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Topic: Blastocyst Implantation (Read 13007 times) |
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Nell
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Re:Day 6 Blastocyst Transfer/Implantation
« Reply #31 on: 04/26/06, 14:09 » |
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Dr. Smith,
Not sure how to start a new thread.
Anyway, I had a day 6 blastocyst transfer with two embryos transfered that looked really good quality. One was actually already just hatched.
I'm currently pregnant at 6 weeks/1 days, but my beta HCG levels are a bit all over the place and have me worried. I was wondering if you had any insight into this:
First beta test (day 17): 440 (great starting number)
Second beta test (day 21): 740 (4 days later, not doubling. vanishing twin??)
Third beta test (day 23): 1514 (2 days later doubled normally)
Fourth beta test (day 27): 2771 (4 days later not doubled yet??!!)
I'm not sure if there's hope for a live birth at this stage. I have an ultrasound scheduled for May 1st at 6 weeks/6 days.
Do you know if late transfers mean late implanters, and whether the live birth rates for day 6 transfers are lower? What could cause a good quality embryo or blastocyst that implants to start deteriorating? I'm doing the right things, taking all the progesterone/estrogen injections as well as folic acid, aspirin and prenatals. I am eating healthy even though I have lack of appetite. I have no nausea, no other symptoms other than off and on breast tenderness and no signs of bleeding or cramping. Just feeling a bit full all the time.
Not sure what's going on given these beta numbers. Have you seen anything like that?
Any insight would be helpful. Thanks.
- N
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Dr Smith
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The success rate for Day 6 blastocysts is slightly lower. It looks like a case of the "vanishing twin". Two embryos implanted and started to grow (hCG at 440), then one dropped out and one continued. It is fairly common. That's why the hCG stopped doubling for a while. The reason for one embryo to stop growing is usally due to the genetics of the embryo. If it was abnormal, nature is very efficient. At the first sign of trouble, the embryo will stop growing.
This early in the game, there are rarely true "symptoms" of pregnancy, particularly since you're taking progesterone supplementation.
Hope everything turns out alright when you get the ultrasound.
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trishwalla
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Hi Dr. Smith. I did my first FET yesterday - one 6 day blast w/ assisted hatching.
Today 24hrs later I'm feeling sensations in my uterine region. At first I thought that might be a good sign, but then I read that it might mean my body is attacking the embryo (NK cells or other immune issues). Any thoughts? Trying not to worry but every twinge gets my mind wandering.
thx.
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debsmythe
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Dear Dr Smith,
Thank you for a fantastic forum. I've really enjoyed reading the posts and have learned so much from a lay person's perspective.
I am 2dp5dt and have a question. I'm 43 yrs old and have a 16mo son conceived through ivf using donor egg (my partners who is 42) In the cycle in which we conceived my son we transferred 3 x 5day embies all at blast stage.
This time our clinic offered us PGD because of age. We decided to go for it.
The law of diminishing returns follows:
Retrieved 24 eggs, 16 fertilised, 15 got to day 3, most 8 cell. We tested the best 7 using FISH method. 3 were no good, 2 were good with bright chromosomes and 2 were good but with fainter chromosomes showing. The clinic said to transfer the 2 good with bright chromosomes.
What concerned me is that on the day of transfer (day 5), in the theatre, they put up the pics of the 2 embryos and announced that one was a compact morula and the other was an 8 cell embryo. I nearly fainted: when I queried this, I was told that PGD slowed down growth and that I shouldn't be concerned. However, I am concerned and I feel enraged. The clinic strongly advised against transferring more than 2 embryos. Because I just know that I wouldn't cope with twins, I agreed. If I had known the 2 we were transferring were so limited, I would have made them put in the other 2 with fainter chromosomal fluorescence.
Also, the lab called me the next day to say that they did not freeze any embies. The untested ones didn't get beyond compact morula and the 2 tested ones with fainter chromosomes did go to blast but one had a funny layer and they don't just freeze one embryo. Fair enough: there's obviously no point in doing something unless all the signs are strongly in favour of a positive outcome.
Do I have any chance with a compacted morula and an 8cell embie at day 5 transfer? Brutal honestly would be greatly appreciated!
Kind and grateful regards
Debs
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Dr Smith
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It is true that PGD slows the embryos down. Many embryos have initiated the early stages of compaction at the time of the biopsy. The embryonic cells are joined by what's called gap junctions which allow cell-cell communication. In order to biopsy a single cell, the gap junctions must be dissociated so that cells will become separate again (allowing the removal of a single cell for FISH). The cells then have to reform the gap junctions after the biopsy and then proceed though the compaction phase (compacted morula) in order to make it to the blastocyst stage. The net result of the dissociation-reassociation is a delay in development of about 12 hours. Hence, a compacted morula on Day 5 is par for the course for a PGD case. However, the 8-cell was toast. I think you still have a chance with the "normal" compacted morula.
I'm glad you made the point of saying that the biopsies of 3 of the embryos gave no FISH signal. This is a common problem with PGD. We get clear results on only about 80% of the embryos we biopsy. Its simply a limitation of the technology for cell fixation for FISH. At the risk of repeating myself ad nauseum, PGD is not a panacea. It carries its own inherent risks to the embryos. The benefits must outweigh the riskes.
Had I been in your shoes, I too would have taken the chance with the "faint chromosome" embryos. Especially since they both made it to the blastocyst stage. 20/20 hindsight, I guess.
Best of luck. Don't give up hope just yet.
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mquartul
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Dear Dr. Smith,
I went through IVF in 2002 after 1 year of trying on our own, and 2 different fertility specialists over a 2 year period. Our first cycle was a day 3 transfer and was successful. We have a 2 year old daughter. Since we have unexplained infertility, we hoped it would happen on its own, but finally decided it was time to go back to our specialist. This time, I had retrieval on day 13, and I did not take the pill during the monitoring month (a change from our first successful cycle). All of my eggs were inmature. 6 matured on their own overnight and five of the 6 fertilized on the second day. The doctor advised us to put all 5 in on day 3, even though we were already a day behind. I just found out today that we were unsuccessful this time. The first time we had insurance. This time we paid out of pocket by getting a home equity loan, and the doctors knew this. I'm definitely wondering if this was the best course of action. The size of our embryos after 1 day of growth were 6, 4, 4, 4, and 2. Would we have had a better chance of success if they had waited another day or two to put them back in? I'm meeting with them next week and we want to try again asap, but we won't be able to afford a 3rd try if the next one fails, too. Any advice you can give to help me discuss with my doctors would be greatly appreciated. Thanks!
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Dr Smith
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It is unusal that all the eggs were immature at the time of retrieval. When this happens, it is often a result of a mix up in the timing or administration of the hCG shot. The hCG induces the final maturation of the eggs and renders them "fertilizable" (if that's a word). The egg retrieval must occur between between 34 and 36 hours after the hCG injection. If it is performed sooner, many of the eggs will be immature at the time of retrieval. Similarly, if the shot was not administrater properly (i.e. the medication was not absorbed quickly), this can also cause immature eggs. We always check the hCG level the next day after the injection to be sure that the shot was taken on time and enough has been absorbed to induce egg maturation.
The stage of the embryos was appropriate for Day 2. Waiting another day to allow the embryos to develop to the 8-cell stage would have provided more information about their developmental potential, but probably wouldn't have changed the outcome. Although eggs matured in vitro (in the lab) can mature to point where they can fertilize, their continued development to the blastocyst stage is less likely compared to embryos generated from eggs that were mature at the time of retrieval. The lab was playing catch-up and damage control from the beginning. Unfortunately, the outcome was predictable.
Discuss the hCG timing and administration with your doctor. Ask if he/she would do something differently next time to address the maturity issue. Make it clear that you do not want a repeat of the last cycle.
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mquartul
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Dr. Smith,
Thank you so much for your quick reply and your frankness about all of my eggs being inmature at the time of retrieval. Another question for you...I had my last ultrasound for this IVF cycle on a Saturday. I exceeded their requirements for retrieval, which were having 3 or more follicles at size 17mm or larger. I was told to give myself my hcG shot that night at 9:45 PM. The nurse practitioner said I could administer the shot in my abdomen with a sub-cue needle. I mentioned that all my previous hcG shots were intramuscular, and she assured me that the sub-cue shot was fine. I administered the shot Saturday evening at 10:00 PM. My retrieval was scheduled for Monday at 10:45 AM. I think we actually got started at about 11:00 AM. My office does not check to see if the hcG shot took effect correctly before doing retrieval. My question is was the administration of the shot and the timing what it should have been on the surface? Thanks so much for what you are doing. Your candor is admirable and I'm sure many of us going through this could use more of it!
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Dr Smith
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The timing looks right and the route of administration (sub-cutaneous) for Ovidrel (a recombinant product) is correct. Novarel and Profasi (urinary-derived hCG) are given I.M., but that's a pain in the butt (pun intended), so most programs have switched to Ovidrel. Follicle sizes look O.K. too. Its a bit of a puzzle... We have had patients that, for whatever reason, do not respond to urinary hCG, but do well on the recombinant products AND also the other way around. Go figure. You might want to switch back to a product that requires an I.M. injection.
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Hausarzt-Sand
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« Reply #40 on: 09/22/07, 09:26 » |
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mlb
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Dear Dr. Smith,
I appreciate your time! This forum is very helpful! I am a 34 yo with no identifiable cause for infertility who has failed 4 previous cycles of IVF (all day 3). Except 1 cycle, all had about 14 eggs, all fertilize but no pregnancy. This time, we are trying for a blastocycst transfer but are struggling with # to transfer, as we don't want a selective reduction. Do you think 2 is reasonable if the quality is good, particularly given our prior efforts? Also, what are your thoughts on uterine artery resistive index - I was told mine was 6 - and viagra/acupuncture were recommended. Any thoughts on this?
thanks, mlb
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Hausarzt-Linner
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Man Lebt nur einmal - probiers aus!
« Reply #42 on: 10/03/07, 18:15 » |
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Sie leben nur einmal - warum dann nicht was neues ausprobieren?
Viagra kaufen. Cialis bestellen. Rezeptfrei - diskret - Originalmedikamente!
Alex Bernstein: Donnerwetter
Es ist fur mich und die Partnerin ein wirklich tolles Erlebnis.
So gut ging es noch nie. Dieses Mittel ist auch mit nur einer halben
10mg-Pille sehr empfehlenswert.
Mark Braun: ...und wenn er nicht mehr steht.....
Ich bin 58 Jahre alt und muss sagen: ...ein geiles Zeug...
Lange Wirkungsdauer ... Anlaufzeit: 2 - 3 Stunden...
Preise die keine Konkurrenz kennen
- keine versteckte Kosten
- Kostenlose, arztliche Telefon-Beratung
- Bequem und diskret online bestellen.
- Diskrete Verpackung und Zahlung
- Kein peinlicher Arztbesuch erforderlich
- Kein langes Warten - Auslieferung innerhalb von 2-3 Tagen
- Visa verifizierter Onlineshop
Originalmedikamente
Cialis 10 Pack. 27,00 Euro
Viagra 10 Pack. 21,00 Euro
Levitra 10 Pack. 40,95 Euro
Prozac 30 Pack. 16,00 Euro
Celexa 30 Pack. 21,50 Euro
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Professionelle mittel gegen impotenz!
« Reply #44 on: 11/22/07, 10:05 » |
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Warum nehme ich Cialis? Es ist einfach ein angenehmens Gefühl. Man brauch sich nicht auf die Errektion zu konzentrieren. Beim Sex ist man viel entspannter, mann kann auch mal die Muskeln im Genitalbereich lockern, ohne das die Errektion im Glied nachlasst. Dadurch ist eine lange Verzögerung der Ejakulation möglich. Man ist beim Sex generell lockerer und entspannter, und kommt auch nicht mehr so schnell ausser Athem, weil man eben locker und entspannt ist, ausser natürlich der kleine Freund :-)/b]
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- Kein peinlicher Arztbesuch erforderlich
- Kein langes Warten - Auslieferung innerhalb von 2-3 Tagen
- Visa verifizierter Onlineshop
[b]Originalmedikamente
Cialis 10 Pack. 27,00 Euro
Viagra 10 Pack. 21,00 Euro
Levitra 10 Pack. 40,95 Euro
Prozac 30 Pack. 16,00 Euro
Celexa 30 Pack. 21,50 Euro
Nur fur kurze Zeit - vier Pillen umsonst erhalten
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