Blastocyst Vs Day 2/3 transfer

[SuziQ]

I've answered my question on who Dr Smith is baby amore.

I found the whole article.

He certainly makes some denigrating comments about clinics who only do 3 day transfers and his thoughts on why. The stress of ivf is bad enough without doctors so blatantly trying to get people to believe there is only one way. Their way - which incidentally brings more money. He almost sounds as though he is in the marketing industry. The best doctors will do what is best for each individual circumstance.

I don't dispute that the dish culture does not harm an embee if it is there for an extra 2 days. What I find outrageous is the mindset that if an embee doesn't make it to blast it would never have survived. But, won't get back on my :soapbox: about the hundreds of thousands of bubs born worldwide before blast transfers started. :-k

[Baby~amore`]

Hi Sue
the clinics don't just discard embryos - the little embryos stop growing /dividing - often day 3 is a crucial day in development. Sadly, it is not to know if they would have survived in the womb anyway.

Happily, the 3000 plus little babies obviously were destined to make it - as Dr Smith acknowledged - no-one said they would have been discarded.

I am sure there are so few published records kept on the actual numbers of fertilised embryos that clinics go through to achieve any of successes.

Or those that even make it day 2 or day 3, those who survive being frozen, and the number of unsuccessful transfers at any clinic. It is all hush hush.

Yes, age affects egg quality and my research has shown that as Dr Timothy Smith says -

The point of growing embryos to the blastocyst stage in the laboratory is to deliberately weed out the embryos that do not have the genetic potential for continued growth.

I even had three embryos make it to hatching blasts (day 6) that did not have the right cell structure to make an ongoing embryo/pregnancy - the scientist explained it to us as we had our transfer - it was missing itty bits inside - that when the embryo hatches one part makes the embryo and the other the placenta. I can't remember exactly which bit was missing now though .

True- he has a very harsh judgement about some $$$ clinics. I accept all Dr's have their own reasons for sprouting their views. Just for record this DR Timothy Smith is not the DR Smith from Westmead.

My clinic Westmead Fertility Centre is a non profit clinic - so they had no reason to make any extra out of me or anyone. Going to blast at Westmead costs nothing extra anyway. WFC supposedly have a lower pregnancy success rate from what I read on other forums too. All heresay ? I don't know.

Sue - I only hope and pray I do take these babies home. I am so scared but also hopeful that God's hand is upon us - and we know will have an army of people [-o< for us through our church, family and friends.

As I know very tragically, firsthand, that even getting pregnant -even when everything seems perfect - it by no means guarantees you of taking home a baby - sadly 50,000 mothers experience pregnancy loss (maybe more if we include conceptions that don't make it past 14 days) every year .

I know even IVF mums have blighted ovums -where the embryo fertilises - but does not continue development - it somehow grows for a bit, the hCG rises / pregnancy symptoms appear and the poor mum thinks she has a viable pregnancy - until the heartbeat scan.

With Miscarriages,stillbirth and neo natal deaths - there are so many unexplained deaths. So the perfect looking embryo is not always the answer to our dreams.

take care
Trish

DD Charlotte Rose 1/9/04 26wks

[SuziQ]

Hi Trish
Yes, I know they're not just discarded. That was a word I chose rather than saying they didn't make it. Typing laziness. I have done a lot of research on this and ivf over the past 15 years.
No I didn't think Dr Smith from an American website would be at Westmead as well!!!
I think my point has been missed. That is - that if an embryo doesn't make it to blast in the dish doesn't definitely mean it wouldn't survive in utero. That's why I keep referring to all those bubs born pre 1997.
I also have experienced the pain of a BFP, appropriately on Remembrance Day this year, that didn't follow through. After 15 years of waiting and then finding out 3 days later that I had a beta of <5 - yes, I know full well all about that pain. Knowing that my journey now has to end and I will never hold my own child in my arms - yep I know that pain too.
I am sure all will be fine for you and I couldn't agree more with your last line

So the perfect looking embryo is not always the answer to our dreams.

[Baby~amore`]

Sue

I knew you knew about Dr Smith - I am sure their are thousands - it was more for benefit of others who know the DR Smith at Westmead that's all.

I am so sorry for your loss - I can't imagine your pain and I hope you can find your peace in realising other dreams.

[Blue Sky]

Hi,

Hope you don’t mind me adding my 2 cents worth. I found the Access article interesting as it was quoting a Cochrane Review - a high standard of literature research which gathers information from various studies to compare and make conclusions based on the combined scientific evidence available. More definitions…

A Cochrane Review is a systematic, up-to-date summary of reliable evidence of the benefits and risks of healthcare.

Cochrane reviews investigate the effects of interventions for prevention, treatment and rehabilitation in a healthcare setting. They are designed to facilitate the choices that doctors, patients, policy makers, and others face in health care. Most Cochrane reviews are based on randomised controlled trials, but other types of evidence may also be taken into account, if appropriate.


I don’t have a definite opinion either way on the issue, but I am more likely to be influenced by the findings from a Cochrane Review. Having said this, I would be interested to find out what my clinic’s position is to some of the questions raised by Dr Smith, however I am fairly sure that they will laugh off the suggestion that the reason that they do not go to blast is because “…they do not want to face the patient and infom them their embryos failed to reach the blastocyst stage”. My clinic is more than adept at handing out bad news!

Cheers
H

[sararms]

Suzi Q and Trish.

This is clearly an emotive subject and for it is very interesting getting views from women who are actually living the nightmare.
Speaking personally, I have only had one stimulated cycle, adnat the risk of boring you I'll just fill you in a bit. At the clinic I use grade one is the best condition for embryos. I produced 18 eggs, 16 were used 13 fertilised. I had two grade one 8 cell embryos put back and that was a negative result. This last time i used two of my frozen embryos. One survived completely in tact remaining as 8 cells grade one and one 7 cell reduced to 4 cells, grade two. Negative again.

What I want to say is, for me, when I seem to be producing good quality embryos, my lining looks excellent at the time of transfer, I for one am bewildered as to why it won't work. Maybe for us, blastocyst transfer would show us whether these embryos are going to make it to the next stage. I hate the thought of having them put back only for them to die almost immediately, and therefore I effectively worrying for nothing for two weeks, getting the inevitable negative. Maybe having blasts transferred would remove that factor. Is it better to transfer nothing, than to transfer something and get nothing? I totally hear your point that thousands of women have successful pregnancies and babies from two day transfer. I hoped I'd be one, and if I'm honest I assumed that it would work first time. After all I'm young, no uterus problems, no cycle problems and the reason we're going through this isdown to a poor sperm count. Surely it would work for us straight away.

As with every woman I want the best result NOW. By any means neccesary. The debate is helpful, it gives me questions to put to my consultant. Having not made up my mind regarding 3 day or blast transfer i need all the help I can get befroe I have to decide.

[SuziQ]

Hey Sararms, that's what this board is all about. Helping and supporting others. If that comes in the form of honest and healthy debate - all the better!
Your history is not unlike mine. Although, we had no fertility issues at all.
My lining has always been perfect and in younger days (1995 - 1997), always ended up with around 12 - 14 embies from around 20 eggs.
Your doctor is the one who will help you the most. Obtaining information from forums and reputable websites will only help you.
Good luck, you'll be fine.

[Baby~amore`]

Hi Blue - how are you ? you have been in my thoughts often.

My understanding (and after doing Nursing degree at uni) is that randomised trials and all 'statistics' are only as accurate as the figures supplied.

Blue - I like the advice you gave Sararms about changing clinic because they allegedly had a higher success rate. Depends how they present them to IVF'ers doesn't it

Sue - you are right too in telling her she has better odds whatever she does because youth is on her side.

Sadly - some scientists/Drs in all fields will go to any lengths to achieve the desired results on paper - look at the famous birth defects Doc.

For the sake of all IVFers I am glad there is independent research like Cochrane to keep the b^%tards honest. It sounds very reputable.

However , I think at the end of the day it doesn't matter how you get pregnant and we all have make our own mind on what is best for our personal situation. I am not sure where Sushee got her figures from

... The chances of success with a Day 2 transfer are very respectable, at around 20%.

...that embryos that make it past the day 3 ‘hurdle’ will become pregnancies, the possibility of this becomes greater (at about 45-50%, I believe)

but I have heard and read similar on several US websites and bandied about AC forums over and over. This certainly influenced the decision to go to blasts. My Dh followed whatever I said. Also age - given that over 50% of my embryos could have probs developing.

I also knew our Frozen embryos didn't seem to make it thru thawing (many don't in any given situation the % is less )- and I personally couldn't imagine having a dozen spare embryos with repeat FET cycles of 1 or 2 cells.

It made sense to see if our embryos passed the 2 -3 day hurdle. I know we had 13 fertilised embryos (out of 17 eggs) on IVF #1 - day 1 - by day 2 (transfer) we were down to 8 embryos - where we transferred 2 @ 4 cells. They didn't offer day 3 at all and I was none the wiser - even about blasts - at this stage I blindly trusted the Drs.

My embryo survival percentages were average for my age but very low overall.Cycle #2 we had 2 good embryos out of 16 fertilised eggs.

I never asked the head scientist at what stage he (or the embryologist) could tell an embryo was a good egg or not ? I wish I had.

This guy had obviously been at Westmead a long time - his staff photo on the wall in waiting room showed a more youthful face than I saw in the transfer room.

[Blue Sky]

Hi Trish,

I just wanted to comment on your statement:

randomised trials and all 'statistics' are only as accurate as the figures supplied.

Sure there are dodgy studies out there. One of the main strengths of the Cochrane reviews are that they pull in information from studies that have been performed (and reported in reputable journals) by various practitioners in different countries and then compare the results. There is discussion on the various methods used, the strengths and weaknesses, and any biases or conflicts of interest. If there are dodgy studies with questionable statistics, these would be highlighted during the review as other studies would not come up with the same results.

This kind of research informs 'Evidence based medicine'. The reviews are updated every so often when new studies come to light.

I'm sure we could find information on the internet to support whatever argument we wanted to put forth. We just need to be careful that the information is reliable and put forth by those without a hidden agenda.
Making informed decisions about our health/bodies/embies is important but knowing what is credible information can be difficult. I for one will be having an informed discussion with my Dr before the next cycle.

Cheers,

[sushee]

Hello girls,

Trish, I wasn't quoting anyone specific, as you know all clinics crow on about their own success rates. I used rounded up/down percentages in my original post. Concept has a success rate with Day 2 embryos of about 24% and with blasts of about 45%.

I expect every person can decide for themselves whether or not an embryo that doesn't survive in the petri dish may or may not have gone on to become a pregnancy. Dr Smith obviously doesn't, and he is rightly entitiled to his opinion, as is anyone else who also believes this. I also know many doctors (and I've said earlier that my doctor is one of them) who believe that an embryo which succumbed in the petri dish may have survived in the natural environs of your body, and unfortunately, it's one of those things that can never be proved by either side.

I agree with my Dr simply because I know women, including our own Magic, who had her gorgeous DD with a grade 3 embryo transferred at Day 2.

When I put up the post, it was mainly for anyone who was still deciding on which way to go to get some information as was given to me by my Dr. Mind you, I, like you sararms, ended up doing a blast transfer for the same reasons (wanting to see if my embryos were making it past Day 3), but alternatively, the reason it took me 7 cycles to make the decision was because, as I discussed above, I was happy to take my chances with a low grade embryo in case I was missing out on the possibility of getting pg, like Magic did. In the end, with so many failures under my belt, I needed to know if any were getting past Day 3.

So it is, and will always be, a personal decision. I wanted to give a fair balance of both sides, so anyone who was trying to make up their minds could gather some information.

But having said that, I fell pg on a blast transfer. Do I believe that's why I fell pg? No. And again, this is simply because I believe this little'un would have made it whether it was a Day 2 or a blast. But that's just my opinion.

love
sushee

[sushee]

Hello again chickies,

You know I don't usually put my signature on in this forum, but did by accident and now cannot edit it out.

I apologise in advance.

love
sushee

[Baby~amore`]

Did anyone see the Human Body birth documentary from BBC ?

- it says that

4 out of 5 embryos dont make it past the 8 week mark

I never knew the rates were as high as this !

[sushee]

Trish

I've got that on DVD. This first time I saw it, I went 'wow!' but it makes sense though. I mean, most women trying to conceive naturally wouldn't even know that a fertilised embryo had been lost when they got AF.

But for us IVFers, it makes more sense when you see how many of our fertilised embryos succumb not long after fertilisation!

My sister was having unprotected sex for over 12 months before falling pg. I'm sure during that time at least a few of her eggs fertilised, if not all, but none made it until her DD 'stuck'. So, I figure, it took her 13 eggs to fall pg, it took me 13 embryos. Sounds about right!

Lol!

love
sushee

[sararms]

I absolutely agree with you sushee. I know a close friend who got pregnant and unfortunately miscarried at 13 weeks. Initially she got pregnant on the first attempt at trying if you will. It then took her another year to have her baby. My doctor told me that most women will have many months where the sperm has fertilised the egg but for whatever reason it has not implanted, for no apparent reason. It therefore is no surprise that it should take quite a few attempts to get pregant through IVF.

Obviously I'm saying that now but at the time of a negative result you ask why it didn't work. I agree that a embryo that is going to "work" will work regardless of whether you hav it put back at two days or at 5/6. It must be so when you think about it otherwise how come women get pregant standing up, while they are drunk, while they are on the pill, while they are smoking. We stop smoking, cut down on caffeine, stop drink etc, because we want the best possible chances, the chances are, it doesn't make that much difference. I like most of you want the best odds, and if that means blastocyst transfer, that is what I'll be doing and then praying to anyone who'll listen to keep that embryo inside me.

[sararms]

I should have said, my GP who has also been through IVF a number of times told me that two teenagers at the peak of fertility have a 33% chance of getting pregant each month. It is interesting that these are approximately the same odds of pregnancy (not live birth) you have of getting pregant through IVF per cycle in the UK. These stats are based on 2/3 day embryo transfer as most clinics including my present one don't do it.

I'm just saying this to suggest that an embryo that is going to work is going to work regardless.

[Visitor9]

Thanks for this thread, I did so many cycles of IVF, with 3 day embies and ended up with 3 pregnancy's .I never really knew what a blast was..it was something on my pricelist that I was $$$.
Next time knowing the odd's ratio and if I do a stim again, I will ask as it was never offered.
Question: Do they thaw as well? Or are they better of a fresh cycle?
Thanks
Bec

[sushee]

Bec,

there are differing opinions, but from what I've read, the majority of medicos believe that blasts thaw better than Day 2s.

But I gather that many clinics will only offer blast transfers to patients who have 'failure to implant' issues - like me - or 'failure to sustain a pg'. In the second case, genetic testing may be offered, as having to culture to blast is usually needed with PGD.

In your case, I'm sure that the fact that you were achieving implantation would make your clinic less inclined to change your protocol, IYKWIM. But it's something to keep in mind for your future cycles, and certainly researching your best options is the best thing you could do for youself as an IVF patient.

love
sushee

[Visitor9]

I agree Sushee,
Stick with what is working!
Thanks
Bec