Blastocyst Vs Day 2/3 transfer

[sushee]

I am not a doctor and don't purport to be one, but often this question gets asked over and over, so I thought I'd share some of the notes I made when discussing this issue with my doctor, and hope that it helps someone make their decision about how they wish to progress with their treatment.

Also having said that, many clinics don't do anything but blast transfers, so for some, it is a moot point anyway.

Why have a Day 2 transfer?

1) Because the rate of loss of embryos at Day 3 (approx 8 cell stage) is quite low, you often have as many embryos to transfer, or cryopreserve for later, as was initially fertilised. This often means that should 10 eggs fertilise and you transfer 2, you will then have 8 embryos in storage for further cycles without the emotional and physical strain of repeated IVF stimulated cycles. It also means being able to do back to back cycles, which is not possible with stimulated cycles.

2) The chances of success with a Day 2 transfer are very respectable, at around 20%. This may be more or less depending on your age group or reason for infertility, but is by no means anything to sneeze at. This represents a 1 in 5 chance of falling pg. So, again, with the above example, your chances of potentially falling pg in the next 5 cycles (and this could be the next five months back to back) are pretty good.

3) The chances of a cancelled cycle due to the loss of all embryos is very, very slim.

Why have a blast transfer?

1) Most embryos have all the necessary material to survive to day 3 (or 8 cell) stage, whether or not they are viable. It's only the more robust and viable embryos, however, that make it past this stage. Therefore, with a blast transfer, natural selection tends to 'eliminate' the embryos that would have had no chance of becoming a viable pregnancy. While there is no guarantee, of course, 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)

2) Blast transfer allows for genetic testing, and this can be beneficial in the case of patients who seem to have difficulties with implantation, or with recurrent miscarriage.

3) Fewer transfers can mean less stress and emotional 'up and downs' than more frequent Day 2 transfers. For someone who's endured many cycles of IVF, this can be an emotional 'relief' to know that you may have fewer transfers, but each has a better chance of success.

What I guess everyone has to consider is that because of the embryo loss associated with blast transfer, it may take as long to achieve a pg, and as many cycles, as it would have with a Day 2 transfer. This is why most clinics will not attempt a blast transfer if embryo numbers are low to start with, as often it is emotionally and physically beneficial to the patient (and maybe the embryos as well!) to get to transfer rather than potentially lose every embryo and have to cancel their cycle. In this way, there is no benefit to a blast transfer if only 1 or 2 embryos are available at day 2, except for intellectual reasons as to whether your embryos were surviving past Day 3.

In my case, we decided to go to a blast transfer with only 3 viable embryos because, after 7 failed cycles, we needed to know if they were making it past that Day 3 'hurdle'. I think we would have done it had we only had 1 embryo. And if this cycle failed, we would have moved on to genetic testing to see if there were genetic problems with our embryos.

I don't think I've covered every single pro or con, but I hope this gives you some idea if you're trying to make up your mind. If anyone wants to add anything or dispute anything, please feel free, I won't take offence or anything. Just wanted to share my experience.

Hope it helps.

love
sushee

[shazey]

Thanks for the information Sushee
I was trying to decide whether to have a day 3 transfer or try and get to blast, when I first started IVF I wanted to go to blast because of the information I had read and my clinic didnt do it at that time, I had 2 beautiful 8 cell embryos put in but got a BFN, when I was on my last 2 embryos I wanted to go to blast as the clinic had now started doing them, but unfortunately my embryos did not divide overnight.
I know that if I go to blast I might not have any to transfer or freeze but my way of thinking is if they didnt make it to blast they wouldnt make it at all I know this is probably not right but its just the way I think.
I am definately going to blast this time, I think you need to try anything and everything and hopefully something will work
Thanks again for this useful information

[abs]

Hi sushee

as a boy, I sometimes get a bit more mixed up with terms... Can you re-explain the two terms. My philosophy is that there is no such thing as stupid questions only stupid answers that lead the asker up the wrong fallopian tube - I'm asking coz I don't know

Day 2 is obviously 2 days after collection & fertilisation - does Blast = Blastocyst, and is that the same as Day 3 ??


We had a mix of 4, 6, 7 and 8 cell transfers - I think the last was on the Wednesday after pickup on the Monday, and was a very nice & healthy (grade 5 I think they called it) 4 cell - and I think the first time I forgot to take the camera in to take a pic when they showed it to us

[sushee]

Hi abs,

It's usual to have a Day 2 transfer, though some clinics will do it at Day 3. If the pick up was Monday and you transfer on Wednesday, it's a Day 2 transfer. A blastocyst (blast for short coz I'm a lazy typer) is a 5 day embryo.

All the embryos will develop at different rates, mainly becuase they don't all fertilise at the exact same moment So on Day 2, you may get a range of 2-8 cells depending on when fertilisation took place and how quickly the more robust ones divide.

I see that you are due the same day as me! Congratulations!

love
sushee

[Baby~amore`]

HI abs - what # IVF cycle was it you & DW fell pregnant - you have given me hope with 'age' breathing down my ..... - you are with WM too

I asked to go to Blastocysts - and then DR said my FS had suggested in my notes but it was never offered on my first cycle when I had 13 eggs that fertilised - and 8 'good' ones left at day 2 .

I had 2 transferred both 4 cell , and 6 frozen - of those I ended up with only 2 transferred 3 others didn't survive thaw /divide. One was left and they made me go through FET cycle and last one sucumbed.

Age affects egg quality and numbers but I would always go to blast now
#2 - I had 16 fertilise - I know that 5 made it to blast day 6 but only 2 were good enough -IYKWIM - other 3 scientist said probably wouldn't be viable embryos.

[abs]

sorry for the reply delay

I get mixed up with definitions, being a boy and all

We got a BFP on the initial transfer after our 2nd stimulation. Pickup was July 25, transfer was July 27 - 2yrs after our first date.

1st stimulation, we had 24 "collections" but due to Jen's size, they could only see part of one ovary so dunno how many more there were on the right hand side. She was really sick after it so they cancelled the initial transfer... 15 actual eggs with 9 fertilisations

Next month we transfered two (by then I had "moved" to canberra for work purposes - coming home on the weekends - so I'd come back for one day midweek for the transfer - my management were supportive of it all... which was good since I'd only been there 4 weeks )

We ran out of the 9, with 2 not surviving the thawing. I still remember getting that first phone call regarding the failure... I ended up leaving the office and going for a walk due to someone turning on the tap in my eyes. I can't believe it shook me so much. They got a little easier to take, if that is possible after each successive transfer


We then took a break for a little while


In May I returned to Sydney after looking at resigning, and since they didn't want to lose me, I was able to get an internal transfer with work back to the company computer centre in the suburbs (and not that far from home too)


A short time later, we spoke about starting up again - I was apprehensive due to her being overstimulated last time. It really took a lot out of me watching her go through that But she said she wanted to.

Stimulation went pretty well, with collection much better than the other time and bonus, we got an additional egg collected (16 this time)

11 fertilised, and we went back on July 27 with a nice grade 5 blob waiting for us... 9 others frozen with one not looking very good so was disposed of.


The day we got that BFP Jen was working on site with a client and was crying with OMG OMG OMG OMG OMG during a break after getting the news from Dee and calling me - honestly I was not expecting a BFP. I think even Dee was super thrilled due to the amount of fun she and Jen had had during the visits.

-------------------


We didn't know it was available to wait to day 5 or so... Didn't realise they'd survive that long out - guess by your comments that most actually don't. It's the ones that do that have an even greater chance of survival



Actually a friend of ours is also going through IVF at WM. Unfortunately they only managed one fertilisation on the first stimulation which didn't take. Seeing he is having stuff happening at work, they'll restart in the new year


Hope to keep reading your updates and congrats once again (and sorry for the long post )

[sushee]

Good luck abs on your scan tomorrow! I had mine yesterday and chose to keep the sex a surprise!

In the end it doesn't matter how you got pg as long as you got pg. Many clinics think that blasts are the only option, and it does in fact increase their success rate per transfer, but I wouldn't have cared how it happened!

And don't feel shy about posting in the PGALTTTC forum too! Like my DH says, he's as pregnant as I am!

love
sushee

[abs]

Good luck abs on your scan tomorrow!

Thanks

I had mine yesterday and chose to keep the sex a surprise!

In the end it doesn't matter how you got pg as long as you got pg. Many clinics think that blasts are the only option, and it does in fact increase their success rate per transfer, but I wouldn't have cared how it happened!

And don't feel shy about posting in the PGALTTTC forum too! Like my DH says, he's as pregnant as I am!

love
sushee

Sometimes I think there are toooo many forums, but really they are all needed

Whilst finding my feet here, I'll visit a couple, then expand my horizons - and I do agree with your DH's comments

[sushee]

bumping up for sararms

[Baby~amore`]

I have to say I think Blasts worked for us.
with hope
Trish

[SuziQ]

My clinic does blast transfers as a matter of course. Unless you only end up with a couple of embees - as I did in July and October.
I guess for me, I tried not to get too hung up on the issue of "if they don't make it past day 3 they wouldn't have survived anyway". I know many, many teenaged children of friends who were IVF bubs - long before blast became the "new-you-beaut be all and end all"

[sushee]

Hi Sue,

I completely agree with you.

While I tried to give both sides of the argument in this thread, I have always believed that this bub that I'm pg to was going to make it whether it was a Day 2 or a blast.

As you know, for me personally, the decision to go to blast was made because of the previous failed cycles, and the need to see if any of our embryos were making it to Day 5. However, I don't necessarily believe that every embryo that succumbs in the petri dish before Day 5 wouldn't have gone on to make a baby. For that matter, neither does my Dr. Which is why all my transfers previous to this one were Day 2 or 3.

I have heard of too many stories of people who transferred grade 3 embryos at Day 2 who went on to successful pgs. These would not even have seen the light of day if a blast transfer was attempted, I'm sure.

I absolutely believe that it is sometimes better for your embryo to be in your womb than in a petri dish, especially when you only have a few embryos to start with. And going to blast often doesn't mean less cycles, just less transfers. I am not sure that, first starting out, I would have been prepared to lose all my embryos (and potential pgs) or have my cycle cancelled trying to get to blast when I have a perfectly respectable chance of falling pg with a Day 2 embryo.

But that's my opinion and one of the reasons why I don't lament that I hadn't tried blasts sooner. I think I made the best decision for myself at the time, and like I said, I think this little'un, who I believe was the most advanced embryo at Day 2, was going to make it whether I had transferred then or at Day 5.

love
sushee

[SuziQ]

Hey Sush, I'm with you 100%

I think this little'un, who I believe was the most advanced embryo at Day 2, was going to make it whether I had transferred then or at Day 5.

As you know, I'm a fatalist all the way. If an embee is going to stick - it's going to stick no matter what.

Some interesting stats:
1978 - First IVF bub in the world (27 years ago).
1980 - First IVF bub in Australia (Monash, 25 years ago)
1996 - Monash celebrate 3000 births (16 years later)
1997 - Monash announces first blastocyst bub

So, Monash helped 3000+ women become mums before blast transfers came along.

If the "have to go to blast" mindset had existed then, that's 3000+ bubs who would never have been born. And, that's just one clinic. In one city. In one country. We can all do the sums ourselves...

We are all different in our belief of when life begins. For me, it's at conception. The thought of any embee being 'discarded' because it did not make it to 5 days fills me with much despair and sadness. Every embee is precious.

My sermon over!

[sararms]

After failing with three 8 cell top class embryos I'm really keen to try with blasts next time. At least you know whether they are truly viable or not rather than putting back embryos that might not even have gotten to blast stage.

I'd try anything right now though. Like most of us I think.

Thanks very much for sending me the link sushee

[SuziQ]

Sararms, I hope that whatever your Dr suggests for you works. In the end, that's all anyone wants. Chances are, given your young age, you'll succeed in the next couple of cycles anyway, regardless of whether you have day 2/3 or blast transfers done.
Research as much as you can and remember what our very own Oracle of BB, Sushee (aka Apollo), has said:

I don't necessarily believe that every embryo that succumbs in the petri dish before Day 5 wouldn't have gone on to make a baby. For that matter, neither does my Dr.
because of the embryo loss associated with blast transfer, it may take as long to achieve a pg, and as many cycles, as it would have with a Day 2 transfer. This is why most clinics will not attempt a blast transfer if embryo numbers are low to start with, as often it is emotionally and physically beneficial to the patient (and maybe the embryos as well!) to get to transfer rather than potentially lose every embryo and have to cancel their cycle. In this way, there is no benefit to a blast transfer if only 1 or 2 embryos are available at day 2, except for intellectual reasons as to whether your embryos were surviving past Day 3.

It's a hard, hard road and very difficult, when just starting out, not to see everything offered as the panacea that you so badly desire.

You'll be fine and I'm sure by this time next year you'll be a mum - one way or another!

[SuziQ]

*ACCESS*

I'm sure most of you are aware of the National Infertility Support Network - ACCESS.

A very special friend and fellow vet AC'r has emailed me an interesting recent study on Blast transfers. It's worth the read.

It can be found in the site's "INFORMATION" area in the "NEWS" section.

Mods - I hope it's ok for me to post this info. Big sorry if it's not opsies: . Just trying to help others with what can be a tricky decision to make.

[Baby~amore`]

Dr Smith :
The primary reason embryos do not make it to the blastocyst stage is because they do not possess the necessary genetic instructions for continued growth. No one can change or improve the genetics of an embryo. Assuming the lab is competent (and most are), there is no "risk" associated with continuing to culture the embryos to the blastocyst stage. I think you're making the false assumption that the embryos are better off in your uterus on day 3. They're not. Under natural conditions, the embryo remains in the Fallopian tube until the fifth day of development (blastocyst stage). The uterine environment on day 3 is not the same as the Fallopian tubes. When sequential culture systems are employed to grow the embryos to the blastocyst stage, the conditions in the laboratory more closely resemble the Fallopian tubes. Therefore, the embryos are better off in the lab for day 4-5 of development.
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. The "risk" you speak of doesn't really exist. If they're gonna make it, they do. If they don't, they don't. Of course, there's always the "risk" that no embryos make it to the blastocyst stage in the laboratory, but (because the problem is related to the genetics of the embryo, not culture conditions in the laboratory) they wouldn't have made in the uterus either.

I hope this clears things up. Good luck. I hope things work out for you.

[SuziQ]

Interesting post baby amore.

Who is Dr Smith?

I guess in a lot of cases, it just comes down to the criteria different clinics use to determine their success rates for different procedures. It pays to make sure your clinic is just not trying to make an even bigger profit than they already do.

In a recent Cochrane review a statistical analysis of pooled data from different trials that between day 2/3 transfer (cleavage stage embryos) and day 5/6 transfer (blastocyst stage embryos) there was no statistically significant difference between live birth rate per couple, pregnancy rate per couple, pregnancy rate per couple where fewer blastocyst than cleavage stage embryos were transferred, multiple pregnancy rate and multiple pregnancy rate where fewer blastocysts were transferred than cleavage embryos. The authors concluded that “The current evidence fails to support a widespread change of practice from cleavage stage to blastocyst stage embryo transfer in couples undergoing IVF.” Given the conflict of one centres trial results with this Cochrane review paper it may be useful to ask clinics their exact results of blastocyst transfer and specifically whether there is a true statistically significant difference between each technique.

Gotta say, I still worry about those 3000+ bubs (from only one clinic) who made it despite not going to blast in the dish and who may very well have been discarded these days.

Age can also play a big part, blast transfers are often beneficial for older mums. For younger girls, success may probably have happened anyway. And, without making a bigger financial donation to their clinic.

But, as you say, it worked for you and you are now a lucky mum-to-be. This time next year, you'll have 3 kids to spend Christmas with.