Wednesday, August 17, 2016

Tough decisions about embryo transfer



It can often be very confusing for a patient to make decisions about their embryo transfer. For example, how many embryos should you transfer ? Do you transfer in a fresh cycle or in a  frozen cycle ? Do you transfer on day 3 or a day 5.

Here are some rules of thumb which I have found helpful.

For one thing, the pregnancy rates with day 5 embryos are definitely better than with day 3. That's pretty much a no-brainer. You should optimally opt for a clinic which routinely does day 5 transfers.

As far as how many embryos to transfer, I think one is the perfect number. If it implants, it gives you a singleton pregnancy , which has the lowest risk of pregnancy complications. Two is fine too, specially if you don't have any babies, and you're getting fed up and frustrated, because the chance of getting pregnant with two blastocysts is definitely better than with one. Even if you end up with twins, the pregnancy can be managed well with good obstetric care. For lots of infertile couples, twins are a bonus because they now have an instant family . Many are happy that their kids will have a sibling , and they don't have to go through an IVF cycle again.

Let's look at a patient who on day 5 has one blastocyst and one morula. She now actually has a surprising number of options which she didn't in the past, when we would be forced to  go ahead and transfer whatever embryos we had, as we didn't want to waste any precious embryos.

Here are some of the options we can offer her. We can still transfer both the embryos. Some people worry about transferring a morula on day 5, but they need to understand that just because the morula is growing slowly, doesn't mean that if it implants, the baby will be abnormal. It just means that the probability of a morula implanting is lesser than that of a blastocyst. However, if it does implant, the baby will be completely healthy.

You can see what blastocysts look like at http://www.drmalpani.com/blastocystimages

Also, the morula will not interfere with the blastocyst implantation, because each of these are in separate shells ( zonae) . They don't interact or affect one another, so you don't need to worry about reducing your chances just because you're transferring a slow growing embryo.

The other option is that we could freeze all her embryos , and then transfer in a frozen cycle, after thawing them and culturing them for 24 hours in vitro before the transfer. This has now become our preferred option, specially for patients who live in India, because the pregnancy rates with frozen embryos are much better than with fresh transfers. Of course, patients need to factor in the additional cost ; the inconvenience ; and the fact that it takes more time because they need to come back again for the transfer.

The other option we could offer her was to transfer the fresh blast and freeze the morula after waiting to see if it becomes a blastocyst on day 6. If it does, then this way she has her  cake and can eat it too. The good news is because we are a full-service clinic with a full-time expert embryologist, we can offer lots of choices to our patients in order to maximise their chances of success. We have the flexibility and the  resources to be able to customise and personalise our treatment, according their needs. This sometimes leaves patients confused, but it's always better to have options !

Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !





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