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amygren - June 22nd, 2006 2:26 PM

Hi Dr. Smith,

I had my ET transfer yesterday, and it was difficult to say the least. I have a tilted uterus which means my cervix is way up high, and it is normally very difficult for the RE to locate and secure. After about 20 minutes of jamming multiple speculums inside me, we finally reached the little bugger and were able to insert and place the first catheter (without embryos). Unfortunately unbeknownst to everyone some mucus got into that catheter, so when they inserted the inner catheter with the embryos (2) and transferred, the embryos got stuck in the outer catheter. The embryologist of course carefully inspected the catheters and stabilized the embryos for a second attempt which was successful. Everyone assured me they were fine, but I can't help but worry they were affected by all the manipulation. Luckily, they were blasts (5dt) and were graded 1AA which is the highest quality possible so I'm hoping they were strong enough to survive the trauma.

What is your opinion on how this will affect our chances of success?

FYI - I am 36 and this was our second IVF attempt. I have successfully achieved pregnancy, but it ended in m/c at 8w.

Thanks for your help!
Amy


Dr Smith - June 23rd, 2006 11:18 AM

Day 5-6 (blastocyst) transfers can be much more difficult than Day 3 (cell-stage) transfers. By Day 5-6, progesterone has closed down the cervical canal with a thick mucus plug, making what would have been a difficult Day 3 transfer, a nightmare on Day 5. Because Day 5-6 transfers can involve a great deal of vaginal and cervical manipulation, we often use concious sedation (same anesthesia as the egg retrieval) for the Day 5-6 transfers. The mucus plug in the tip of the catheter is not uncommon in Day 5-6 transfers. I've seen it quite a few times (even after repeatedly rinsing of the cervical canal with culture medium). As long as the embryos were recovered and re-transferred, your chances a good. With the atraumatic catheters we use now a days, repeating the transfer does not apear to adversly effect the endometrium. No worries. Best of luck.


LucyLu - December 10th, 2006 2:00 PM

Hi Dr. Smith,
I also had this happen to me at my transfer last week. Day 5 transfer using DE - we transferred 2 Grade 4AA blasts with embryo glue. The embryologist immediately checked the catheter, discovered one was stuck, and it was then transferred also. Transfer was easy and otherwise uneventful. You stated that this does not appear to cause trauma to the endometrium, but what about to the blasts themselves? The doctor and embryologist assured me that it would not.
A couple of other questions - what is your opinion of embryo glue? I had a DE cycle (fresh and one FET) fail this year which is why they recommended it. I have no known uterine/immune/implantation issues, after extensive testing.
Finally, this cycle was excellent - donor (proven) had 28 eggs retrieved, 24 fertilized, and 15 embryos made it to blast (the 2 we transferred plus 13 frozen). Of the thirteen frozen, 9 were frozen on day 5 and 4 on day 6 -all were expanded to about 4 and 11 are AA and 2 were AB). (My previous cyle, which was with a first-time donor, resulted in 4 total blasts, the 2 transferred on day 5 were 3AA and the 2 frozen on day 6 were 2AA and I think 3AA.) The embryologist was ecstatic. This clinic's fresh DE cycle success rate is about 65%. I am hoping the sheer number and quality bodes well for my upcoming beta? Do you think my chances are better this time? (At least I have good back-up in the freezer!) Thanks in advance - you are a lifesaver!


Dr Smith - December 11th, 2006 11:03 AM

As I mentioned in the previous post, reloading the catheter and repeating the transfer (using an atraumtic catheter- as everyone does these days) does not appear to affect the succes rate. The bastocysts are very small compared to the catheter and do not appear "traumatized" by the relaoding of the catheter and the second transfer.

"Embryo Glue" is the name of a commercial product (catchy, don't you think?). Except in company-sponsored studies (VitroLife), Embryo Glue has not been shown to improve success rates. Yes, I use it in my lab because it can't hurt and, who knows, maybe it helps. And that's all I gotta say 'bout that.

Based on embryo "quality" alone, your chances are about the same for this cycle as last time. There isn't much difference between a 3AA and a 4AA except for the degree of expansion, which is not so important. The AA designation means that all the embryos had an adequate inner cell mass (stem cells). The difference between a "3" expansion and a "4" expansion is about 3 hours. Once they get to a 3, they go on to a 4 a few hours.

The embryologist was happy because the number of embryos available for freezing was over the top and unusual. I'd be ecstatic too. Even if the fresh cycle doesn't work, you have several additional trys.


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