# Blastocyst Transfer



## Vicky W

Hi Peter

This is not an urgent question, but something which I 
would like to understand more about.

I have seen some information on the web about blastocyst transfer (usually takes place ? day 5) and how it is much more effective than day 2 transfer because the embryos that make it to day 5 are more likely to implant (as some will have fallen by the wayside, having proved non-viable in the extra 3 days in the lab).

What is your opinion of this method and is it generally available in the UK?

Any info would be gratefully received!

Thanks


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## peter

Dear Vicky,

Blastocyst transfer means allowing all of your embryos to grow to day 4/5 in the lab and then selecting one blastocyst for transfer. You are right in saying that if an embryos reaches blastocyst stage in the lab then it is likely to be a good one. It is interesting to note that the first ever test tube baby was a blastocyst.

The technique is useful in those people who have had several unsuccessful IVF/ICSI cycles as it gives the embryologist a better idea as to embryo quality. The drawback is that if none of the embryos reach blastocyst stage then there will be no transfer in that cycle.

The technique is widely available within the UK.

Hope this helps!

Peter



Vicky W said:


> Hi Peter
> 
> This is not an urgent question, but something which I
> would like to understand more about.
> 
> I have seen some information on the web about blastocyst transfer (usually takes place ? day 5) and how it is much more effective than day 2 transfer because the embryos that make it to day 5 are more likely to implant (as some will have fallen by the wayside, having proved non-viable in the extra 3 days in the lab).
> 
> What is your opinion of this method and is it generally available in the UK?
> 
> Any info would be gratefully received!
> 
> Thanks


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## Debs

Peter,

Do you know if blast is more sucessful than assisted hatching? I know each clinics success rates differ but just wondered if you had an opinion as I will be having one of these options for my next cycle depending on how many eggs they retrieve. If I produce a good number (that would be a first) then I will have blast - if I dont however then they will consider assisted hatching.

Also can you have more than one blast put back?

Thanks for your time 

Love

DebsXXX


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## peter

Dear Debs,

Assisted hatching is usually done on earlier embryos (2-6 cell) and is another technique employed when someone has had several unsuccessful attempts. The mebryo is acytually ready to hatch naturally at the blastocyst stage so there is no great advantage in doing the procudre to a blastocyst. Success rates vary enormously from clinic to clinic but I would say that the two techniques are broadly comparable.

At present the maximum number of embryos we can transfer is 2 so in theory you could have two blastocysts. In practice it usually happens that there is only one good blastocyst to transfer so most people end up having just one.

Hope this helps!

Peter


Debs said:


> Peter,
> 
> Do you know if blast is more sucessful than assisted hatching? I know each clinics success rates differ but just wondered if you had an opinion as I will be having one of these options for my next cycle depending on how many eggs they retrieve. If I produce a good number (that would be a first) then I will have blast - if I dont however then they will consider assisted hatching.
> 
> Also can you have more than one blast put back?
> 
> Thanks for your time
> 
> Love
> 
> DebsXXX


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## Janieb

Peter

Just a quickie. How many embryos usually get to blastocyst stage in culture? My clinic only freeze at blastocyst stage not embryo stage which worried me as I understood it was quite a low chance. Why is there so many varying ideas in fertility clinics?

Today I found out that 5 of my 9 leftover embies got to blastocyst stage so are in the freezer. As my FSH was 9 I had a higher dose of stims, but I am presuming that my egg quality must be good to get this far.

Hope Catie is doing well now.

Thanks,

Jane


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## peter

Please see my comments in your text:



Janieb said:


> Peter
> 
> Just a quickie. How many embryos usually get to blastocyst stage in culture?
> 
> It varies from person to person and cycle to cycle.
> 
> My clinic only freeze at blastocyst stage not embryo stage which worried me as I understood it was quite a low chance.
> 
> It is! See above.
> This is an unusual approach which I have not come across before. I would ask them to justify their approach as in my opinion you are missing out on frozen embryos.
> 
> Why is there so many varying ideas in fertility clinics?
> 
> Becuase no one really knows the right answer and each clinic is trying to optimisie its results.
> 
> Today I found out that 5 of my 9 leftover embies got to blastocyst stage so are in the freezer. As my FSH was 9 I had a higher dose of stims, but I am presuming that my egg quality must be good to get this far.
> 
> This is very good blastocyst rate, perhaps your clinic do have something here??
> 
> Hope Catie is doing well now.
> 
> Catie is back to normal now, many thanks for your good wishes
> 
> Regards,
> 
> Peter
> 
> Thanks,
> 
> Jane


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## Janieb

Peter

Sorry I meant approx generalised percentage of embryos making it to blastocyst, I realise actual numbers don't count here and can vary.

I read that it was as low as 1 in 6 which is about 15%.

Also other reading material says that if an embryo is not going to get to blastocyst in culture it won't either in the uterus. Other say the uterus is the best place. Your view?

I realise my rate is good but I am still trying to get my head around the blastocyst approach.

Thanks again 

Jane


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## peter

Please see my comments in your text:



Janieb said:


> Peter
> 
> Sorry I meant approx generalised percentage of embryos making it to blastocyst, I realise actual numbers don't count here and can vary.
> 
> I read that it was as low as 1 in 6 which is about 15%.
> 
> That is about right.
> 
> Also other reading material says that if an embryo is not going to get to blastocyst in culture it won't either in the uterus. Other say the uterus is the best place. Your view?
> 
> The uterus has got to be the best place for an embryo but by the same token if an embryo reaches blastocsyt in vitro it is probably a good embryo. No one knows the answer to this question at present.
> 
> I realise my rate is good but I am still trying to get my head around the blastocyst approach.
> 
> There is a move to single embryo transfers to try to reduce the incidence of multiple pregnancies. The best approach to this is baslrocyst transfer but patients must be aware that sometimes they will get no transfer if they opt for this route. The first ever test tube baby was a blastocyst so this is nothing new!!
> 
> Regards,
> 
> Peter
> 
> Thanks again
> 
> Jane


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## KT

Dear Peter

I have recently had a meeting with my doctor to discuss our next ICSI cycle (this will be the 4th). He has recommended letting all the embryos go to blastocyst stage before transfer. Is this usual? 
He wants to do this to see if they can survive beyond the compacting stage (that's the furthest we've ever seen our embryos go) as he feels it will give him an idea of my inherent fertility - I'm only 29. (ie if I'm fertile even though I have blocked tubes and DH has poor sperm). Is this a good way of indicating this?

He has warned us that there is a risk that none of the embryos may survive and we may not have any for transfer. Is this a high risk?

Also if they don't survive - what exactly does this tell us and what can be done about it?

Sorry to bombard you with questions but at the time of the meeting I couldn't think what to ask.

Many thanks 

Kerry


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## niki66

Hi Peter
I'm in Australia and my clinics practise is to wherever possible go for blastocyst transfer
on my third icsi cycle had 4 fertilised and three made it to blasto, the best one which was expanding was replaced and i got a very painful heavy periodon day of my test (so didn't do it), could this have been a clinical preg, my coordinator thought maybe and this a good sign - your opinion
the two frozen were a little behind transfered blasto, do they have the same survival rate if transfered separately, does replacing two just mean that if one had the energy to create a preg it would have anyway even if it was transfered over two fets, i am hoping they both make it of course, we hope to limit the possibility of twins but don't want to limit our chance of success
thankyou for your time, there is so many questions when your on this rollercoaster
niki in aussie


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## peter

Please see my comments in your text:



KT said:


> Dear Peter
> 
> I have recently had a meeting with my doctor to discuss our next ICSI cycle (this will be the 4th). He has recommended letting all the embryos go to blastocyst stage before transfer. Is this usual?
> He wants to do this to see if they can survive beyond the compacting stage (that's the furthest we've ever seen our embryos go) as he feels it will give him an idea of my inherent fertility - I'm only 29. (ie if I'm fertile even though I have blocked tubes and DH has poor sperm). Is this a good way of indicating this?
> 
> This is a good idea, good blastocysts produce very good pregnancy rates.
> 
> He has warned us that there is a risk that none of the embryos may survive and we may not have any for transfer. Is this a high risk?
> 
> Depends on the clinic. The clinic I work at in Toronto has a 60% blastocsyt rate but this is exceptionally good.
> 
> Also if they don't survive - what exactly does this tell us and what can be done about it?
> 
> It really only tells us that blastocyst culture is not a good idea in your case.
> 
> Regards,
> 
> Peter
> 
> Sorry to bombard you with questions but at the time of the meeting I couldn't think what to ask.
> 
> Many thanks
> 
> Kerry


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## peter

Please see my comments in your text



niki66 said:


> Hi Peter
> I'm in Australia and my clinics practise is to wherever possible go for blastocyst transfer
> 
> This is good, I work for a clinic in Toronto (markham Fertility Centre) and they get brilliant results from blastocsyt only transfers.
> 
> on my third icsi cycle had 4 fertilised and three made it to blasto, the best one which was expanding was replaced and i got a very painful heavy periodon day of my test (so didn't do it), could this have been a clinical preg, my coordinator thought maybe and this a good sign - your opinion
> 
> Yes, it is a good sign
> 
> the two frozen were a little behind transfered blasto, do they have the same survival rate if transfered separately,
> 
> one mebryo at a time is becoming the option of choice, especially in the case of blastocysts.
> 
> does replacing two just mean that if one had the energy to create a preg it would have anyway even if it was transfered over two fets, i am hoping they both make it of course, we hope to limit the possibility of twins but don't want to limit our chance of success
> thankyou for your time, there is so many questions when your on this rollercoaster
> 
> One is the best option, especially with blastocysts as multiple pregnancy needs to be avoided.
> 
> Regards,
> 
> Peter
> 
> niki in aussie


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## H

Hi Peter
Ive not spoken to you before but always read your posts and now I too have a question for you if you dont mind.
I had a frozen/thawed blastocyst transfer yesterday and they noticed a couple of hours before transfer that a couple of the cells were darker, is this something to worry about?
we were feeling very positive about the blasto as the pg rates are much higher but now these dark cells are concerning me, any advice on this?

Many thanks
H x


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## peter

Dear H,

As there are about 120 cells in a blastocyst then two or three dark cells do not really matter. In general a dark cell is an indication that the cell is not as healthy as it could be.

I am delighted to hear that you have opted for blastocyst transfer as I see this as the way forward.

Good luck and think positive!!

Peter



H said:


> Hi Peter
> Ive not spoken to you before but always read your posts and now I too have a question for you if you dont mind.
> I had a frozen/thawed blastocyst transfer yesterday and they noticed a couple of hours before transfer that a couple of the cells were darker, is this something to worry about?
> we were feeling very positive about the blasto as the pg rates are much higher but now these dark cells are concerning me, any advice on this?
> 
> Many thanks
> H x


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## Tracey S

Peter

I have always been very interested in Blastocysts right from the word go in relation to my IVF treatment. I asked my Nottingham clinic before even starting with them last August and they said they have been doing them but have had mixed results - which I would expect in early stages anyway. I guess what they are trying to say is they do not see themselves at the forefront of this at present. Their general policy is to day 2 transfer but have had good results recently with day 3. My first IVF had no frosties that would have survived and resulted in ectopic (I am 36 with tubal damage) so no suprises there. My 2nd IVF was negative but resulted in 9 frozen embies which is very pleasing. 8 days ago I had 2 put back in on completely natural FET and am waiting to see..... I am on no drugs at all. Whilst still trying to remain positive on this cycle for future reference (whatever the result) what are your thoughts on taking the remaining 7 to blastocyst? The 2 they took out both happened to be 2 cells (there are a couple of 4 cells) and the morning of transfer went to a 4 cell and a 3 cell very quickly so were put back in.
Do you think 7 would be sufficient to try and how much longer would it take to get to blastocyst stage.
Thanks
Tracey


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## peter

Dear Tracey,

Trying to grow thawed embryos on to blastocyst is a good idea as long as you can accept that none might make it and you may therefore not get a transfer. It would also be sensible to only thaw two at a time just in case you ended up with blastocsyts from everything which is unlikely but possible. Re-freezing of such embryos is probably not a good idea.

I firmly believe that the blastocyst transfer procedure is the best way of ensuring that the best embryos are transferred, otherwise embryo choice for transfer is just guess work.

Hope this helps!

Peter



Tracey S said:


> Peter
> 
> I have always been very interested in Blastocysts right from the word go in relation to my IVF treatment. I asked my Nottingham clinic before even starting with them last August and they said they have been doing them but have had mixed results - which I would expect in early stages anyway. I guess what they are trying to say is they do not see themselves at the forefront of this at present. Their general policy is to day 2 transfer but have had good results recently with day 3. My first IVF had no frosties that would have survived and resulted in ectopic (I am 36 with tubal damage) so no suprises there. My 2nd IVF was negative but resulted in 9 frozen embies which is very pleasing. 8 days ago I had 2 put back in on completely natural FET and am waiting to see..... I am on no drugs at all. Whilst still trying to remain positive on this cycle for future reference (whatever the result) what are your thoughts on taking the remaining 7 to blastocyst? The 2 they took out both happened to be 2 cells (there are a couple of 4 cells) and the morning of transfer went to a 4 cell and a 3 cell very quickly so were put back in.
> Do you think 7 would be sufficient to try and how much longer would it take to get to blastocyst stage.
> Thanks
> Tracey


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## Tracey S

Thanks Peter

can I send them out to Torronto??

Tracey


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## peter

> Dea Tracey,,
> 
> If you would like to!! It 's a great place to visit!!
> 
> Regards,
> 
> Peter
> 
> quote author=Tracey S link=board=51;threadid=2133;start=0#msg26958 date=1048354259]
> Thanks Peter
> 
> can I send them out to Torronto??
> 
> Tracey


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## Tracey S

PEter

might have to go out to toronto now as AF started today like clockwork and unlike me I thought it had worked this time!!
Was thinking about your above comments re blasto and was wondering if should try and get the 7 to blasto - two at a time of course as above. Peter would I be still be ok having a natural FET like this month as all mine are day 2 frozen and would take a while to get to blasto wouldn't it - if they didn;t work wouldn't this hold me up?

Thanks - sorry but need to move forward with this.
Tracey


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## peter

Please see my comments in your text



Tracey S said:


> PEter
> 
> might have to go out to toronto now as AF started today like clockwork and unlike me I thought it had worked this time!!
> 
> Sorry to hear that
> 
> Was thinking about your above comments re blasto and was wondering if should try and get the 7 to blasto - two at a time of course as above. Peter would I be still be ok having a natural FET like this month as all mine are day 2 frozen and would take a while to get to blasto wouldn't it - if they didn;t work wouldn't this hold me up?
> 
> A natural cycle is perfectly OK but you would have to bear in mind that if no blastocysts formed then you would have to wait another month for another go. You also need the advice from your embryologists regarding your embryo quality as if they were not good when frozen then it might be worth thawing more than 2 each time to optimise your chances of a blastocyst. Please also make sure that your embryologists have experience of blastocyst and pregnancies from work, if not take your embryos to someone who has.
> 
> Let me know if you go ahead with this as I am very interested.
> 
> Peter
> 
> Thanks - sorry but need to move forward with this.
> Tracey


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## Tracey S

Peter

Many thanks for the help - I will give myself time before booking a review either by phone or in person.
DH is very sceptical about blasto but does not to be fair he says know enough and he is a numbers man after all!
Nuture in Nottingham believe the 7 frozen are good ones - we had 9 to begin with all day 2's are all 2 or 4 cells of a suitable grading. The two they took out last time seemed robust but were put back in straight away - they both went from 2 cells to a 3 and a 4 respectively immediatley and no fragmentation. Nuture have had successul blasto's but I don't know enough and need to speak to embryology. If not I am not sure where to take them in reality as in every other aspect I am very pleased with the service. They are also on the conservative side which I like in this process. Clearly you believe blasto the way to go rather than day 2 FET I am assuming and I will of course keep you posted as I truly believe we will get there one day as every other aspect is fine with me.
Thanks Peter
Tracey


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## H

Hi Peter
Just a quick question, approx. which days is a blastocyst likely to implant. I had blasto transfer on day 23 of my cycle ovulation occured on approx. day 17/18.
I know its usually 4-5days post ovulation but as it was put back later with it being a blasto I wondered approx. which day it is likely to happen if it does?

Many Thanks
H


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## peter

Please see my comments in your text:



Tracey S said:


> Peter
> 
> Many thanks for the help - I will give myself time before booking a review either by phone or in person.
> DH is very sceptical about blasto but does not to be fair he says know enough and he is a numbers man after all!
> 
> It's basically quality not quantity
> 
> Nuture in Nottingham believe the 7 frozen are good ones - we had 9 to begin with all day 2's are all 2 or 4 cells of a suitable grading. The two they took out last time seemed robust but were put back in straight away - they both went from 2 cells to a 3 and a 4 respectively immediatley and no fragmentation. Nuture have had successul blasto's but I don't know enough and need to speak to embryology.
> 
> I don't know either. I know that there have been some changes recently on the enbryology staff.
> 
> If not I am not sure where to take them in reality as in every other aspect I am very pleased with the service.
> 
> Lokk on the HFEA website www.hfea.org.uk where all of the data for all of the clinics should be available.
> 
> They are also on the conservative side which I like in this process. Clearly you believe blasto the way to go rather than day 2 FET I am assuming and I will of course keep you posted as I truly believe we will get there one day as every other aspect is fine with me.
> 
> I am sure and good luck!!
> 
> Peter
> 
> Thanks Peter
> Tracey


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## peter

Dear H,

Blastocysts implant around 1-2 days following ET.

Regards,

Peter



H said:


> Hi Peter
> Just a quick question, approx. which days is a blastocyst likely to implant. I had blasto transfer on day 23 of my cycle ovulation occured on approx. day 17/18.
> I know its usually 4-5days post ovulation but as it was put back later with it being a blasto I wondered approx. which day it is likely to happen if it does?
> 
> Many Thanks
> H


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## H

thanks for your reply Peter
I was hoping that implantation took place later as I am feeling af type pains today but obviously not, oh well will keep my fingers crossed still
thanks
H


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## peter

Dear H,

The idea of feeling implantation is a bit far fetched for me. Don't worry too much about general aches and pains these are to be expected but are almost certainly nothing to do with implantation.

Regards,

Peter



H said:


> thanks for your reply Peter
> I was hoping that implantation took place later as I am feeling af type pains today but obviously not, oh well will keep my fingers crossed still
> thanks
> H


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## H

thanks Peter
I wuld tend to agree to be honest, I dont think that you would actually feel implantation taking place but then we imagine all sorts of things are happening to us during this time.
I just need to be patient and stop letting my mind make up all sorts of things.
thanks for your quick reply
H


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## Tracey S

Peter

Hope you had a nice break - we have now accepted the negative FET result and are moving forward. We have spoken to embryology concerning our 7 remaining frosties and they are reluctant to take them to blasto as they prefer when they do do them to take them from fresh. They are also as I said not at the forefront of blastocycst embies and have done some clearly but didn't have the results to hand.
They have proposed a half-way house on this one - ie take some to 3 days from 2 - Peter you are the expert and I am assuming that this is because there are certain "important" changes that take place between 2 and 3 days - is this so? Nuture reckon they have had good results with this recently.
I am undecided but want to push on - as do we both and DH would like to try this half way house and if not successul go for a fresh cycle and go for blasto with those.
If we do send our embyros elsewhere my concern is the time spent to go through the process of tests etc again.
This probably sounds daft as a little more time could well pay off but once on the IVF bandwagon it is hard for us to stop rolling.....
I have a phone review with the specialist on Friday so will keep you posted.
Your thoughts would be much appreciated though if I were you I would be advising blasto at somewhere that has proven results. Hope I haven't anwered my own question - got carried away!!
Thanks
Tracey


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## Tracey S

Peter

I wonder when you have a moment if you could possibly consider the above - sorry!
The saga continues - the consultant says she agrees with embryology but if an embryo is going to take it will take - which I agree with and without prompting you I am sure you will too.
she believes putting day 2 back is just fine but if I want to go for day 3 then that is fine too only we will have to risk abandoning if they don't take out enough to survive thaw. (that would happen with blasto anyway). also she said that we would only know they got to day 3 not if they would continue - we don't know this with an embryo's do we - we are not mind readers and surely these are all indicators (some being better than others of course).
They are reluctant to use the frozen to take to blasto and would prefer fresh - so do we change clinics or go for FET again with these and see if I am luckier.
Thanks
Tracey


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## Mummytoone

Hmmm intersting Fee.......

I wonder if it is coz their FET stats out this year are not too good.

Food for thought..............................


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