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deb67 - December 6th, 2006 8:59 AM

Hello! Okay my history is 3 iui's, 2nd fresh ivf I got dd with 5day blasts and they grew out 5 others to blast. This was at a clinic in Rockville. Now I live 2 1/2 hours south and am going to another clinic. This clinic is much smaller. My RE was open to using the same protocol as my old RE where I got my dd. I did 3 FET's (one cancelled and one m/c at 6 1/2 weeks) and did my ER this past Monday. RE called me yesterday and said 19 follies retrieved, they did icsi on 16, and 10 fertilized. He asked me if I wanted to do a 5 day transfer as that is what gave me my daughter in 2004. I am so confused on what to do. How do you know if a lab is capable of handling blasts? I know my old clinic would do fine but with this new one. I am not sure at all. I just need some good advice!
deb
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Dr Smith - December 6th, 2006 1:39 PM

The RE wouldn't offer a blastocyst transfer unless he had complete confidence in the lab. Since you have 10 embryos, it is likely that you will have blastocysts to transfer. Based on the information you provided, I'd say go with a Day 5 transfer. At least you will know that the embryos that are transferred are capable of implantation. Best of luck.

deb67 - December 6th, 2006 3:15 PM

Thanks for responding. For some reason I have had trouble getting ahold of the doctor. My husband spoke with the staff and then talked to the embryologist. The embryologist said they normally don't do day 5 fresh transfers. They do 3 day and then grow out the rest to blasts. So he has no stats on day 5 transfer. I am really torn about what to do. He said they didn't even look at the embies today. So I have no idea how many I even have to work with. I am really stressing myself out. I know that day 5 would be the best but now I am not sure if I have confidence in the lab. He told my husband that knowing that we might do day 5 he will not do the assisted hatching and will have to change it into a new dish or something???
How do you know if a lab is qualified for day 5?
If I were your wife (or partner) what would you do?
Thanks again!
debra

Dr Smith - December 7th, 2006 12:26 PM

Hmm. The embryologist's response casts a little doubt on their capablity, but not that much. I'd say if they rarely culture embryos to the blastocyst stage, then bail out with a day 3. However, it sounds like they routinely culture to blastocyst for freezing (as it is for many labs). If you are worried about the "quality" of the blastocysts they freeze, the easiest way to check is to ask for their current FET rates for blastocysts. A live birth rate of 30-40% is acceptable for frozen-thawed blastocysts. Significantly lower than that, Day 3 is the safer route.

A different culture media formulation is required for continued growth to the blastocyst stage - hence why they change the dish they are in.

If culturing embryos to the blastocyst stage, assisted hatching on day 3 is not advised. During subsequent manipulation in the lab, cells could "pop out" of the hole in the protein coat. Lost cells could compromise development. It is possible to perform assisted hatching on blastocyst stage embryos, but I'm finding that few programs do this. They have not aquired the technique.

deb67 - December 7th, 2006 1:36 PM

Thank you Dr. Smith! We talked to RE today and he said I still have 10 embies cleaving which shocked me since we had 10 that fertilized. He said that 5 look really good for turning into blasts. Since I have that many to work with we are going to go for the gold of 5 day blasts. The lab didn't do the AH on the 3 day thank goodness. Thanks for your advice I hope I can post later and let you know I got a BFP!
Debra

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