle less (say about 40%).

A3. My vote is for the out of towner. More experience in thawing blastocyst stage embryos, a respectable FET rate and to avoid any potential transportation dangers.

A4. The whole bed rest issue is a matter of personal preference for each doc. There is nothing in the scientific litertature to promote perscribing one period of time over another. Because we transfer the embryos at the stage where implantation can proceed immedately following transfer, we recommend 24h of post transfer bedrest to keep things quiet through the initial attachment/implantation phase. The implantation process continues for about 10 days after that, but once they have attached securely to the endometrium, additional bed rest is probably superfluous. You can detect low levels of hCG in the blood as early as 10 days post Day 5 transfer, but we usually wait until Day 13-14 for a definitive value to eliminate false positives (chemical pregnancies). This avoids the "you're a little bit pregnant" anxiety and torment for the patient. By waiting until Day 13-14, you either are or you aren't.

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