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Topic: Blastocyst Implantation (Read 13008 times) |
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helena
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Dear Dr. Smith,
I have never requested this type of information on line, but found that a lot of the information that you have provided in all of the requests was very good. My best friend and I are both going through IVF. We are both very curious about what happens in the lab and why the physicians are soo resistant to giving information on your embryos even after a failed cycle. I had couple of questions about the process.
1. What is the time frame for implantation for a day five blastocyst transfer?
2. Is there any way of knowing if an embryo did indeed go through the implantation process? Are there any physical symptoms or tests?
3. What are the chances of a positive pregnancy if 2 blastocysts were transferred that were 1AA?
4. Is there any additional information that you could supply me with regarding blastocysts and your justification for preferring this type of transfer over the Day 3 transfer? I already reviewed your comments from the earlier discussion.
Thanks for your help.
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Dr Smith
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A1. Blastocyst stage embryos attach to the endometrium within 24-36 hours after transfer. The implantation process (as the embryo burrows into the endometrium) takes about 10 days to complete.
A2. If implantation did occur, an elevated hCG level will be detected in the serum at about 10 days post transfer.
A3. Each good quality blastocyst stage embryo that is transferred has about a 30% chance of attaching, implanting and going to term. If two embryos are transferred, the odds are about 60% of taking home a baby from that cycle.
A4. If you've read the other posts, then I don't have much to add. In a nutshell, blastocyst transfer is more "natural", has a significantly higher implantation rate that Day 3 transfers, reduces the chances of triplets, quads, etc. and provides much more information about the developmental potential of the embryos.
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hopeful DC
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Thanks for the information Dr. Smith. Could you also comment on why IVF centers may be reluctant to discuss or give information about the embryos? When I tried to get information about the stages of development of the embryos, it was like pulling teeth. My RE was very tight lipped. Do we have the right to request the lab report that documents the development of the embryos?
Thanks for your input. I really appreciate having this type of interaction with an embryologist. I think that the other women will agree that having the "secret answers" does help to put us at ease through the process.
-hopeful dc
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Dr Smith
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You absolutely have the right to the lab/embryo growth information. The reluctancy to provide this information probably stems from the fear of accusation and blame. If patients don't realized that only a few embryos (if you're lucky) in any crop have the developmental potential to make it to the blastocyst stage, then, when they look at the embryology records and see that several embryos arrested development, they are quick to blame the laboratory and accuse the doctor for this (natural occurance). Some patients are very quick to assign blame when the "miracle" of IVF fails to provide them with a baby. After all, they seem to think, it must be someone's fault. Not so, I say! We cannot control nature to that degree and when it doesn't work, its usually no one's fault. Sometimes there are errors in judgment on the part of the doctor or lab personel, but this is relatively rare (although you don't get that impression from reading this message board). Keep in mind, when IVF is successful, people don't usually post here.
Since few doctors or lab professionals take the time to explain the inevitable attrition in embryo development, they set themselves up for this blame. Keeping secrets arrouses suspicion. Some doctors think the patients won't understand or can't handle the whole truth. Crap! I think there should be greater patient awareness of the embryo development process and less blame when things don't work out. Like you, I believe having all the available information (i.e. what can be controlled and what is out of our control) reduces the stress associated with the IVF process. Which is, of course, why I devote my time to this message board.
O.K. I'm off my soapbox now.
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hopeful DC
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I totally agree with you. Knowing puts patient's at ease and gives them realistic expectations. We don't need to have information sugar coated! I think that if patients are knowledgeable about their treatment and request answers to their questions, the physicians should be forthcoming with the information. If a patient chooses not to be proactive and does not want to know too many details, then you treat the patient accordingly. The moment that you start to ask important and good questions they always want to know if you are a nurse or in the health profession. I always get this question from all of my doctors. They seem to treat me differently once they realize that I work in the field of clinical research....I have worked in a lab before as well, so many things that happen in a lab are not foreign to me.
I agree that if patients were better informed about the natural attrition and how this happens in relation to IVF, they would not blame doctors and the lab. I think it will help patients to have a more realistic expectation of what could happen, good and bad.
Thanks sooo much for your comments. I will definitely demand copies of the lab reports. They sure did not volunteer any of this information. I have to squeeze out the little info I have!!
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jackie
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Dr.Smith
I would like to ask you a question re:my situation. Me and my dh have gone through 3 IUIs with clomid, several with injectables and decided to take a break and re-evaluate where we were. We decided, with the help of my MD to move forward to IVF. She has treated me on the same protocals seen from some of the top infertility clinics and only transfers day 5 blastocysts, does assisted hatching and ICSI on all of her patients. I felt really comfortable reading some of your previous postings. They were very reassuring.
But can you tell me what your perspective would be on my case. I am 39, dh is 37 and we have just had 4 blastocysts transfered on yesterday. We had 2 grade 5 extended blastocysts and 2 grade 3's. (Grade 5 being the best quality). I started out with 10 fertilized eggs and ended up with 4 of good to great qualtiy. So, based on my age factior it was recommended to transfer 4. Based on your expertise, what would you think my success would be. Thanks for your two cents! 
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Dr Smith
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Pretty darn good. You had a good cycle and I'd predict you have about a 50/50 chance at this point (and it doesn't get much better than that).
Best of luck.
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jacki
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Thanks for your feedback - that's very promising! 
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jacki
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Dr. Smith
I am half way through my 2ww and this period is agnozing. Can you tell me if it's possible for me to start my cycle before my beta on Thursday or because I am still taking progesterone and estrace that my cycle will be delayed after the test. It's so discourgaging to start your cycle before the test. I know with the IUIs this happened but I was unsure if its the same when doing IVF. Thanks for your reply.
Jackie
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Dr Smith
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It is possible to begin menstruation prior to the pregnancy test, but the estrogen and progesterone supplementation usually prevents this. Hang in there.
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DianaEvans
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Dear Dr. Smith: most excellent dialogue threads here. Very informative and your positive points are well appreciated by the submittors of the question and as a sideline readed, I am impressed by the positive balance.
I have to say all this IVF technology is fascinating and I wish I could live another 100 years to see the progress...But I am where I am now...
So, now I have a question (I was looking to post to the Lauren thread on 3 day embroyo transfer vs. blastocyst transfer, but lost it), if I may.
Just went through round 2 IVF as a 42.75 year old. First cycle back in July(42.25) was 8 eggs retrieved, 5 ICSI'ed, 4 made it, but only 3 were transfered (11,7,6 cell respectively). #4 wasn't deemed viable enough for continued growth or freezing.
I took 4-5 months off IVF, stopped running aggressively, (kept swimming 1 hour 4 times a week for Cardio), took Chaste Tree. Dropped my E2 from 126 to 25 in one month on Chaste Tree. So that seemed to work. I had two starts canceled at the get go because of high E2 prior to the Chaste Tree. Otherwise, I am totally healthy in solid condition with minimal stress.
Switched clinics for IVF 2: Did a Lupron cycle with less Follastim> better results-I think! 11 eggs harvested, 3 immature, 8 ICSI'ed, 6 fertilized. I have find out the quality. Planting is this Wednesday. Clinique calls for 4 to 5 implanted given my age (42.75). at day 3. But they let all remainder embroyos go to blasto.... So with 6 fertilized eggs, I am left with a quandry (I suppose) of implanting 4 now and having 2 continue to possibly go blasto and freeze or implant 5 and have 1 possibly to to blasto and freeze.
My gut says go for broke with 5 and my age makes triplets almost zilch liklihood-so I have been told and read. I would be blessed with one child and will massively adjust if twins were the double blessing. I know it is all based in the DNA instructions now.... If one has to choose amongst the 6 eggs given the 4 to 5 egg limit, the highest quality eggs have the best chance of going to blasto? or should the highest quality be implanted on Day 3?
My partner is not really open to a third round and would rather proceed to donor egg next IF this attempt is not lucky. So that kind of lurks in the back of my mind. However, I feel lucky, as it is Year of the Dog now. And that's compatible with Year of the Rabbit (myself). Well, having the stars aligned can't hurt......Yes, I am completely wrapped/rationale as a trained chemist, but just am open to other cultures/possibilities.
So kindly share with me your straight up insights. I know I have to get a ton more info out of my clinic. I thrive on data. In advance, thank you very much for your time and trouble. Diana
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Dr Smith
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Sorry to be late in posting. Got busy in the clinic and well, you know...
I would suggest going with the 5 embryos showing the best developmental potential on Day 3. The embryos should have reached the 8-cell stage (or higher) by Day 3 and, hopefully, with minimal fragmentation. As you correctly surmised, the chance of triplets is very low at your age, even with 5 Day 3 embryos transferred.
Do you know how Chaste Tree reduces estrogen levels? I read that it acted on Dopamine receptors to reduce Prolactin release from the pituitary and thereby indirectly increase progesterone levels in the luteal phase ( a way to treat PMS symptoms). I couldn't find anything about lowering estrogen.
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DianaEvans2
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Dear Dr. Smith:
Thank you so ever much for replying and of course, no worries, I can only imagine how busy you are at the clinic! And naturally, the in-person patients and embryos are the top priority! I am just delighted with this forum and your straight forward sharing of information-that in itself, is a huge psychological plus!
Yes, I went with 5 embryos. Cells were 8,8,7,7, and 4. Per the picture and the doc's comments, the 4 cell was not-fragmented (I also looked on line to see what fragmented embryos looked like) and that seemed to be the case-the 4 cells seemed even too. I asked for grading, but I wasn't given it. I'll ask again.
#6 embryo was just a 2 cell, so it is being "watched" to day 5 to see if it kicks in and develops. Not likely per the doc, but you never know....
As to the Chaste Tree, I did a ton of reading before taking this "tree bark". My E2 was measured 126, and 110 (the month prior) and I didn't even get to start on stimulation meds, hence my decision to try something not-pharmecuetical based. The E2 dropped to 25 as mentioned before. I could not find anything in all my reading as to why the E2 dropped- only that Chaste Tree "balances" Estrogen and PRogestregen. But it did make a marked difference in the redness/length of my period. I went from 2.5 days and light (E2=126,110) to 4 days and bright red (E2=25). Not sure if this is meaningful correlation, but it was an observation. I am sorry that I can not share more about the Chaste Tree, but the emperical data out there is either not collected or not analyzed in a systematic way. I gather if it is was a real science to this bark, some company would have bottled it for a huge margin by now. (I do work in corporate america!)
Further, I stopped Chaste Tree when I started this cycle of pharma meds. I didn't wish to send too many hormonal signals to my brain and "confuse" things. I just took it, so I could at least get to the IVF starting line-so here I am, now letting DNA does its thing and resting a few days for best implantation possibilities. Per docs, the lining looked good the day before retrieval. 10 units and triple layer of something and clear (not cloudy). I saw it on the sono.
One question please? I was told that 70% fertilized rate of mature harvested eggs is par for the course. I asked, what happened with 8 mature eggs, going to 6 fertilized?? with ICSI (we used that because of his morphology being 7% on the Kruger, but motility and count were in the mid-high end of the ranges).
Once again, thank you so very much for your kind extension of time and trouble. Wishing you a wonderful Ground-hog day! Diana
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Dr Smith
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They are correct in saying the 75-80% of the mature eggs will show normal signs of fertilization on Day 1, regardless of the method of insemination (i.e. routine IVF insemination or ICSI). So why don't the remaining 20% of the ICSI'd eggs show signs of fertilization? After all, there is a sperm inside, and by definition, the are fertilized....
Well, it turns out that some eggs are duds. Even when you put a sperm inside by ICSI, the eggs fails to "activate", a term referring to a cascade of biochemical events inside the egg which result in hardening of the zona pellucida and the formation of pronuclei (one from the sperm and one from the egg). These pronuclei then migrate towards each other and eventually fuse to form the nucleus of the one-celled embryo (zygote).
Activation failure is usually attributed to incomplete cytoplasmic maturation of the egg during follicular development. During cytoplasmic maturation inside the follicle, all the biochemical "goodies" necessary for activation and early development are formed and stored in the egg cytoplasm. If the maturation is cut short, the egg cytoplasm does not contain all the "goodies" it needs and therefore the activation cascade stops when the first shortage shows up. This usually occur prior to formation of the pronuclei, but can occur afterwards, thus explaining why some pronuclear stage embryos fail to advance to the two cell stage.
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DianaEvans2
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Dr. Smith:
well, guarded good news that I thought I would share! Second IVF worked ! Pregnancy was confirmed by blood work last Monday. I go for the double check tomorrow via blood work and then the sono this Friday. Meanwhile, I continue on 1.5 cc of progestrone shots once a day. It seems like a big dose to me. I understand the shots are to "support/sustain" the pregnancy, but not sure which metrics are calculated to arrive at this dosage? I suppose an individual's hormonal chemistry is part of it (as possibly age) I'm 42.9 now.
I'm cautiously optimistic as I had a miscarriage at 39, so I am aware of all the hurdles still to come. Thanks again for your previous clarity and support. Wishing you a great President's Day! Diana
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