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I have been reading many of your past posts on the advantages of Day 5 transfer. Thank you so much for all the great information. I have one quick question as I am trying to put together my arguments to fight for the Day 5.
It seems to me that clinics would have a much improved success rate if they were only transferring embryos that had proved viability ( I understand that viability still does not guarantee pregnancy or live birth). Wouldn’t that be to their advantage as opposed to setting up already hormonally charged women for heartbreak? I would much rather be told that sorry we had to cancel your transfer since nothing went to blast as opposed to waiting 2 weeks for basically the same answer. I would also think the pressure from the insurance industry would be on clinics to only perform transfers when there really is a better expectation of success. Insurance companies usually are quite vocal about saving money why are they not a bigger voice in this issue? Our insurance covers 2 retrievals, 2 fertilizations and 2 transfers so again if the transfer is doomed isn’t it better to know beforehand?
I was up to all hours reading many of your old posts so I would also like to take this opportunity to thank you for the education and for taking so much time and patience helping the women in this site. I am sure you have a more than full dance card between your prominent clinic work, consulting, wife and children, etc that you still carve out time to help us here is amazing and I hope you realize that it really means the world to so many of us here.
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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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