Growth slows at blastocyst stage
1 Replies
barnes - November 27

Hi -
I've had 3 fresh IVF cycles. Development usually seems to be pretty good until day 5 - twice I've been had day-6 transfers due to slow-developing blastocysts. One resulted in 2 empty sacs and the other was negative. The cycle where I had a day-5 transfer wasn't much better - trisomy 15.

My husband and I have normal karyotyping and no problems were evident for me in testing for recurrent pregnancy loss. We suspect the problem is the frozen testicular sperm we're using. We're exploring whether we can use fresh epidydimal sperm, and our RE reluctantly is suggesting PGD. But do the delays that we're experiencing at the blastocyst stage indicate that we're dealing with pretty severe chromosomal issues? Any suggestions on factors to consider as we decide whether to continue? (I'm 35.)

Thank you in advance for anyone insight you can provide.

 

Dr Smith - November 28

It has been my experience that when there is a severe problem with the sperm (i.e. using frozen-thawed testicular sperm), the embryos slow down at the morula-to-blastocyst transition (Day 4-5). Fewer embryos get over this hump to develop to the blastocyst stage. Those that do make it to the blastocyst stage often take until Day 6. And even the ones that make it to the blastocyst stage on Day 6, their inner cell mass (comprised of stem cells) is small. When the inner cell mass is small, there is a higher likihood of an empty sac pregnancy. Does all this sound familiar? I don't know for sure, but these observations are highly suggestive of a serious genetic problem with the sperm. Using fresh epididymal sperm may help because the sperm are more mature and the embryologist performing the ICSI has a larger population of sperm to choose the "best ones" from.

I think PGD may be considration in your case, but I understand your RE's reluctance. The embryo development is already compromised. Biopsying the embryos on Day 3 may push them over the edge and make them arrest development (even if they are "normal" by PGD. PGD is a balance between risks and benefits.

 

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