Embryo transfer on Day 3 or Day 5?

One of the common questions that patients ask about IVF is the difference between doing an embryo transfer on Day 3 or Day 5 following egg pick up. To answer this, we should know a little about the reproduction physiology. When a woman conceives naturally, fertilization occurs in her fallopian tubes. It takes about 3 to 4 days for the fertilized egg to travel through the fallopian tube to the endometrial cavity of the uterus ( mother’s womb). During the transit of the fertilized egg (called a zygote at that stage), the zygote divides into an embryo (by day 2-3) and then further divides to a morula (by day 4) prior to arriving/implanting in the uterus. So, by the time the pregnancy implants in the uterus, it's at a stage of development called a blastocyst on day 5.

Investigations on this field show that blastocyst transfer (day 5) during IVF treatments results in a significantly higher chance of pregnancy compared to an embryo transfer on day 3.

We have routinely been performing blastocyst culture and transfer for many years and observe significantly higher implantation and pregnancy rates as compared to what we see with day 3 embryos. First of all, it could be that longer incubation of embryos in the laboratory allows healthier embryos to grow, while those that are not healthy generally stop growing. This would increase the likelihood that better quality embryos would be chosen and transferred into the patient’s uterus, potentially increasing the chance for pregnancy. Another possible reason is that it more physiologically mimics that which occurs in nature during a spontaneous pregnancy. IVF labs which have poorer techniques and personnel, tend to favour day 3 transfers, as they may not be able to nurture the growing embryos for 5 days. However, if a very limited number of embryos are available on day 3 and no embryo selection is required, then the benefit of a day-5embryo transfer may be limited to the improved synchronization between embryo and endometrium. Because it is obvious that the best conditioned place for the embryos is the mother’s womb itself.

Finally, a clinic’s success with embryo cryopreservation following extended culture should also be carefully considered. We believe that extended culture to day 5 must go hand in hand with an excellent cryopreservation program in order to maximize patient success.

http://turkey-ivf.com/day-3-day-5-ivf-icsi.html

Egg Freezing

Egg freezing, as the name suggests, is the process of freezing and storing human eggs for use in in vitro fertilization (IVF). As part of an IVF cycle, the patient is given certain hormonal drugs for stimulating the ovaries to produce eggs. The eggs develop within the follicles, which are monitored until they grow large enough. This usually takes around two weeks. The follicles are then emptied carefully and the embryos are identified and separated. The egg retrieval process takes place as the patient under general anesthetic or sedation. At this point, the eggs are either fertilized and prepared for implantation or placed in liquid nitrogen for storage.

Egg freezing and embryo freezing

Embryo freezing has been done for many years now, and thousands of babies around the world have been born from frozen embryos. However, egg freezing is still a rather new technique. The number of babies born from frozen eggs amount to around 900, and the procedure is considered experimental by some clinics.

Why opt for egg freezing and storage?

Egg freezing and storage is done so that it can be used for fertility treatment in the future. It is especially recommended for patients undergoing some forms of cancer treatment or medical treatment that could affect fertility. It is also recommended for patients who are concerned about declining fertility over time, but are not ready to have a child at present.

The procedure for egg freezing

The egg freezing procedure is conducted in six steps given below:

1. Your doctor will first explain the entire egg freezing procedure and the risks involved before you agree to it. Some clinics may also have a specialist counselor who you can consult to know more about the process and whether you should go ahead with it.

2. If you agree to the egg freezing procedure, you will first undergo screening tests to ensure that you do not have infectious diseases like hepatitis B or C or a HIV infection.

3. Once you complete the screening, you need to give written consent for storing your eggs

4. A standard IVF cycle is started and the eggs are collected using the conventional procedure.

5. The eggs are added to a cryoprotectant or freezing solution so that they are protected while they are in a frozen state.

6. The eggs are frozen either by vitrification, which is a fast freezing process, or by cooling them slowly. Once frozen, they are stored in liquid nitrogen storage tanks.

What does the consent form specify?

The consent form that you sign before the egg freezing process gives you certain control over what will happen to your eggs. The specifics of the form may vary with each clinic, but they usually let you specify the following:

• Your consent to the eggs being stored and used later for your IVF treatment
• The period of storage for your eggs, with the usual period being 10 years
• What should be done with the stored eggs in the event of your death or if you are no longer able to make decisions for yourself
• If your eggs may be used for your treatment alone or for training/research or donated for others' treatment

Pre-implantation Genetic Diagnosis (PGD)

Pre-implantation genetic diagnosis or PGD is a technique of preventing certain inherited conditions from being passed on to a couple's child. The process involves a thorough checking of the embryo's genes during an IVF cycle.

When is PGD recommended?

This procedure is recommended under the following conditions:

• The couple has had abortions in the past because the baby was found to have a genetic condition
• The couple has a child or family history of serious genetic conditions

What does PGD test for?

The embryo can be tested for more than 100 genetic conditions using PGD. If the genetic conditions mentioned in the above section are considered sufficiently serious, the clinic may be permitted to check the embryo for that condition.

What clinics can offer PGD?

Clinics offering PGD need to have a specific license to do so. The license lets the clinic test an embryo for any single condition or combination thereof that is considered serious enough. Some clinics may be experienced in testing certain genetic conditions more than others.

Risks of PGD

The risks associated with PGD testing are the same as those of a conventional IVF cycle, but there are some additional risks like those given below:

• The embryos may get damaged during the cell removal process
• The testing may not be fully conclusive or reliable

The procedure

The procedure for Pre-implantation genetic diagnosis usually involves seven steps that are given below:

1. A conventional IVF cycle begins and the eggs are retrieved and fertilized by the male partner's sperm

2. The fertilized eggs are separated and placed in incubation. They develop into embryos, which are place in the lab for 48-72 hours until they reach the eight-cell stage.

3. The embryologist then removes a cell (blastomere) or two from the embryo

4. The cells undergo genetic testing to see if the embryos to which they belong contain the genetic condition(s) in the couple, couple's family, or couple's child.

5. Embryos that do not have the condition are separated. Some are transferred to the uterus for development

6. Other unaffected and separated embryos are cryogenically frozen for later IVF cycles. Embryos that have the genetic condition perish.

7. The woman undergoes a pregnancy test two weeks after the embryos are transferred

In some cases, the embryos may be allowed to grow for five-six days, at which point they will each have 100-150 cells that either form the placenta (trophectoderm) or the fetus (inner cell mass). Cells are removed from the trophectoderm without harming the embryo, which helps in getting more accurate results.

The chances of successful pregnancy after PGD

Lack of data associated with PGD makes it difficult to assess success rates, but most couples using this procedure do it because they want to avoid their child from suffering a genetic disease, and not for any fertility problem. Success, of course, depends on a lot of conditions like the woman's age and the cause of infertility, if any. Sometimes, there may not be any embryos suitable for transfer after PGD because:

• All of them had the genetic disease
• Removal of cells damaged the embryos
• Not enough embryos were available

Intrauterine Insemination or In-vitro Fertilization?

As is known, the first approach for couples who do not have any evincible problem, in other words, were diagnosed with idiopathic infertility is intrauterine insemination for several times and then in-vitro fertilization treatments if no pregnancy occurs.

Read more:

http://turkey-ivf.com/ivf/intrauterine-insemination-or-in-vitro-fertilization.html