Thursday, August 11, 2016

A simple way to increase pregnancy rates after IVF

Frozen embryo after thawing
The same embryo after another 24 hours of culture in vitro, before being transferred

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

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  1. Anonymous3:13 PM

    Instead of writing , we have improved pregnancy rates , why not show a graph - some real statistics ? Do IVF doctors ( Indian ) ever maintain such statistical records ? If you people have maintained so , there will be so many interesting publications ! I have one more doubt , how many IVF clinics in India are maintaining automated freezing facility , how could someone believe your freezing facilities are fool - proof ? For example , if the person responsible for refilling liquid nitrogen forgets or neglects his job knowingly or unknowingly what will happen to the embies ?

    1. Yes, we do have statistics, since we keep the medical records of our patients on an EMR ( electronic medical record). It's possible to publish papers, but it makes sense to do so only if we have something new to say. " Me-too" papers just as to noise !

      Nothing in life is fool - proof - even automated services fail !

      It's important to find a clinic you can trust !

  2. Anonymous8:46 PM

    True , nothing in life is fool - proof ! But , don't you follow the best fool - proofing strategies for your life , then why not for the precious patient embryos ?

    1. Because patients would have to pay a lot more for this additional service

    2. Anonymous9:54 PM

      Is this an answer , Dr ? Didn't we pay for liquid nitrogen alone several thousands ? :)

    3. You don't pay for the liquid nitrogen. You pay for our safeguarding your embryos ! Yes, we could buy the alarm systems ( which would costs a few lakhs for all the containers) , and then we would have to start charging as much as IVF clinics in the USA, which would make IVF even more unaffordable than it it. We need to adapt to Indian conditions

    4. Anonymous2:40 PM

      Aren't the first two lines of your answer a kind of emotional manipulation ? I guess , the charge for freezing must be fixed based on the raw materials used for the procedure , labour cost , affordability and the profit factor. I do not think buying an automated freezer will automatically raise the cost of IVF equal to what is charged in the glorious USA ( Why everything is compared with USA and not with Europe ! )


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