Our clinic is moving from doing fresh embryo transfers to doing frozen embryo transfers routinely. We find that the pregnancy rates are much better , and this could be because we can prepare the endometrium optimally in a frozen cycle , so that it's more receptive , and implantation rates are higher.
When we do a fresh cycle, we sometimes need to compromise on endometrial receptivity because our focus is on getting good quality eggs. While the two often go hand in hand, sometimes they're not well synchronized , which means we may need to sacrifice endometrial receptivity in order to collect good quality eggs . This means that even though we get good blastocysts, the pregnancy rate might not be high because the endometrium is not receptive.
Doing a freeze-thaw cycle helps us to overcome this problem. We typically grow embryos to blastocysts in the fresh cycle, and we only freeze good quality blastocysts by vitrifying them . We will transfer these in a frozen-thaw cycle , where we can focus purely on preparing the endometrium for implantation. The survival rates in our clinic after thawing vitrified blastocysts are a hundred percent. which means patients now have the benefits of both the best quality embryos , as well as an optimally receptive endometrium. With the best of both worlds, our pregnancy rates are much higher.
A little tweak we've introduced is to thaw the embryos twenty-four hours before the transfer. This is very helpful , because it allows us to make sure that the embryos continue to grow well even after the thaw. Patients can also see for themselves that their embryo is alive , because many sometimes worry that freezing will either kill the embryo , or that a frozen embryo won't be as good as a fresh embryo. Seeing that their embryos have continued to grow in-vitro after the thaw is very reassuring. A picture is worth a 1000 words !
This is especially true when we freeze collapsed blastocysts. These don't look very good when we thaw them , because they are just a clump of cells. However, when we incubate them for 24 hours after thawing , many will form an expanded blastocyst, which can be very reassuring for both the patient and for us. This is now our preferred treatment protocol.
You can see what blastocysts look like at http://www.drmalpani.com/blastocystimages
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