Contact me !

If you need to contact me , please write to me to this email ID : manjupadmasekar@yahoo.com. I will be happy to help.

Tuesday, January 1, 2013

Is a day 5 embryo transfer better than a day 2 or 3 embryo transfer ?

Blastocyst

Myth : A day 5 embryo transfer (blastocyst transfer) is better than day 2 to 3 embryo transfer (cleavage stage embryo transfer).

Fact : When  blastocyst transfer was introduced a decade back , there was a lot of hype surrounding it. It is of course amazing to watch a human embryo grow into a blastocyst invitro ; and it is very reassuring to know that the cell culture media and laboratory culture conditions in the IVF lab have improved so much that we can routinely grow embryos to Day 5. But is it really useful from the patient’s point of view ? A few IVF centres initially claimed that pregnancy rate increased tremendously with blastocyst transfer when compared to cleavage stage embryo transfer. One such example is this paper (PMID:10856474) from the very famous CCRM in which they claimed a 70 % implantation rate (with heart tone) with the transfer of two good quality blastocysts. But as time went on and when enough clinical evidence accumulated based on several Randomised Clinical Trials (RCTs) , it became clear that as usual overenthusiastic researchers have made a mountain out of a molehill !

 Before going into the details, here is a brief summary about human embryo development:

A human embryo starts its development as a zygote. A zygote is the initial cell which is formed when an egg and a sperm fuse with each other. It carries the genetic material from both the parents. Approximately at around 30 hours after fertilization a zygote divides into two cells and the cells are called blastomeres. On the third day of fertilization a zygote usually contains 8 blastomeres. A cleavage stage embryo transfer is usually performed at this stage. The zygote further divides and at around day 5 of fertilization it contains around 70-100 cells. From this time onwards a zygote is called a blastocyst. The blastocyst contains an inner cell mass (ICM) which subsequently forms the embryo and an outer layer of cells called trophoblast which develops into the placenta. The meeting of egg and the sperm takes place in the fallopian tube and the embryo thus formed resides in the fallopian tube for upto 4 days. The gentle contractions of the fallopian tube pushes the embryo towards the uterus and the embryo reaches the uterus usually at around day 4-5 of fertilization; that is in the blastocyst stage.

 If an embryo reaches the uterus when it is a blastocyst , then isn’t it logical to transfer the embryo produced in vitro back to the uterus during the same time period , so that the synchrony between the endometrium and the embryo is not lost ? Also , when embryos are allowed to develop in vitro , not all of them develop into blastocysts. Many embryos arrest during the initial developmental stages. If this is the case , then doesn’t doing a blastocyst transfer ensures that you transfer only embryos which are viable enough to develop into a baby when compared to cleavage stage embryo transfer ? Won’t better embryo selection improve pregnancy rates ? All these logical questions led to the development and propagation of blastocyst transfer with great expectations. It was assumed ( quite logically !) that a blastocyst transfer will lead to a dramatic improvement in IVF pregnancy rates. But logical reasoning is not always enough to decipher biological secrets ! Blastocyst transfer ultimately proved to be no better than a cleavage stage embryo transfer.

A recent analysis of 23 RCTs showed that transfer of cleavage stage embryos resulted in a higher clinical pregnancy rates than blastocyst transfer (PMID:22786480). But the live birth rate is slightly higher in the blastocyst transfer group when compared to the cleavage stage embryo transfer group.

The results are surprising ! There are two reasons for the study results favouring a cleavage stage embryo transfer in terms of higher clinical pregnancy rate:

1) A blastocyst transfer can lead to higher embryo transfer cancellation rate. Not all the embryos develop into a blastocyst and the blastocyst formation rate are less for women of advanced maternal age ; women with poor ovarian reserve ; and women with poor embryo quality. Such women are at higher risk of cycle cancellation if none of their embryos reach the blastocyst stage.
2) More embryos are available for freezing if the embryos are frozen at the cleavage stage,  and hence there are more chances for performing subsequent frozen embryo transfer (which improves the cumulative pregnancy rate).

This means that your odds of getting pregnant are higher if you are doing a cleavage stage embryo transfer. It is wise to opt for cleavage stage embryo transfer if you have only a few embryos for transfer ; or if you are of advanced maternal age. Further advances have to be made and more evidence is actually needed to prove that a blastocyst transfer is really better than a day 3 embryo transfer . Until then , the claim that a day 5 embryo transfer is better than cleavage stage embryo transfer is just a logical fallacy !

I got a comment from an anonymous commenter on the above article :

The difference between the live birth rates from a cleaving embryo compared to a blastocyst would logically be comparable for populations with a lower incidence of aneuploid embryos (e.g. women <= 35 years of age). Are any of the RCTs which were evaluated specifically targeted at older women with a higher rate of aneuploid embryos? In that scenario, I would anticipate that the live birth rate of blastocyst transfer would be higher. This is, of course, assuming that the skill of the embryologist, the quality of the lab, or the effectiveness of the protocol is not in question. It is well known that all of these critical factors are not equal depending on the chosen facility.

You write – “ The conclusion that the odds of getting pregnant using a cleavage stage embryo transfer may be true in the 23 RCTs, but the true goal is a live birth. Transferring potentially incompetent embryos does not advance one toward this objective. 

 
This excerpt of the review reveals the flaw:

"This review of 25 studies... Disappointingly, only half of the included studies reported miscarriage or live birth rates. Twelve RCTs reported live birth rates and there was evidence of a significant difference in live birth rate per couple favouring blastocyst culture (1510 women, Peto OR 1.40, 95% CI 1.13 to 1.74) (Day 2 to 3: 31%; Day 5 to 6: 38.8%, I2= 40%)." 

 
I cannot imagine a scenario where one would not favor a statistically significant improvement to the live birth rate, and therefore do interpret the data to conclude that there is an advantage to blastocyst transfer.”

and my reply is :

You have put forth a very valid argument – I agree that the goal of any IVF cycle should be live birth ! Since blastocyst transfer has shown a small significant difference in live birth rate it should be logical to conclude that day 5 transfer is better than a day 3 transfer. The authors state that “This means that for a typical rate of 31% in clinics that use early cleavage stage cycles, the rate of live births would increase to 32% to 42% if clinics used blastocyst transfer”. The authors also state that there is no difference in clinical pregnancy rate or miscarriage rates (?) between cleavage stage embryo transfer or blastocyst transfer ! The question, ‘to blastocyst or not ’ is not even necessary in young women with lots of eggs and embryos – of course most clinics will naturally go in for a blastocyst transfer (commercially too it is a better option for them !) The argument whether day 5 ET is better than day 3 ET arises in the case of older women and women with poor ovarian reserve since these are the challenging women who have a guarded prognosis.

My point is that I do not think blastocyst transfer can benefit older women or women with fewer embryos! The odds of achieving a successful pregnancy and live birth via IVF is compromised in older women and in women with poor ovarian reserve  because the amount of eggs obtained and embryos formed is reduced ; and the presence of a high percentage of aneuploid embryos in older women further reduces their chances of success. When you have fewer embryos it is wise to be cautious and transfer the embryos as early as possible to the uterus– after all, the rule of thumb in medicine is ‘first do no harm’ ! It should be kept in mind that even in young woman with good quality embryos , the blastocyst formation rate is just 35-40 %. Will embryos which do not grow to a blastocyst in vitro  achieve a viable pregnancy when transferred in vivo at an earlier stage ? When we do not have a solid answer to this question, isn’t it wise to do a day 3 transfer for women who do not have a good prognosis ?  There is a high risk that their embryos may arrest in vitro if you try to grow them to Day 5, as a result of which there maybe no embryos to transfer at all !

Another important aspect is the emotional impact on patients when they are left with no embryo to transfer ! 40 % of poor prognosis patient’s embryos will not grow to blastocysts ! Patients go through a lot of trouble when doing IVF. When they are left with no embryos to transfer , they can be devastated ! It discourages them and they are likely to give up., You may ask - ‘When there is a risk of reduced live birth rate (1-10% reduction in live birth rate !) after achieving a pregnancy with cleavage stage embryo transfer, why shouldn’t a day 5 transfer be the norm in older women too ?’ Is not getting pregnant better than not having embryos to transfer ? Is not having a live birth better than not getting pregnant at all ? Very hard questions to answer !
 I believe that the cons outweigh the pros of day 5 ET in older women and women with poor ovarian reserve when compared to day 3 ET ! Studies have shown that older women have decreased chance of pregnancy with day 5 ET (I am not aware of any RCTs).  When there is no valid proof in favor of day 5 ET  it is good to stick to  procedures which don’t cause any obvious harm : ) 

I believe that day 5 ET is not better than day 3 ET (I would even say day 3 ET is better for some group of women !) – and I have few  embryos I will definitely avoid day 5 ET !
You have said, “I cannot imagine a scenario where one would not favor a statistically significant improvement to the live birth rate, and therefore do interpret the data to conclude that there is an advantage to blastocyst transfer” . My interpretation is that since the risk of day 5 ET outweighs its advantage, day 3 ET should be preferred until more data is available !

Thanks  for initiating this valuable discussion ! 

29 comments:

  1. Interesting, but it seems like the conventional logic was true, but when real world constraints are added, it gets a bit foggy. The article you cited: "Cleavage stage versus blastocyst stage embryo transfer in assisted reproductive technology" seems to suggest that there is interaction between egg supply and pregnancy success by day 5 transfers. So it would seem that women with poor egg supply would be better off transferring at day 3 because it affords them a greater number of attempts, where as women with an abundance of eggs would be better served by waiting until day 5.

    So if you were only looking at a single cycle and assumed that a woman had to choose between a day 3 and day 5, the day 5 would be marginally better for the purpose of achieving pregnancy and live birth.

    So in the case of my wife and I, given that we have egg supply issues, we'd be better off going for a day 3. If we didn't have egg supply issues, a day 5 might be better. Sound about right to you?

    ReplyDelete
  2. Dana, I have updated the above post.

    Yes, what you have interpreted is very true !

    Manju

    ReplyDelete
  3. As a 34yr old physician (heme-onc) going through my first cycle of IVF (with a surrogate) as I had a hysterectomy last year, We have decided on a day 3 transfer for similar reasons that you outline above. Although I'm not quite AMA my ovarian reserve is not great which is likely an age/blood supply issue to my ovaries post op and we only got 1 egg on retrieval (with max stim meds, growth hormone etc...). That egg was fertilized and on day 2 is 18/20 so reasonable quality. My clinic is very pro day 5 transfer and I've reviewed all of the literature and most recent Cochrane review from July 2012. I think if I had more eggs/embryo's I would definitely wait until day 5 to pick the 'strongest' but with only one I think getting it transferred to a natural environment is mentally much better for both me and the surrogate. It's hard to know where the extra 1-10% benefit is coming with the day 5 data (ie is it b/c you pick the strongest embryo or b/c its the natural time to implant). When you only have one of those 2 theories on your side I definitely feel better to just put it in there and take the ~30% chance of live birth b/c my situation is not the same as those who got to day 5 with multiple eggs/embryos who had the 32-40% rate.

    ReplyDelete
  4. I'm 34 yr old physician (heme/onc) going through my first cycle of IVF (with a surrogate) as I've had a hysterectomy last year for severe fibroid disease. Although I'm not AMA my ovarian reserve is not great likely a combination of age and poor blood supply to my ovaries post op. I had a max stim protocol including growth hormone etc...had 2 large follicles with only 1 egg retrieved. It was fertilized and is now a day 2 good quality embryo 18/20. My clinic is very pro day 5 transfer (although they still do ~30% day 3 transfers for various reasons). We've decided to do a day 3 transfer for the vary reasons you've outlined. I've read all the recent data including the most recent Cochrane review from July 2012 and although the composite data quotes a 2-10% increase live birth rate in day 5 transfers it's hard to know where that benefit is coming from. How much is from picking the 'strongest' and how much is from being better 'timing' for implantation. I think when you have low egg retrieval a day 3 is much more enticing b/c I'd prefer to get the egg in the natural environment and see what happens given we can't pick the 'best'. No one really knows what the best answer is when you don't have much to choose from...but I think psychologically most people with 1-2 eggs would rather transfer at day 3 with one embryo and fail then wait until day 5 and have nothing to try with. Thanks for the review

    ReplyDelete
    Replies
    1. Dear commenter,

      I am so happy to see your comment. I hope your comment helps people who are searching for reasonable answers. Good luck and have a wonderful 2ww. I am also in my 2ww since yesterday. 3 day 3 embies were transferred. I don't think the increased live birth rate in a day 5 transfer is because of 'timing' or 'good' embryos. When a woman could get blastocysts, I would say her egg quality is overall better and hence increased live birth date perhaps.
      I am happy to know you.
      'Happy' 2ww !

      Delete
  5. The issue is, there is nothing to support the central premise- that the uterus is more favorable than the laboratory environment, and may allow an embryo that will fail in the lab to progress in the uterus. This may have been true when IVF was first introduced and cell culture methods were not optimized, but it is true no longer.

    There is plenty of evidence to support that whatever will make it in the womb will also make it in the culture dish, and vice versa. The only real advantage that blastocyst transfer offers is) you avoid all the potential pitfalls of a multiples pregnancy and b) you weed out all the ones that will fail in the first few days, which is not an advantage to not be taken lightly.

    The rest...success rates of either, blah blah blah is not really the most scientific way to assess this situation, because there are too many confounding variables, including what you pointed out: a high cycle cancellation rate in the 5-day transfer group, for the obvious reasons.

    I'm not sure why people look at cycle cancellation as the worst thing that can happen---they stand on their head to avoid it (with high dose stims, etc), often to the detriment of quality of the embryos that they produce.

    All of this is a debate about the best way to do things, but at the end of the day, its irrelevant in that whatever embryo has the hidden potential to make it, will, and this is not affected by when you transfer. Hoping that one of the 3 you got in there is it!

    ReplyDelete
  6. Jay, nice to see you and I am happy that your cycle was much better this time, and you ended with 8 blastocysts. Good luck, I am sure you will have your little one out of those precious blasties.

    We defroze five day 3 embryos and transferred three embies which are 8 cells with no fragmentation . The remaining 2 were 7 cells with no fragments. They grew the remaining 2 embies which turned into 4AA and 2AA blasts and were refrozen again.

    Do I feel happy that they grew to blasts - ofcourse yes ! But does it say anything about my other 3 that were transferred - I do not believe so.

    Let us forget the scientific studies and the conclusions derived, I personally wonder whether in vitro conditions are better than in vivo conditions ! When we do a blastocyst culture do we help the embryo overcome the selection pressure that exist in the uterus ? Don't we provide the embryos extra cozy laboratory conditions which can never be any close to the uterus ? Do many embryos which do not survive in the uterus are grown to blastocysts in vitro because of all the beyond perfect nutrient formulations of the in vitro culture medium ? Doesn't the lack of increase in clinical pregnancy rate with blastocyst transfer (even after the selection !) indicate that my assumption could be true ? : )

    Jay, I am a very emotional person, I would be happy to transfer embryos to my uterus after an IVF cycle rather being left with nothing to transfer - might be it is stupid to feel so if you analyze rationally but what is wrong if my intuition says that my uterus might be a better environment ? After all there are no solid proof .....

    Using high dose FSH for a poor responder can be detrimental but I don't think it affects a normal responder and her pregnancy chances. How will you determine which is a low dose for a particular women ? For a woman with PCOD even a dose of 75 iu can lead to hyperstimulation ! For a women with poor ovarian response 300 iu might do nothing but 400 iu might lead to the development of one or two folicles.....

    Jay my mind is totally numb to be honest ....the hormones and the fear has made my brain unable to read or grab anything from it : )

    Thanks for the good wishes !

    Manju

    ReplyDelete
  7. I think right now its best not to go into why I made that point. Hopefully, at the end of this 2WW you don't need to read up literature anymore because you are knocked up. Best of luck!


    ReplyDelete
    Replies
    1. Jay, I conceived once with a day 2 transfer and never with day 3 or day 5.....

      I never have a doubt that my uterus is an issue, even if my lining is not thick enough !

      Let us see what happens ! I will be happy to know why you made that point !

      Delete
  8. However, with a 3 day embryo a pgd cannot be done, which many parents want. This test for healthy embryos was not mentioned. What's the point of doing a 2-3 day if the pregnancy ends in miscarriage due to chromosomal abnormal embryos?

    ReplyDelete
  9. Anon, I couldn't agree more. Even at age 28 we had about 30% abnormal embryos! Thankfully, pgd allowed us to transfer normal ones. Not seeing an advantage to the three day, unless you don't mind a crap shoot, ie miscarriage or baby with problems.

    ReplyDelete
  10. I'm 38 and doing my first IVF cycle. I had only 5 embryos to start. 3 of them made it to day 5 and 2 of them tested normal with PGS. The success rate at my clinic is 85% given a PGS tested blastocyst for women 38-40 years old. My doctor is strongly in the blastocyst and genetic testing camp.

    I was worried that I wouldn't have any embryo on day 5, but I decided to trust my doctor who have an excellent success rate and a very well-run embryonic lab. Even if we only had one blastocyst, we still would have done the genetic testing to reduce the chances birth defect, miscarriage, disappointment, and heartache. We will be doing a single transfer in two weeks. Please pray for me.

    ReplyDelete
    Replies
    1. Jules, I am happy to know that you got 3 blastocyst. I agree it is very good. But please do not claim or assume that PGS reduces m/c. It doesn't. 85 % success rate is great ofcourse! Have you asked them how much was the take home baby rate ? Is it PGS or CCS ? I will definitely pray for you. May all your dreams come true ! Do not forget to share with us your ET outcome. Lots of good luck !

      Delete
    2. Manju, 85% is the live birth rate and 90% is the clinical pregnancy rate. We did CCS. Since the test screen out embryo with chromosomal disorder, wouldn't that reduces m/c from aneuploidy? I'm 38 and have a high rate of abnormal eggs. Since I already have one child (conceived naturally), I did not want to transfer multiple embryos and risk having multiples. So it was crucial for me to identify strong and normal embryos to implant. Thank you for your prayers. I really enjoy your blog and will update you on the outcome.

      Delete
    3. Jules, I am sorry to say this but you are completely misleaded about the success rate. Can I know with which clinic and doctor you are getting treatment from ? Ofcourse yes, CCS screens all the 24 chromosomes for aneuploidy and hence a chromosomally normal embryo must lessen your chance of miscarriage. But a recent systemic review did not find any evidence to support this. Please read : http://www.rbej.com/content/12/1/22

      Jules, I am not trying to discourage you. Your comment will be read by many and they should not be misguided. That is why I am trying to tell the scientific facts which I know. But very sincerely I pray that you get your much needed baby. Please keep us informed !

      Delete
    4. I see Dr Anderson in Southern California. Here is the link to his site that talk about his success rate on blastocyst with PGS: http://www.socalfertility.com/ivf-pgd-pgs. If you could tell me how I was mislead, I'd appreciate it.

      Delete
    5. Jules, that is impressive :) But for me this evidence means nothing. It is not something which is published in a reputable scientific journal, it is not a clinical research data. Have you read the paper I have given you ?

      85 percent clinical pregnancy rate is ofcourse very impressive and I want you to be within that 85%. Good luck and thanks for the info, I really appreciate it.


      Delete
    6. This comment has been removed by the author.

      Delete
    7. Jules, can I ask you something ? Is that success rate table created using donor eggs too ? For example they show 50 % success rate for 43 year old. Without PGS 43 year old women's global success rate is just 3% using IVF . Many old women do not get CCS normal embryo to transfer and moreover many old women's embryos do not grow up to day 5. If that is so, the 50 % success rate is for women who used their own eggs or is it a graph which includes the success rate for women who used donor eggs too ?

      What is your AMH and FSH ? I heard they do not work with women having high FSH because their success rate will fall. How much did you pay for the cycle ?

      Delete
    8. Manju,
      I forgot to say thank you for sharing for the very interesting paper. I haven't seen it from that angle before. I think that I would agree with the fact that IVF with PGS does not have good clinical trials. It is difficult to expect a patient to allow themselves to be sorted into two possible treatments, only one expected to be better, when they are paying the bill
      But I don’t see how you could prove that any single embryo that demised on day 5 would have implanted if only you’d transferred it on day 3. You can take a group of embryos from the same patient, transfer some on day 3 and see whether the rest go on or die, but that still doesn’t prove that the embryo you transferred would have died in the lab. I believe that the clinics that argue for day 3 transfer either can’t grow embryos to day 5 or are very concerned about the potential risk of imprinting errors with prolonged culture. PGS probably can reduce a woman’s chance of pregnancy if her embryos can’t survive the added manipulations or if the technical manipulations are performed poorly.
      I do agree with the authors that the use of PGS is problematic –especially when it is used for everyone, at every lab (even those with poor technique) , for all kinds of patients. Older patients should in theory benefit but if they make few embryos, they are most likely to not have a transfer at all, which makes patients unhappy.

      Delete
    9. Jules, I am so happy for the comments and the knowledge you have :) I am very, very impressed. I think you must use your knowledge to help other patients. It helps a lot - both you and other patients. I learned a lot from you :)

      It is impossible to find whether an embryo which died on day 3 in lab would have survived in vivo. But it is possible to compare the pregnancy rates between patients who receive day 5 embryo and patients who receive day 3 embryos. Unfortunately meta-analysis of such studies didn't show that day 5 transfer is better for achieving a pregnancy.

      For a younger woman who produce lot of eggs, even a SET with day 3 embryo is equally effective as transfer of a single day 5 embryo. For older women the risk of not having embryos to transfer outweighs the benefit of a day 5 transfer!

      Jules, in the clinic I go they do both transfers. If they have found better success rate with day 5 transfer, they must have opted to do only day 5 transfers, afterall every clinic wants to have high success rate.

      Culturing embryos to day 5 is thought to change the genetic imprinting (induce epigenetic changes) of the embryos, but I do not think that is the reason why clinics opt for day 3 transfer. Culturing embryos to day 5 is not difficult as you might imagine. They just have to use a different culture medium, that is all!

      If someone asks me whether a day 5 transfer is better than day 3 transfer in respect to pregnancy rate, I would say no. And in respect to reducing multiple pregnancies - younger women can do day 3 SET which is equally effective for them as day 5 single embryo transfer.Most older women and women with poor ovarian reserve unfortunately have no such choice most of the time, the yield of eggs and embryos is lesser and hence there is no point in waiting for a day 5 transfer, day 3 transfer is wise in such cases. If you ask whether an embryo that doesn't survive on day 5 in lab will be genetically normal and grow in-vivo- no clear answers, but perhaps you must refer to references 12, 15 and 16 of the paper I have quoted.(they said there are some anecdotal evidence)

      This is the scenario when CCS is not used. But when a woman have access to CCS then..... I will answer your second part below.

      Delete
    10. Conclusion : (I need to agree :)

      If a young woman who opt for SET can try day 5 transfer - I think it is beneficial and it does increase the chance of live birth rate.
      Older women who wants to do SET can also opt for day 5 transfer provided they must clearly understand the risks involved :

      They might be left with no embryo to transfer.
      We do not know whether an embryo which didn't survive invitro will not survive invivo too.

      Delete
  11. Hi Manju, I'll answer each of your question one by one. I hope I didn't miss any.

    Have you read the paper I have given you? Yes. My response is that the success of PGS is highly dependent on technical competence and embryo culture quality. It is crucial for the embryonic lab to have a proven record of being able to culture embryos until day 5/6. Two of my five embryos did not make it to day 5, but those could have been abnormal embryos that wouldn't have develop if transferred. It is hard to say what would have happened to them if they were transferred. The paper said that many clinics misrepresent the outcome because the success rate is not based on the number of women who start an IVF cycle, but rather the number of women who underwent a transfer. It is true that the 85% live birth rate that I mentioned is the success rate IF a transfer is done. However, the doctor have clearly explained that to us and my husband and I agreed that it was the best option for us because we do not want multiples and we want to avoid taking crap shoots. I'm not saying this was a no-brainer decision for us. I was an emotional wreck while waiting for almost a week after the biopsy to get the result.

    Is that success rate table created using donor eggs too? No, the success rate is using women's own egg IF they do a SET of an euploid blastocyst. It is not comparable to the success rate of all women starting an IVF cycle. These rates is the clinic's rate and are not published in any medical journal. For a 43 year old, there is a chart on that page that shows that only 8% of 43 year old should expect to have at least one normal blastocyst. Then out of that 8% of 43 year old, the success rate is 50% per single embryo transfer. That number is in line with the 3% that you mentioned. For a 38-40 year old like myself, the chart shows that there is a 75% chance of having at least one normal blastocyst. If I transfer one of those normal blastocyst, the clinic's live birth rate is 85%.

    What is your AMH and FSH? They were normal. However, I only have one ovary and would likely produce half the amount of eggs that I potentially could have produced, but Dr. Anderson did not winced at that. Dr. Anderson is famous in my area and I know a few people (some older than me) that have been helped by him. I have not heard of a case where he turns patients away. If anything, I've heard that he likes to urge older patients to go directly to IVF before exhausting other options, such as IUI.

    How much did you pay for the cycle? I'm fortunate that my health insurance covers 3 cycles of IVF. However, I had to pay for the PGS out of pocket probably because it is still consider a clinical trial. That amounted to roughly $5000 USD. If I did not have insurance coverage, it would have cost me around $17000 for for the whole cycle which includes the clinic fees, lab fees, medication, surgical center fees, and PGS.

    ReplyDelete
    Replies
    1. And it is a joy to discuss with you - thanks ! :) More insights are very much welcome

      Delete
    2. Jules, I am happy that you are intelligent enough to make a decision which is best for you.

      If CCS could really increase live birth rate of women upto 85%, that is very impressive and I agree that it is the best step forward.

      For younger women, this technique offers the greatest advantage in terms of reducing multiple births and I agree it is very, very important.

      The problem again is the prognosis of older women - I agree that CCS will help older women in many different ways:

      It helps to have a good idea about their prognosis, because it will help to understand whether they are producing chromosomally normal embryos or not. If they produce eggs and embryos and no chromosomally normal embryos then they can move to other options like donor eggs or adoption. CCS in this way prevents a lot of heart breaks.

      But as you have mentioned, when you normalize the success rate of 43 year old women who does CCS, again it comes closer to only 4 %. I agree a 4% live birth rate in a women of 43 is good while without CCS their live birth rate falls closer to 1%.

      But there are some questions to answer still :

      Do all the embryos labelled as genetically abnormal fail to give rise to a healthy baby ? Jules, embryos have the ability to self-correct. By doing CCS are we removing all those embryos which have the potential to become a healthy baby ? I am still wondering about the miscarriage rates : Ofcourse if they show a data which says that the live birth rate is increased, it must obviously decrease miscarriage rate. My only concern is that there are still no studies with proper strength to show that.

      If it is a clinical trial (they are experimenting on you), have you ever wondered why you must pay out of your pocket ? They must have enough funding to do that!

      Delete
    3. One more thing Jules, check for their 2011 success rates here : http://nccd.cdc.gov/DRH_ART/Apps/FertilityClinicReport.aspx

      Also ask them with how many patients per group they have made that graph.

      Delete
  12. Hi Manju, I've seen the 2011 rates but that is 3 years ago and much have changed since then Like I mentioned, the graph is not based on the number of patients that start an IVF cycle, it is based on the number of PGS tested blastocyst transfer.

    I just want to provide you an update on my transfer. I had a beta today at 10 days post FET and it is BFP. I know I still have a long journey ahead, but I couldn't be happier.

    ReplyDelete
    Replies
    1. Congrats Jules, that's a great, great news :) Wish you a very happy and healthy 9 months.

      Whatever it is, I do not think the graph is the correct representation of their success rate. They will publish their recent success rate very soon in that website, I will follow it.

      Again your single success story doesn't mean much :) Hope I find a good scientific publication from them very soon.

      Delete

Please do write to me! It makes me happy :)

Related Posts Plugin for WordPress, Blogger...