Freezing embies
7 Replies
Aimee37 - September 12

Hi Dr. Smith-
I have a quick Q to ask you.

Now my clinic only freezes embryos that make it to day 5 or 6. Why do some clinics freeze 3 day old embies? It does not make sense since some of those would not make it to day the blast stage anyway? I mean it would definitely save some disspointment for the patient if and when they want to go for an FET. ??? I just question this!!

Also- Why do some clinics give thier patients Valium the day of transfer? My clinic does not, they do not feel it is necessary. Does Valium actualy help your uterus relax??



Dr Smith - September 12

Embryos that reach the blastocyst stage have demonstrated their developmental potential. In most labs, blastocyst stage embryos survive the freeze-thaw process better than Day 3, cell stage embryos. The success rate for FETs with blastocysts is significantly higher than with Day 3, cell stage embryos. So, why do some clinics still freeze at Day 3?

1. Almost everybody gets a freeze $$$
2. It used to be the standard, circa 80s-90s
3. Old habits die hard
4. Some programs are incapable of growing blastocyst stage embryos or freezing them properly

Valium relaxes everything, including the uterus (Thank you for flying Air Valium). Some physians believe that embryo transfer causes stress (dah!) and when the patient is stressed, the muscles of the cervix ay contract making an atraumatic ET more difficult. Stess also causes the release of the hormone cortisol (like in the weight reduction commercials) and cortisol inhibits implantation. A patient stoned on Valium has to spend more time in the recovery room following ET. In fertility factory programs, they don't have enough beds in the recovery room to accomodate a bunch of stoned patients. Rapid procesing of the patients is the rule. Round 'em up, move 'em out, Rawhide! We use Valium or sedation in our program. The patients seemed to be happy with that (zzzzz...) and our pregnancy rates are pretty good. You be the judge.


Aimee37 - September 12

Thanx a bunch Dr. Smith!

I am just aking a bunch of Q's before my 2nd IVF. I just hope I do not have another chemical pregnancy. Things look better this round due to less Lupron (10 units vs 20 units) I have 18 mature eggs and my lining is 13.1 (no period this time, using old lining) My ER is this Thursday & I am going to beg for a 5 day transfer!! My RE does not give Valium, mainly I think because my clinic is very big and it works like a factory (Shady Grove Fertility) and there is a bed shortage. Also because I will have a full bladder and there will be leakage if on Valium! :o

Now if my uterus contracts a day or two after transfer, will it effect implantation? I did have uterus contractions the nite after transfer and a few nites thereafter(noturnal orgasms) I mentioned this in a previous post and if this effected my chemical pregnancy or not. I would like a Valium but my RE will not prescribe it. :-\

Thanks for all your help Dr. Smith! Love your sense of humor! ;D


Dr Smith - September 13

Well, we don't want any "accidents" in recovery, do we?. In our program, we do not perform the embryo transfer with the aid of ultrasound, so there is no need for a full bladder. A full bladder increases the stress level too, particularly if you're transfer #27 that morning. Look out! She's gonna blow! To use U/S or not is a personal preference of the physician. There have been numerous publications on both sides of this fence. One method is not clearly superior to another.

If they transfer the embryos at the blastocyst stage, it is most likely that the embryos will attach to the endometrium that day/night. Once attached and initiating implantation, the embryos will not be dislodged by contractions (another good reason for blastocyst transfer). If the embryos are transferred on Day 3, they may slosh around a bit during contractions, as they cannot attach to the endometrium until the reach the blastocyst stage on Day 5-6 of development. Contractions may evict them from the "sweet spot" near the top of the uterine cavity to the less hospitable region of the lower endometrium or, alternatively, squeeze them into the tube. Progesterone has a "calming" effect on uterine contractions. You may need additional progesterone during the period leading up to the transfer to ensure you have enough on board to prevent contrations immediately after transfer.

Usually, chemical pregnancies are caused by genetically abnormal embryos and/or immune issues (elevated or overzealous NK cells). It is unlikely these contractions would cause a chemical pregnancy UNLESS the embryos were relocated to a lower region of the uterine cavity that is not designed to allow implantation This nature's way of preventing a pregnancy doomed to miscarriage because of its location in the uterus. The growing baby would put too much pressure on the cervix, dilate it prematurely and result in disaster.


Aimee37 - September 13

Thanks for your reponse Dr. Smith ;D

You crack me up! When I had my last transfer I was seen 45 min. late because the RE had a difficult transfer with a previous patient. She was obese and it was quite difficult for the RE. I was in alot of bladder pain so I snuck out to relieve myself but I opened up the wrong door! :o LOL! Instead, I accidently walked in on the difficut transfer! LOL! Anyway, by the time she did my transfer I was still in alot of pain, combo of swollen ovaries. That damn cervial clamp is not the most comfortable feeling either! :-\ I was to lie on the table afterward for 30 min. but if I had to go to the BR I could do so after 10 min. I wish I was given Valium to calm my arse down, I was a nervous wreck and hormonally grumpy! LOL

Thanx for the detailed explanation on uterus contractions. I am actually supposse to inject 50 mg of Progesterone the day of the ER (in the pm) along with Estrace. After that I am to take Estrace in the am and pm and 50mg PIO in PM. Do you think I have enough progesterone? My RE tells me I have more than enough? Would it hurt if I took a little more just to be safe, like a prometrium suppossitory? Would it not be a good thing to take more than enough Progesterone? i know it leaves you feeling sluggish, etc.

Another Q- My ER is tomorrow @ 7:30am and I was to to the trigger shot at 7:30pm last nite. I took it at 7:27pm instead. Will this make a difference? I will not ovulate early? I was on Menopur with LH it in since Mon.
I just have this fear of ovulating prematurely. Am a big time worry wart! :-\ LOL

Thanks for your precious time Dr. Smith! ;D


Dr Smith - September 13

Dear Worry Wort: Try compound Z (Zanax). Its not effective on worts, but it does help with the worrie part.

Thanks for the ET story. LOL.

The tenaculum (cervical clamp), besides hurting like hell, can also trigger uterine contractions, although these usually occur in the first couple of hours post transfer. We use conscious sedation (same as during the egg retrival) for patients requiring a tenaculum for transfer. They don't feel it, the doc doesn't get all stressed out and the transfer goes more smoothly. You could ask your doc about that, but you'd be spending more time in recovery...

There is no consensus on how much progesterone is enough. The progesterone given after the ER is considerably higher that the amount on a natural cycle, so most docs think its enough. We use 50 the day of retrieval and 100 after that. Even with that dose, we've had the occasional patient complain of uterine contractions a couple of days after transfer. Prometrium could help and may be more appealing to your doc than increasing you IM progesterone.

Women ovulate approximately 39-40 hours after the hCG shot. Of course, there's that always that one in a million that ovulates sooner, but its extremely rare. So... being 3 minutes off on your injection time is one less thing for you to worry about. I'm sure you can find another one to replace it if you look around.

Best of luck on your ER tomorrow.


Aimee37 - September 13

Thanks once again for your quick response in attempts to ease my obsessive worriness! ;D Xanex eh? I used to be on that for high anxiety until my RE told me to stop taking it because it might case my prolactin level to rise. All my blood tests were eggscellent though. ;D I do not have any on hand with me now. Do you think if I took a Benadryl or something that might help calm my hyper neurotic self down some? ???

I have some Prometrium and I was thinking after the transfer I might take one pill of Prometrium in the a.m. and the 50mg PIO in the pm. How much is one pill of Prometrium? 100mg? But the concentration of these pills have less progesterone because they are less concentrated right? What do your patients take after transfer? I just want to play it safe!!

OK I am not worried not about taking the HCG shot a measly 3 minutes early! LMAO!! ;D Oh gawd...I kill myself.

Thanks for the good luck wishes!! Much appreciated!! ;)


Dr Smith - September 15

Your questions are of a medical nature so I should defer to a physician. Don't want to cross over into another gang's turf, could be dangerous. Maybe Dr Jacob?

For what its worth, I don't think its a good idea to self-medicate until you've run it by a physician.



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