blastocysts and asrm
2 Replies
kkr - January 28


In reading your answers, I see you are a strong proponent of tranferring at the blastocyst stage. The clinic I will be using also transfers at the blastocyst stage when possible.

However, in reading Blue Cross Blue Shield MA guidelines (my insurance company), the 11/06 guidelines specifically exclude coverage for blastocyst transfer except after PGD. Below is the reason for the exclusion. I am wondering if you know of any updated finding from ASRM re: blastocyst transfer that I could bring to the attention of BCBS. The info BCBS relies on is from 2000 and it seems like that info could be quite dated.

I appreciate your help.

BCBS guidlines:

Blastocyst transfer: See the 2000 ASRM (American Society of Reproductive Medicine) Practice Committee Report on Blastocyst Production and Transfer in Clinical-Assisted Reproduction. Blastocyst transfer is done to reduce ART-associated multiple pregnancy. While IVF centers suggest that blastocyst transfer may produce greater outcomes in difficult patient groups, there is no evidence in the medical literature to support it. ASRM stated that it could not recommend blastocyst transfer at this time for advanced maternal age, decreased ovarian reserve, or history of recurrent failure in previous ART procedures. While blastocyst transfer appears to provide some advantage in a number setting, the ASRM concluded that it is too soon to recommend blastocyst transfer as the preferred method


Dr Smith - January 30

Yes, the 2000 guidelines are outdated. They conceed that that the same pregnancy rate was achieved by transferring significantly fewer blastocyst stage embryos, thus significantly reducing the incidence of twins, triplets, etc.

Blastocyst transfers did not provide any direct benefit to specific patient populations. Blastocyst transfer is not a panacea. O.K.

BUT It does give a much greater amount of information to the RE and the patient about the cause of their infertility. Most embryos look at least passible on Day 3. So they are transferred. When it doesn't work, no one knows why. So, the patients steps up to the plate and pays for another cycle. When that doesn't work, and there is still no good answer for the failure, it is chalked up to the "luck of the draw". "It doesn't work ever time. Be patient." "Try again." And on, and on, and on.

When blastocyst transfer is attempted and only a few of the embryos reach the blastocyst stage, or, in the worst case senario none of embryos reach the blastocyst stage, the answer is clear. There is a serious problem with the embryos. If the cycle is unsuccessful, time to move on. No mystery, no second mortgage.

If several embryos form blastocysts with good developmental potential and no pregnancy results, then its time to look elsewhere such as endometrial developmet or immunological problems, etc. No time wasted on two or three unsuccessful cycles, no second mortgage.

In addition to reducing high order multiple gestations, blastocyst culture and transfer provides additional DIAGNOSTIC information about the underlying cause of the couple's infertility and allows for a more informed decision about the next step of treatment, should the IVF cycle fail.

Sooooo, knowing this, why would the ASRM conclude that there is insuficient evidence to prefer blastocyst transfer. They chose not to look at one of the most obvious benefits - information.

Of course, the insurance folks are incapable of reading between the lines, so this whole point is completely lost on them. Remember, they are in the business of collecting premiums, not paying claims. Yes, there is an extra charge for extended culture of the embryos to the blastocyst stage. However, if it reduced the number of failed IVF cycles they had to pay for.... Duh.

There's something you should know. Insurance companies have bean counters deciding on what is cost effective and what is not. A failed IVF cycle costs the insurance company less than a sucessful one. That's because obstetrical care and the new baby will cost them more at the same preium price. Hmm. Go figure (pun intended).


birdy - October 15

Hi Dr. Smith,

I am 33 and my husband and I have been trying now for over 2 years and we have followed all the increments along the process. We are living in Thailand and attending a very reputable hospital in Thailand.

2.5 years ago I had laparoscopic surgery because my doctor thought that I had endometriosis turns out that was minor but I did have a few benign tumors growing in the lining of my uterus. My cycle is very regular, every 28 days.

Since then I have gone through IUI over many times, I have tried clomid and IUI. I have been now taking Gonal injections and we have done IVF five times now.
The first time I had IVF I ovulated before the extraction and the second time my doctor said that my LH levels were elevating too early cause the eggs to start developing too early. The third time we tried a 3 day embryo implantation. The 4th time we were using the frozen batch of embryos, which were the left overs from the previous cycle so perhaps not the best AND finally this last time we used day 5 blastocyst implantation, out of 10 embryos only 2 survived to the finally stage and those were implanted. It was unsuccessful.

I am wondering if there is anything that we are missing. Is it possible for my LH levels to have such an effect on the process. I have been with my doctor for the entire time and I feel very comfortable with him but should I be looking for a second opinion. Please help. If there is any advice you can give at all I would appreciate it



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