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val - October 1st, 2006 1:32 PM

Dear Doctor,

I am about to have 2 embryos transferred tomorrow day 4. Both have developped into 4 cells which is not optimum but the embryologist told me that from day 2 to day 3 they doubled in size .

I am puzzled as to why the embryologist think that a transfer in day 4 is the same as day 5 except that in day 5 will know for sure if they are viable.

My embryologist set me up for a transfer on day 4 and i am worried that we are rushing to transfer instead of waiting one more day to ensure that the embryo reach the blastocyst stage

So i would appreciate if you could please respond to me asap and give me your perspective on the pros and cons of transfer on day 4 versus day 5.

Many thanks
Val

Dr Smith - October 3rd, 2006 9:06 AM

Sorry for the delay. I have been very busy in the lab.

Transfer on Day 4 is a little better than transfer on Day 3. By Day 4, the embryos should have developed to the 8-cell+ stage and have intiated compaction (a process where all the cells adhere closely to each other). Embryos that have advanced to the 4-8 cell stage by Day 4 are unlikely to continue development. If your transfer was originally scheduled to be Day 5 and it was moved up to Day 4, it is a "bail out" transfer. They were concerned that, if they waited until Day 5, the embryos would have shown unambiquous signs of arrested development. The transfer would then be cancelled and the "Well you never can tell..." argument for transferring arrested embryos wouldn't have flown. Worried that you would blame the doc or the lab for this outcome, they moved up your transfer. This is not an unusually practice, but I personally believe it is a travesty.


val - October 3rd, 2006 9:52 AM

Thank you so much Doctor for your prompt answer. I really appreciate your contribution in helping me as well as all the women on this forum.You are a wonderful gift for us.

I have better news to share related to my question yesterday.

The 2 embryos that were transfered yesterday ( day 4 )were actually in a more advanced stage.

The first embryo had 12 cells at time of transfer and the other one had 8 cells ( that was the one that had 4 cells on day 3).
I believe the embryologist whom i spoke to on day 3 must have only given me the information for the smallest embryo (4 cells) while i understood that both embryos had 4 cells.
I am feeling more hopeful since they have developped well on day 4

I laid down for 1/2 hour after the transfer and the doctor told me that it was enough for the embryos to find a place in the uterus lining.

According to you what's the likelihood that embryos on day 4 would stay in the uterus and keep on growing normally before implanting to the uterus ?
Is there any risk that they might fall down if they were unable to stick to the lining ?

I have rested all day yesterday and took off 2 more days.

I hope that will help.

Thanks again Doctor for your wonderful assistance and knowledge sharing

Best regards
val :)



I


Dr Smith - October 5th, 2006 7:40 AM

They will stay in the uterus no matter what you do. However, they may move around to some degree within the uterine cavity. There are areas of the endometrium that are more receptive to embryo implantation than others. One of the proposed reasons why IVF doesn't work ever time is that the embryos moved to a less hospitable place following transfer. This movement was not a result of the patient moving around, but rather uterine contractions which are not under voluntary control. The laying around after transfer is not physically necessary, but it has a psychological effect for the patient that they have done everything "right" and if it doesn't work it wasn't becasue of anything she did or did not do.

The embryo that had reached the 12-cell stage should have initiated compaction by Day 4. If it was not compacting, this is not a good sign. The 8-cell was a day behind in development. Based on the information you provided, I would not be overly optimistic. They should have waited one more day to determine if they are able to develop to the blastocyst stage. Embryos must reach the blastocyst stage to be capable of attachment and implantation. Another advange to blastocyst transfer is that the embryos are able to attach immediately folowing transfer and there's no extra time (2-3 days following a Day 3 transfer) for them to move around in the uterine cavity before attaching.


val - October 11th, 2006 6:16 PM

Thank you Doctor for your explanation.
The 1st embryo was at morula stage.
I should know if i am pregnant on Friday Oct 13th ( hoping that it will be a lucky day for me...)
I have to say that i am extremely nervous that it didn't go well.
As i am approaching the " DAY", it's becoming more excruciating.

I have a question. Do you think that it is normal to feel mild sensation in the lower part of the uterus ( probably at the cervix or a bit below). It's very very mild but i don't know if it's because it's more psychosomatic or if it's real.

I am afraid it's as if i am going to have my periods.
Do you think that if i do a home test tomorrow ( day 14 of the transfer) it might give me an indication whether i am pregnant of not ?
Thanks a lot Doctor for your patience in replying so kindly.
Regards

Dr Smith - October 12th, 2006 11:42 AM

Unfortunately, you cannot trust any of the sensations you experience during the two week wait because your body is under the influence of progesterone supplementation (and whatever else they've got you on). These hormones can make you feel pregnant when your not and, conversely, make you feel like your period's coming when its not. Try to ignore what you feel (yeah, I know - easy for me to say, I'm not the waiting for the pregnancy test).

You may be able to detect hCG by a urine pregnancy test 13 days out from transfer. If it will keep you from going crazy (and/or killing your husband), you could try. The sensitivity of the urine test is below that of the blood test. In other words, you can be pregnant by the blood test and not by the urine test. No matter what, YOU STILL HAVE TO GO FOR THE BLOOD TEST!.

Best of luck.

val - October 13th, 2006 5:59 PM

Dear Doctor,

Thank you so much for your response.
I did a home test this morning that was negative and the blood test confirmed it later on today....No luck for me on this 1st IVF.
I will try again and this time will ask for a 5 day transfer.
Thanks for your wonderful support and knowledge.
Best regards
Val

val - October 13th, 2006 9:07 PM

Dear Doctor,

I forgot to ask you the following questions:

1/ what should i ask my RE in regards to the failure of the 1st IVF cycle? Is there specific things that i should examine further ( some tests?)

2/ Do you think that they would be able to tell me the quality of the morula that was transfered on day 4 ? I know that they didn't reveal much to me and at that time i was not even aware that there were grading of embryo quality.

3/do you believe that the RE should adjust the medication protocol to increase my chances for producing more eggs and improve the egg quality?

My FSH varies from 7.2 to 9.2 depending on the month ( more towards 7 though).

I was pregnant 3 years ago with my boyfriend but at that time decided to abort....I never got over it but must look forward now to new fortune.

I am hoping that if it happened naturally 3 years ago, IVF is likely to succeed eventually with his sperms...if God wants of course.

Thanks for your support
Best
Val

Dr Smith - October 18th, 2006 1:31 PM

Keep in mind that, even in the best case senarios, IVF fails half the time. So, a single failed IVF cycle is not definitive and can easiliy be chocked up to the luck of the draw.

Only one of your embryos had developed to the appropriate stage by Day 4 and even so, it was a little behind (no compaction). Quality-wise, that's all there is to know. There we not very many eggs. Varying the protocol may help a little, but it probably won't make a huge change in the numbers of egs retrieved.

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