How many should I transfer?

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3 posts on this thread and the last post was on March 18th, 2006 9:18 AM by Dr Smith

Erin - March 17th, 2006 12:46 AM

Dr.

A little history. I'm 35. Endometriosis. Hypo-thyroid, due to treated Graves Disease in my 20's.

1st IVF cycle canceled due to medication reaction.

2nd cycle. 12 eggs retrieved, 9 fertilized. 3 transferred on day 3 in fresh cycle, chemical pregnancy. 4 transferred on frozen cycle (also not blasts), chemical pregnacy.

3rd cycle. 12 retrieved, 11 fertilized. 4 Transferred on fresh. No pg. 3 transferred on frozen, 1 was at blast, no pg.

Now we're on our 4th cycle. Retrieved 15 eggs, 13 fertilized. Tomorrow is day 3. I'll be getting my report from the RE to consider a day 3 transfer. I need this to be my last cycle. I don't have the heart to go through the disappointment again, and if I'm headed for egg donation, I want to head that direction sooner than later. I don't want triplets, but could manage twins. I'm expecting 7-8 good quality embroyos tomorrow, based on past history. My embryologists says that day 3 embroyos freeze better than blasts. If I want to transfer 4 blasts, should I just wait until day 5 and transfer everything that is left. I don't want to be left with 6 blasts, and have to freeze them if they won't fair as well. If I'm going to put them all in, would a day 3 transfer be better? I'm more open to selective reduction than to another failed cycle. My last batch of frozens, didn't thaw well, and I don't want to waste them in their best state.

Could you give me suggestions for haivng 5, 6, 7, 8, 9 good embroyos on day 3? I would reduce to twins if my RE suggested it. I want healthy babies.

Thank you so much in advance. I have learned so much from your site, and will continue to refer others here. Your straight talk is very appreciated.

Erin

Dr Smith - March 17th, 2006 8:15 AM

If I were in your shoes, I'd wait until the embryos reach the blastocyst stage. At your age, I would expect around 3-4 good quality blastocyst stage embryos on Day 5-6 from the 13 fertilized on Day 1. I would recommend transfer of no more than 3 good quality blastocst stage embryos or a maximum of 4, if the quality is not so good. Cryopreserve any remaining GOOD QUALITY blastocyst stage embryos (even though the lab appears to be struggling with getting good freeze/thaw results from blastocysts). The trick in freezing and thawing blastocysts is not in the technical aspects of the freezing and thawing procedure itself, its in ONLY freezing good quality blastocyst stage embryos. Blastocysts of POOR quality do not freeze/thaw well. Most programs are reluctant to discard blastocyst stage embryos, even poor quality ones, and so they end up freezing them only to have (predictably) disappointing results.

Erin - March 17th, 2006 12:29 PM

Dr. Smith

Day 3 Results. 2 more of the 13 fertilized, and then 2 arrested. Ended up with 13 embroyos.

1 9 Cell - Grade 2
2 8 Cell - Grade 1
3 8 Cell - Grade 2

2 7 Cell - Grade 1
1 7 Cell - Grade 2
1 6 Cell - Grade 1

1 6 Cell - Grade 3
2 5 Cell - Grade 3

The 1st 6, we are culturing to blast. Next 4 freezing today on day 3. Last 3 we are watching, expecting them to arrest.

If on day 5 we transfer 3 blasts, what would my percentage of having, trips, twins, or singleton births?

Same question for transferring 4...

Just trying to maximize my outcome, and minimize my risk. My RE & embroylogist agree with you, and would prefer to transfer 3 blasts. I would just like to look at the weighted outcomes, before making a final decision. I undertstand too, that we'll have a better gauge on embroyo quality on day 5.

Your input is greatly appreciated.

Erin

Dr Smith - March 18th, 2006 9:18 AM

It really isn't possible to determine how many to transfer or what your chances of success or multiple gestation is at this point. It depends the number of embryos available and the quality of the embryos at the time of transfer. I would recommend that you let your RE and the embryologist advise you on the day of transfer. They will have a better grasp of the situation.

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