# Blasts over the age of 40 at Lister



## Be Lucky (Mar 22, 2008)

Dear all- fellow over 40s

I usually post on the Lister site but I was just trying here to see if any1 can answer my questions!
I am 42 and had 2 5 day blasts transferred on Sat at the Lister.

Have had quite a bit of cramping but believe that is normal.  I was just wondering if anymore knows the success rate for my age with blasts.

I was told 40% but on some sites I have seen 60 to 70% quoted.  Does it depend on the clinic? Can anybody help me?

Regards

Be Lucky


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## Guest (May 1, 2008)

Hi Be Lucky

i cant answer your question cause i am only just starting out.  I was considering the lister and i see a lot of ladies are getting treatment there.  but what i would like to ask is how did you find the lister - were they sensitive to your needs?  i wish you all the best


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## Be Lucky (Mar 22, 2008)

Dear shad i wld say go 4 it!hav found the lister excellent in every way esp 4 older ladies.good luck berniex


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## Guest (May 2, 2008)

Be Lucky said:


> Dear shad i wld say go 4 it!hav found the lister excellent in every way esp 4 older ladies.good luck berniex


can i see any consultant at the Lister or do they assign one? I am learning from this site that some are more sympathetic than others


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## Be Lucky (Mar 22, 2008)

Dear Shad

I sent you a msg yesterday saying I would recommend Dr Jaya Parikh and Dr Marie Wren.  But that is just because I have personal experience of them.

I often use the internet on my mobile so maybe that why it didn't register the msg!

Good Luck


Bernie


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## Guest (May 3, 2008)

Be Lucky said:


> Dear Shad
> 
> I sent you a msg yesterday saying I would recommend Dr Jaya Parikh and Dr Marie Wren. But that is just because I have personal experience of them.
> 
> ...


Hi Bernie

didnt get your msg but thanks for the info. i will speak to the Lister on Tuesday. i might also go to the LWC for a consultation and see what they advise. i believe with them you pay for 3 attempts with IVF?


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## Be Lucky (Mar 22, 2008)

Dear shad wher is lwc?how much r 3 attempts?i think our 1 attempt at lister added up2 Â£6k or Â£6.5k.due2 test monday but had brown discharge 2day and was v worried that period was on way.rang lister emergency number they very good and the nurse said as they had transferred 2 embroyos and mayb 1 had come away but 1 was ok.but if it got worse 2 ring again.she said take 1 suppositries  on top of the 1 i take 2nite.did i read that u need donor sperm?u still needivf as well.im not an expert but cant u just hav insemination?but maybe u need ivf?good luck with everything bernie


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## Guest (May 3, 2008)

Be Lucky said:


> Dear shad wher is lwc?how much r 3 attempts?i think our 1 attempt at lister added up2 Â£6k or Â£6.5k.due2 test monday but had brown discharge 2day and was v worried that period was on way.rang lister emergency number they very good and the nurse said as they had transferred 2 embroyos and mayb 1 had come away but 1 was ok.but if it got worse 2 ring again.she said take 1 suppositries on top of the 1 i take 2nite.did i read that u need donor sperm?u still needivf as well.im not an expert but cant u just hav insemination?but maybe u need ivf?good luck with everything bernie


It is about £5450. Take a look at their site:

http://www.londonwomensclinic.co.uk/treatments/ivf_package.html

they are on harley street, central london

the reason for IVF is because of my age. Hopefully iVF will increase my chances and also the embryos can be checked for genetic disorders which you cant do with insemination

/links


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## Be Lucky (Mar 22, 2008)

Thanx.I will look at it.good luck ag


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## anna the third (Jan 15, 2008)

the main reason for IF issues at our age is simply egg quality. younger women have maybe 4/5 good eggs whereas we have maybe 1/20 good ones. (per US websites)  

q.e.d. transfer as many as possible each time to try to "find" the god eggs and certainly don't wait for blasts under any circumstances. (waiting espcially with older eggs can cause the embryos to run our of mitochrondria/energy and arrest when inside it would not ahve done.)

Id be asking the embryologists at the lister again exactly why they advised blasts. get them to put it in writing. if they say it's owing to higher success rates, that's disingenuous - though accurate for their statistics - as, once you screen out a few embryos by waiting and letting those die off, of course there will be higher rates. an extreme example is like saying women at 8 months are more liekly to give birth than those at 3 months. do you see what i mean? 

going to blast changes nothing intrinsically about the embryo - our MASSIVE issue is chromosomes -  and should only be used when there are SO many fertilised that it is impossible to choose the best ones to go back.


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## Be Lucky (Mar 22, 2008)

Hi anna thanx 4 ur msg.i dont think they hav that high figure 4 blasts at lister though.only 9 women conceived at my age by blasts in last 3 yrs.sorry on mobil


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## muddypaws (Apr 10, 2008)

Anna,
That's an interesting piece of information about older eggs, where does it come from? Also, how would they know that an embryo doesn't run out of mitochondrial energy when it is transferred? I thought that what hapened to embryos inside compared to incubation was still one of life's mysteries! Also, it's my understanding that the quality and development of embryos is key to whether blastocyst culture is followed rather than necessarily age. It does seem that age is about egg quality but once you get good quality embryos that's more important isn't it?

Different clinics have different views on the research etc and just to reassure you be lucky, I am 40 and waiting to see how eleven day 3 embryos develop to blasts on Monday. As for age, there are such small numbers of over 40s TTC that most stats are a bit meaningless!

Muddylane


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## Jo (Mar 22, 2002)

Good Luck Muddylane for Monday   hope you get a lovely amount of blasts to choose from.

love Jo
x x x


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## anna the third (Jan 15, 2008)

ML, hi, and yes I take your points completely. 

I agree with you that chromosomes are key for us. absolutely. 

However, something I have observed and find difficult to explain away is that many many women on FF of all ages end up with eg only 2 blasts from eg large nos of fertilised eggs. (Im ignoring the poor medical management issues when eg women are allowed to develop 30 follicles, 20 are collected and only 10 fertilise.) 

Now, YOUNG women with their 2 blasts often get bfps notwithstanding lowly graded embryos. (ie what the embryologist can SEE, not chromosomal analaysis) whereas OLDER women with perfect blasts - superficially - get nowhere. This all indicates to me that the younger women's eggs have significant potential and any LACK of development (the reduction from the number of fert eggs to eg 2) is down to being significantly compromised by coming out of the body. (now, logically, the only other explanation i have for the tiny number of blasts is that even younger women only produce circa 2 good eggs each cycle - it's possible but unlikely as there is no indication whatsoever in medicine that this is right.)

Some of this lack of success for older women is down to poorer receptors and interactions witin the uterus, undoubtedly and some also stems from immune issues. The rest is chrom related. Therefore it makes more sense to me to get as many back in, trying to implant (to find this elusive good egg) than to risk any further stress on the fert eggs. After all, no clinic tries to say the fert eggs do BETTER outside the body do they?

Lastly, we should be sensitive to the fact that clinics' success rates improve dramatically with blasts - but it is just stats!  they should compare implantation rates day 3 as a % of eggs fertilised with implantation rates day 5/%eggs fertilised for a proper comparison.  


I for one this next time will do day 3 transfer of what looks best (and out of my probable 10 fertilsied, it isn't that hard to analyse, once you take into account where they are now cellwise, gradingswise,  which have been on track on along, which had vacuoles at collection etc.) Day 3 last time I had 8 grade 1, 8 cells but when you apply the other parameters, you very quickly get down to the likely best two. i would then freeze the remainder and try FEt the following months rather than pot luck of another ivf.i have very few concerns with the freezing process as my clinic (lister) is fine on this.  Im also aware that the stimms rocess and conmmensurately high E2 that develops, can prevent implantation and so i would do an unmedicated trasnfer the following month and hopefully the month after. 

very best of uck with your 11 ML -   for you and do let me know how you get on as I will you too with my apporach. one way or another we'll get there!  xxx


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## daisyg (Jan 7, 2004)

Hi All,

I totally agree with Anna. Both the top two clinics in the world - CCRM and Cornell tend to not recommend blast transfer for women past 40 plus unless their embryos fulful a strict critieria on day 3 (e.g. at lest 4 x 8-celled embryos on day 3, strict fragmentation criteria etc. etc.). They often recommend getting as many embryos as possible and transferring the lot if possible on day 3 to give the best chance of a live birth (easier to do in the US of course).

The key to over 40 success as a generalisation appears to be to produce more than 5 oocytes and to maximise number of embryos for transfer. Of courses, this is possible in the US but not so easy in the UK with a 3 embryo limit. However, it still seems to be an accepted opinion (certainly with REs in the US) that over 40s appear to do better with a day 3 transfer of the best 3 (or more) embies rather than blastocyst.

Maybe there is a certain cut-off where day 3 may be better. Perhaps blasts may still be a viable option if you make lots of embryos which look good quality on day 3 , but it you don't, then I think day 3 is better. Certainly over 42 plus I would go with the day 3 option personally.

Certainly the risk of multiples in over 40s is pretty minimal compared to younger women who blasts may be better for in order to avoid HOM risk.

There is no escaping the facts as Anna has outlined regarding aneuploid embryos being the biggest barrier to over 40 live birth. I think that over 40 eggs may not do well being taken to blast which is why the top 2 clinics in the world tend to transfer on day 3 for over 40s. Taking an embryo to blast over 40 does not weed out chromosomally normal embryos sadly. All it does is waste potentially transferrable and possibly viable day 3 embryos. Women over 40 generally do not produce enough embryos to justify blastocyst tx and are better I believe transferring all on day 3 if possible.

I went to Cornell at age 44.5 and cycled with my own eggs. I produced 6 embryos and transferred all 6 and became pg with a singleton. Sadly, I miscarried this pregnancy. I had also got pregnant on 2 previous ivf attempts in the UK (both at age 44 - each time making 6 embryos and transferring the best on day 3. I miscarried all of these as well.

Also, bear in mind that age and anueoploidy is not the only factor. Women over 40 tend to have more systemic issues which can prevent pregnancy and it is really important to eliminate these before cycling. e.g. Uterine issues (fibroids etc), thryroid problems, clotting issues, genetic karyotyping for man and womean, autoimmune issues (e.g. arthritis etc), poor absorbtion of folic acid, insulin resistance issues etc etc. Dont' forget older sperm which may be a problem and/or sperm issues in general which are often inadequately investigated.

Anna, where I am not sure I agree is going by the look of your embryos to pick the best. PGD has shown time and again that this is not an accurate way of picking non aneuploid embryos. Indeed, the best looking D3 8 cell embryos are often abnormal - just no way of telling as you know, sadly. However, you have to go by something, and this is the only way open to us (and is still a good guideline).

http://www.ncbi.nlm.nih.gov/pubmed/17197285

http://www.ingentaconnect.com/content/klu/jarg/2001/00000018/00000010/00343777?crawler=true

http://patient-research.elsevier.com/patientresearch/displayAbs?key=S0015028205030402&referrer=www.google.co.uk%252Fsearch%253Fsourceid%253Dnavclient%2526ie%253DUTF-8%2526rlz%253D1T4GGIT_en___GB207%2526q%253Dfive%252Bembryos%252Boptimum

http://cat.inist.fr/?aModele=afficheN&cpsidt=14397120

http://books.google.co.uk/books?id=1j1JKgytEjsC&pg=PA140&lpg=PA140&dq=cornell+ivf+blastocyst+over+40&source=web&ots=3UWTwvznoU&sig=wWOg-0yOdby0eW1Kh5YNQ2BsHko&hl=en&sa=X&oi=book_result&resnum=3&ct=result#PPA143,M1

Finally, and VERY importantly - it is only worth taking embryos to blast if the clinic's embryology lab/embyologists are experienced in blastocyst cultivation and transfer - this is SO important. You need to check their success rates and history with blastocyst tx for over 40s.

This is an interesting area of debate!

Best wishes,

Daisy
x


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## Be Lucky (Mar 22, 2008)

Thanks ladies 4 this interestin debate!anna my msg was on mobile and cut off last night b4 i had completed it.ru at the lister now?i hav emailed dr parikh ther 2 ask advice.daisy .v interestin re age as me 43 in august and my dh 47.thanx again berniex


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## anna the third (Jan 15, 2008)

Daisy completely agree with you....though you expressed it much better than i did.

All, please think about Daisy's analysis, maybe to discuss with consultants - I really think, having done huge amounts of reaseach on this, we are right.  

and vis a vis the use of embryo appearance meaning close to sweet nothing...you are of course quite right - volume of eggs to "find" the few good ones HAS to be the answer!)

ladies that means transferring 3 (and you can get that in the UK even if blasts over 40) OR going abroad. don't rule out eg Jinemed in turkey though I persoanlly am still struggling with a bit of a gulp factor on going abroad.  

xxx


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## muddypaws (Apr 10, 2008)

Hi,
Whilst I am sure that your experience is really helpful for those who are in the process of deciding about blasts or not, for myself and Be Lucky, it's too late! We've already made the decision to go to blastocyst and Be Lucky has had hers transferred - so there's no turning back for us. I felt much more anxious after reading your info and was in a position where it could make no difference to the outcome. Fortunately, this morning I have four great blastocysts with 5 embryos that are to be developed for a further day with the hope for more blasts to freeze. I am very happy with this  . I also have faith in my embryologist and this isn't a blind faith because usually I am pretty hard to please and very assertive about my needs and questions! All in all I now feel very pleased about my current and cycle and wish Bernie the best of luck too. Let me know the outcome Bernie, our 2ww will overlap a bit and so fingers crossed! Sending you......
 

Muddylane x


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## anna the third (Jan 15, 2008)

ML, hurrah!! that's a fantastic outcome. you must be delighted. 4 blasts already and possibly some more to come. excellent.  fingers crossed. will you have 3 transferred today then?


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## anna the third (Jan 15, 2008)

any good news from anyone? hoping to hear something positive.


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