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I will be 40 in June and undergoing my 2nd IVF cycle. We are doing back to back Meldrum protocols with no natural cycle in between. I have one blocked tube and not other problems for myself or my husband.
Last cycle we retrieved 12 eggs, 11 were mature and 8 fertilized. At our first report we were told 4 were good and 4 were okay. By day 3, 2 additional eggs were reported as good. At our 5 day transfer we were shocked when we were told that we were tranferring a morula and a blastomere. We were told that there was no grading since they were not blastocysts. We were also told that the most advanced embryo would probably make it to blastocyst in a couple of hours. One of our remaining embryos made it to blastocyst on day 6 but was not graded high enough to warrant freezing.
On this cycle our doctor is leaving us on the same protocol and upping our Bravelle a bit. He also recommended that we use AH on all embryos. He did say that this was just to help things and not because we have a thick out layer.
Do you have any thoughts or comments about assisted hatching in this scenario?
Also, the doctors office just told me that they only do 3 day transfers with AH. Does this decrease our chances because we can't go to day 5 and have a better idea of how the embryos are doing?
Thanks for your help. It is great that you provide this service to help us better understand what is going on.
Natalie
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You might have been confused with the terminology at the time of you last transfer. They probably told you that they were transferring a morula and a blastocyst (not a blastomere). [i]Blastomeres[/i] are the individual cells within a developing embryo prior to the blastocyst stage. They would never transfer a single blastomere.
Compacted morulas and early blastocyst stage embryos are not graded. Expanded blastocyst embryos are graded based on the degree of expansion, the number and appearance of the stem cells and on the appearance of the trophectoderm (the cells that will make the fetal portion of the placenta). Until the blastocyst stage embryos expand, they cannot be graded. They were correct in telling you that the embryos would likely develop to the expanded blastocyst stage in the next few hours. Expansion of the blastocyst stage embryo happens very quickly, in a period of about 6-8 hours.
Assisted hatching can be performed at the blastocyst stage using a very similar technique as the one used for assisted hatching of Day 3 embryos. The blastocyst stage embryos must be "shrunk" by placing them in a slightly hypertonic medium (culture medium containing 0.1M sucrose). This reduces the internal pressure inside the blastocoel cavity and causes to trophectoderm cells to retract slightly from the protein coat. The same acidic Tyrode's solution (or laser) is then applied to the protein coat to disolve an area through which the embryo will "hatch". The embryo is then returned to isotonic medium and allowed to re-expand prior to transfer. Morula stage embryos can be hatched in the same way as Day 3 embryos. You may provide the lab at your program with the following reference so that they may read the specifics of this protocol:
Fertil Steril. 2002 Mar;77(3):615-7.
Healthy twin delivery after day 7 blastocyst transfer coupled with assisted hatching.
Sagoskin AW, Han T, Graham JR, Levy MJ, Stillman RJ, Tucker MJ.
I have been using this hatching protocol for blastocysts for 6 years and observed an increase in blastocyst implantation rate following implementation (particularly for Day 6 transfers). I can see no reason why your program cannot offer you the benfits of both blastocyst culture and assisted hatching. Best of luck on your upcoming cycle.
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