# So blastocyst is best?



## MS Apple (Mar 5, 2013)

Dear ancient ladies of wisdom...

I have egg collection on Monday, 6 follicles at the ripe old age of 42 and have a small question, that my nurse seemed so vague about.

If I have some eggs to collect, and if they gets fertilised, is the best plan before transfer that they go to Blasto?

I asked my nurse and she said, 'well, it's hard to tell... ' which confused me somewhat!

I know I can't control things now, aside continuing the diet of doom (!) but just wanted to get some more info so I am not all disappointed if they have to transfer on day 2 or day 3 instead of 5.

Sorry if this is the most basic IVF question, must be my growing years  

X


----------



## Artypants (Jan 6, 2012)

Hi MS

Great number of follies! I think the theory is, day 5 is best as normally the strongest embryos survive until day 5. However people have had great success with day 3 and day 2. its nerve wracking going to day 5 as you do tend to get a lot dropping off by then.

Good luck


----------



## Haydan (Oct 12, 2013)

I can understand why your Nurse said "it's hard to tell" though she could have been more helpful! 
It is a good sign if you have embies that make it to blast stage but it's not necessarily the best thing to do as 5 days is along time out of their natural home - you - so the embryologist will put them back in at the best time for them. 

They've only recently started doing blastocyst stage so millions of women will have got pg without it in the past. 

Don't get too hung up on it, if the embryologist suggest 2 or 3 day transfer it's not a bad thing, just means your embies need to be back in you instead of a Petri dish. Plus there are risks taking them to day 5 as artypants said there is the possibility they could die off, trust the embryologist with their advice, they want it to be successful too.


----------



## EssieJean (Aug 11, 2011)

Hi MS ... my clinic only do 3 day transfers... had 2 bfps albeit not gone full term.. nothing to do with being 3dt but "just one of those things" as they say.  My last was strong .. just not in right place. 

Blast is really good but wouldn't put too much pressure on yourself. lots of women get their bfps from 2 and 3 day transfers  

Good luck!

Essie xx


----------



## Blondie71 (Oct 26, 2011)

FET 3dt for me here too x


----------



## dillydolly (Mar 11, 2005)

I think it varies clinic to clinic. Some like to get them in early as they think it best and some feel that if the embryos don't make it to blasts then they wouldn't make it to a successful pregnancy

One clinic I went to did day 2/3 transfer on me but I felt like they were rushing me to do transfer where as I would have rather waited till day 5

Another clinic said day 5 only cos if they don't make it to day 5 then they wouldn't have made a successful pregnancy


----------



## KandK (Nov 17, 2011)

The studies say 5 day blastocysts have a much higher implantation rate.  There are lots of studies by the way, and easy to find.  At 5 days the embies are in the right environment (ie. the uterus) as they would be in a natural conception.  At day 3 embies are still in the fallopian tubes.  The older you are the more important it is that your embies are good quality - and that means blastocyst transfer.  If they don't make it to blast then they more likely than not would not have made it in your body either (read studies, not my personal opinion again).  

BUT it is down to the quality of the lab.  Labs who are not keen to do 5 day transfers is because it is more labour intensive (ie. the medium the embies are in has to be changed on day 3) and for labs who are not so good at this things can go wrong.  Also there is a cost factor.  5 day embies cost the lab more.  

Last but not least there is the $$$ factor.  Most clinics want you to get to transfer as they are guaranteed their money and sadly anyone over 38 is considered to be a lower chance for that.  The gold standard is blastocyst transfer and most of the good clinics are getting them even with older patients.  Ask for statistics on their transfer days 2, 3 and 5 days (they have to publish these, they are available to patients).  If their success rate is low with 5 day transfers or if they are only doing them on "select" patients (ie. younger ones) then your lab isn't up to scratch and I'd be looking elsewhere if that is possible.

I had no success with 3 day transfers (one chemical and one mmc).  Then DEMANDED I get a 5 day transfer (they don't like doing them on older ladies) and then next 2 cycles were BFP and DS born in March last year, and BFP the following cycle and I am currently 6 months pregnant with twins (and I am pushing 41).  My suggestion is push for a 5 day transfer, it is YOUR money after all (and YOUR embies!).  I didn't regret it and only wish I had done it for the first 2 cycles and would have saved myself over 10K.


----------



## Blondie71 (Oct 26, 2011)

Def agree with what you say about the lab, that for me was one of the top priorities and my lab based the best outcome for me on what they could see happening with my eggs on the day.


----------



## Louisej29 (Nov 19, 2012)

I'm not totally sold on blasto is best

I've had top quality blasts that have resulted in bfn

Both of my bfp cycles were not blasts.  !


----------



## FlyingCat (Jan 23, 2011)

Just thought I'd add a few ideas to the debate.

I'm afraid I don't know much about the specifics of older ladies or concerns about egg quality...

What my clinic have explained to me is that first and foremost - as far as we currently know - an embryo has a better chance back inside you as soon as possible regardless of how good it is. Labs are good but we generally expect mother nature to be better.

If there are only 1 or two embryos at day 2 or three, most clinics will normally say put them back then - giving them the very best chance to develop. However there is an emerging view that actually the chances in the lab are now pretty much as good as in you so some people are choosing to wait til later to see how they develop - particularly if single embryo transfer is preferred. 

My personal view on this is that if the embryos have the same chance in the dish I'd rather be able to observe them and know whats going on for a bit longer and if they're going to fail before day 5 then avoid transfer - rather than plunge directly into a 2ww. Of course this means you risk losing all embryos before going to transfer - if you feel like you'd regret your choice if this happened and wish you'd put them back then probably best not follow this route...

However, if there are more than 1/2 embryos, the clinics all want to put back the best embryo they can and the longer they can observe an embryo the better they can choose which one is best. Since the embryoscope got invented embriologists are able to much more closely observe embryos meaning that in many cases they know much earlier which are the strongest looking embryos. Some believe that now we know which are the best embryos already by day 3.

However days 4 and 5 show different bits of development than days 1-3. e.g. If there are male factor issues these are likely to show up as poor development/ stopping on day 4. If you have concerns about sperm quality waiting and seeing til day 5 can give valuable info allowing you to chose a better embryo than might be apparent on day 3.

So in short your nurse was right - its complicated and there's no such thing as the right decision for everybody. As always with this process you have to make the decision which best helps your individual circumstances.

Good luck.


----------



## Moominmum (Sep 29, 2012)

The way I understand it is that the whole point is to find out which of the embies that are the best for ET for a successful outcome. So if you have many left by day 3 of similar grade, leaving them to day 5 and go to blasto will hopefully enable the clinic to get a better understanding of the embies in order to pick the best for ET.

If you by day 2/3 "only" have 2 embies left, you might as well have ET that day. I think it is generally argued that the womb is a better incubator than any lab! 

Lastly, I get the impression that the quality/grading used is not necessarily that relevant for us "oldies" as the main issue, besides fewer eggs, will be issues with the genetics for which you have to test specifically. Of course at a cost of muchos dolares...


----------



## vaninort (Nov 6, 2013)

I have also been told by various consultants that there are risks with testing genetics on the embros as it can damage them.

I have had both - 3 day transfer and 5 day blasto - sadly neither worked. I think it is down to egg genetic quality and immune balance - I think I have issues with both plus age against me at 42. Cheery soul aren't I? 

xx


----------



## MS Apple (Mar 5, 2013)

Thanks so much for the comprehensive replies, really great. I am at the Lister in London after moving from Bristol NHS offering I checked out.  Feel way better at this clinic as the protocol is completely different and I feel they know their stuff. Better live rates than my initial hospital. 

Will take their knowledge and trust them on what's best... Not sure I will even get a choice.. . Would be better that way as today I can't even decide what pants to wear   

Collection tomorrow so will see how things go.

Thanks so much ladies - it's really helped me!

Much love.



X


----------



## Louisej29 (Nov 19, 2012)

Good luck for tomorrow.  I was at the lister and can't fault them. Top place to be. Though I've still to get the take home baby I did get pregnant twice there and every single consultant / embryologist we saw we had complete trust in.  You're in very safe hands there.  

X


----------



## urbangirl (Jul 28, 2010)

I was always pushed to do early transfers in the beginning and I assumed it was because that's the way it is, but later on I twigged that it was simply because the clinics presumed nothing, or hardly anything, would make it to the blast stage (but I was a bit older than you). Since then, I insist on going to blast. I read a piece by one of the top US consultants who said if an embryo is chromosomally normal it should make it to blast, and that clinics sometimes encourage patients to put embryos in before simply because they don't want them to end up with nothing to transfer.  Despite that, I still believe the natural environment can't be bettered by a lab, but it is very helpful to know how the embryos are developing.  The Lister must have a decent lab, at least. I don't know if I'd trust going to blast with every lab.


----------



## Molly99 (Apr 16, 2012)

I heard something interesting about this from my clinic this week.  They are moving away from 5 day blasts and towards getting them back as quickly as possible, in their view inside is best and the latest research shows this is the new way of thinking.

I've no idea personally.  I like the idea of a 5 day blast because at least you know that it is strong and so potentially it could save an agonizing 2ww.  Happy to go with whatever they think mind you, so we have a 2 day transfer booked in for tomorrow.


----------



## KandK (Nov 17, 2011)

Molly99 I'd love to see that research, and so would my DH (who is an ob/gyn and works in infertility) as he has never heard of it and it goes against all logical thinking.  The chemical environment in the fallopian tubes is totally different to the chemical environment of the uterus and a 3 day (or less) embryo is naturally in the fallopian tubes at this stage.  Days 5-7 is when it arrives in the uterus, it is at the blastocyst stage and has hatched/soon will hatch to allow embedding into the uterine wall and "plugging into" the lining where it will release chemicals to be supported in further development.  A 2 or 3 day embryo is not at this stage and shouldn't be in the uterus at this stage so I have absolutely no idea of how "current research" could indicate anything else?  There is a reason at 3 days the embryo's (in the lab) have their culture medium changed, their needs change after day 3 and they move to the next (and very crucial) stage of development.  Not saying 3 day embies will never work in a uterus, research shows they can - but research also shows a 75% higher chance of a 5 day embie embedding and turning into a successful pregnancy vs. a 35% chance of a 3 day embie making it and a tiny 11% chance of a 2 day embie making it.  If you have that research please post it because my DH is up to date with all that stuff and we have heard nothing about it - and we also obviously know many highly educated docs who write so many articles and they have never heard of it either.


----------



## Molly99 (Apr 16, 2012)

Very interesting KandK, it makes sense that day 5 is safest.  However, your post makes depressing reading for my day 2 transfer tomorrow  

Don't shoot the messenger, it isn't my research  .  This is how Create (and a few other clinics) seem to be doing it now.  They have said from the start that back in the body is the safest but at a scan last week I heard that they prefer not to wait until day 5 any more.  I don't know what research they would be privy to but there the experts for us, so I'm trusting them.  It was the first that I'd heard it really too.


----------



## KandK (Nov 17, 2011)

nawwww sorry I didn't mean it to sound like I was jumping on you about it - just really I am curious about that research.  My DH has written a few articles and been published and we know so many docs and they all work together on articles and none of them have heard of it either.  I really sincerely believe that doctors are doing this for $$$.  The bulk of the money for IVF comes from the lab - this is where the cost to the clinic lies.  The cost factor of getting and supporting eggs to blastocyst is much higher and you need skilled embryologists and lab technicians to do this.  The 5 days of storing and supporting an embie and changing the culture medium costs $$$.  If they get the embies out on day 2-3 then it's obviously way way cheaper and the clinic pockets that money.  Did they charge you less money because they did a 2 day transfer? (I am guessing not).  It's win win for them, they get the same amount of $, they transferred your embie, wiped their hands clean of you and IF (and it's an IF, you have hope) your cycle fails then they give you the whole spiel about your eggs are no good and have you thought of donor eggs, or let's try another cycle as it is a numbers game after all....  Honestly I have seen it first hand and DH knows heaps of doctors acting like this.  They are not doing IVF for charity, they are doing it for money.  I posted on your other thread too, so hopefully it gives you some hope....


----------



## Molly99 (Apr 16, 2012)

OMG, you make it sound horrible . I hope that my clinic care just a little about whether we succeed!

I'm Googling now, as this has me really worried. You know that Googling can never come to any good 

I did just see this in the April 2014 Oxford Journal though which found that Day 5 has no advantages over day 3 http://humrep.oxfordjournals.org/content/15/9/1947.full

Obviously we'd know sooner if our embie isn't going to make it if we waited for a blast but I have to have hope that it might inside me where it belongs too x


----------



## KandK (Nov 17, 2011)

No offence to any Saudi people out there but they are not considered to be big players or particularly credible in infertility research and they have questionable standards when it comes to their studies.  As I said DH is a ob/gyn so we have access to the FULL articles (the ones you read online are reduced ones and excerpts).  Statistically their article is crap because they used such a small group of ladies.  This wasn't your typical USA type study of over 1,000 women (these types have greater statistical relevance).  Also the middle eastern clinics "choose" or cherry pick their participants, that study had almost nil women over the age of 40 years (and the results of pregnancy for the older women wasn't separately noted as it should have been).  And they would put 3 OR MORE embryos in any women aged over 38.  That is a hot topic in the western world, we are moving into less embryo transfers and of higher quality to reduce multiples and complications - they are putting 3 embies in to maximize their statistics and that is wrong.  Sorry to hijack the thread OP


----------



## Molly99 (Apr 16, 2012)

Oo, I'm going to leave this one too now and hope that our clinics are the experts!


----------



## Moominmum (Sep 29, 2012)

Create seems to have more of a "Scandinavian" approach and with that I mean less drugs and 2/3 days transfers. I understand that this approach is not unusual in Europe. I am originally from Scandinavia and checked with some good clinics in my hometown initially but decided to go with a top London clinic in the end because of logistics. I regret that. I felt very much that they were a business rather than a clinic serving me.

I suppose that only results can say which approach is the "best" but as clinics seems to pick and chose their patients to various degrees you can't do a like for like comparison.

Have faith in your clinic!


----------



## urbangirl (Jul 28, 2010)

I'm not so negative about early transfers, even though I don't want one, because SIRM in the US, for example, though they favour day 5 transfers say that if, for example someone had a day 3 transfer and it was successful that is because it was an embryo that would have made it to blast in the lab.  i.e it's not so much what day you transfer that is important, but whether that embryo was competent in the first place.  Not all blastocysts are competent though.


----------

