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Sorry I contributed to your insomnia, but as an author, I'm flattered. Look out Mary Higgins!
Many patients feel as you do - "Tell it to me straight, doc". Unfortunately, in this particular branch of medicine, the patient is considered too fragile to receive accurate information. Docs try to keep it upbeat and hopeful, but I personally think that is a disservice to the patient. I will continue to be a lone voice in the wilderness. However, many of the things we do in ART are patient driven. I believe if more patients ask for blastocyst transfer, the docs will have to give in. Patients also have to make sure the doc knows he/she is off the hook if there are no embryos for transfer. Many patients, in their disappointment, are looking for someone to blame. The doc and the lab are handy targets. In some cases, its true that things could have been managed better, but most of us are out there putting our hearts and souls into the work we do. In ideal word, patients would realize that we can't control many of the variables involved in reprduction (i.e. genetics).
The insurance issue will surprise you. From a purely cost effective basis, it is their interest that you do not become pregnant (yes, you heard me right). Two IVF attempts is less expensive than a pregnancy. If you do become pregnant, you will submit more claims during your pregnancy, delivery and postnatal care. Insurance companies are in the business of collecting premiums, not paying claims. From there point of view, the best insured individual never requires medical treatment, but continues to pay their premiums on time. So much for blastocyst transfer being insurance driven. We do have one selling point. Blastocyst transfer can reduce the number of high order multiple gestations (triplets, etc.) and those pregnancies, deliveries and postnatal care are disporportionaly higher than singleton births. At this point, we are loosing that battle too.
Before you ask your doctor for blastocyst transfer, make sure they have adequate experience in growing embryos to the blastocyst stage. Ask what their success rate is with blastocyst transfer. Ask which patients (if any) receive blastcyst transfers. That should give you some insight into their capabilities. If its only the very best prognosis patients, it may be a red flag. Due to limitations in the lab, some programs can only safely grow embryos to Day 3. In these cases, the risk associated with growing the embryos to Day 5 under suboptimal conditions is higher than transferring the embryos on Day 3. If you are unimpressed with the answers you get, and you are still convinced that you want blastocyst transfer, seek out a program with extensive experience in growing blastocyst stage embryos. You will be in good hands.
Good luck in your fight.
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