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In Vitro Fertilization and Embryo Transfer






Blastocyst embryo transfer (BET) is a new assisted reproductive technology that has been incorporated with in vitro fertilization (IVF) treatment to increase pregnancy rates while simultaneously decreasing the risk of multiple pregnancies. In vitro fertilisation usually involves the transfer of embryos two to three days after they have been successfully fertilised.  Blastocyst Culture and Transfer is a technique in which an embryo is developed in the laboratory for 4-6 days after fertilisation before being placed in womb. The embryo gains many cells as a result of being developed for so many days. The embryos developed for 4-6 days are much more advanced than the ones developed for just three days. These Embryos are called blastocysts. BET helps reduce the incidence of multiple gestation pregnancies by transferring fewer embryos.

What is Blastocyst culture?

Until recently, successfully culturing embryos to the blastocyst stage was difficult. This term describes the process when the embryos grow for longer in the laboratory, and undergo critical developmental changes before being returned to the womb. Scientific advances have led to the development of culture media that mimic the changing environment of the reproductive tract and meet the unique requirements of the embryo as it travels from the fallopian tubes. This now allows up to 60% of embryos to successfully grow to the blastocyst stage in the laboratory environment. This period of extended culture helps experts to select the most competent embryo (s) for transfer to your womb. Therefore, blastocyst culture maximises the chance of you achieving a viable pregnancy. During the additional two days of in vitro culture (day 3 to 5), the embryologists have an opportunity to observe embryonic development and to select those embryos which appear to have the best potential for continued growth and implantation. Although this period of extended culture doesn’t necessarily improve the quality of the embryos, or guarantee that they reach the blastocyst stage, there are impressive success rates available for this treatment.

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What is the procedure involved into Blastocyst embryo transfer?

During IVF treatment with blastocyst transfer, unfertilized eggs (oocytes) are retrieved from the ovary. They are then fertilized in an IVF laboratory setting, creating an embryo. Instead of being transferred to the uterus after three days, which is the case during traditional IVF treatment, the embryos are allowed to progress to the blastocyst stage over a period of five to six days. During unassisted fertilization, the embryo must reach the blastocyst stage in order to attach to the uterine wall. Because, during blastocyst transfer IVF, the embryos are implanted in the uterus during this same stage of development, some consider this to be a more natural implantation method. Blastocyst transfer mimics natural conception in which the embryo travels down the fallopian tube and reaches the uterine cavity five days after fertilisation. This synchronises the development of the embryo and the lining of the womb to increase the chance of implantation. Only healthy embryos are selected for transfer.

For whom is Blastocyst Embryo Transfer Recommended?

Blastocyst transfer is not suitable for everyone. It is a laboratory selection process to identify the best embryo. Couples who have had unsuccessful prior attempts with IVF or IVF and ICSI treatment despite having many good quality eggs retrieved are being offered Blastocyst Culture as an alternative treatment. Couples with multiple good quality embryos on day 3 are also good candidates for Blastocyst Culture. The ability to select the most viable embryos for transfer and implantation should improve their chance of achieving a pregnancy. Blastocyst transfer is not an option for all IVF patients. The technique is most successful with patients who are younger and have a large number of eggs available at retrieval. On average, patients with six or more high quality embryos on day three are the best candidates for blastocyst culture because there is a better chance of more embryos growing successfully till day five.

Frozen Blastocyst Transfer (FBT)

There is a chance that you may have some blastocysts (advanced five to six day embryos) available for freezing (using a process called vitrification) after you have had your best embryo (s) transferred. Freezing and warming can cause damage to the cells of blastocysts, particularly those which are not good quality. For these reason only very good quality blastocysts embryos are selected for freezing. Having blastocysts frozen means that you can undergo future cycles of IVF without having to stimulate your ovaries, collect and fertilise your eggs. Instead we can warm the frozen blastocyst (s) and transfer them to your womb in a much more simplified frozen blastocyst warming cycle. Your chance of becoming pregnant following replacement of frozen warmed blastocysts is comparable to that following replacement of fresh embryos. There is no evidence that any babies resulting from warmed blastocysts have an increased risk of abnormality.

Advantages of blastocyst transfer

Although you can choose to have the embryos transferred on the third day after fertilization, a blastocyst transfer has many obvious. The first is that it makes it easy to weed out the healthy embryos from the abnormal ones without spending for expensive screening procedures. Studies show that embryos that do not reach the blastocyst stage are more likely to have abnormal chromosome numbers, which means they would have eventually miscarried. Doctors observed that as much as 40% of embryos fail to make it to the blastocyst stage. Thus, waiting for the embryos to reach the blastocyst stage decreases the number of abnormal embryos, leaving you with the ones that are most likely to develop into a healthy baby. The fact that the embryo has already hatched out of its shell also gives it an improved implantation rate. In fact, blastocyst embryos have a 50 % chance of implantation. This means you will only need to have one or two blastocysts transferred, leaving you with a few back up embryos just in case this cycle fails. Spare blastocyst embryos may be cryopreserved until they are needed in the future. Another advantage of developing all embryos to the blastocyst stage is that it makes embryo cryopreservation (freezing) more efficient, since embryos without the capacity for full development are not frozen. Blastocyst transfer also allows the option of single embryo transfer.

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What are the disadvantages of blastocyst transfer?

Although blastocyst embryo transfer increases your chance of getting pregnant, it also increases the risk of multiple births. It is more difficult for an embryo to develop into a blastocyst. Therefore, there is the possibility that an IVF cycle will not result in a transfer of any embryos if none of the three day old embryos develop into blastocysts. The other disadvantage of the procedure has to do with cryopreserving the remaining embryos. Blastocysts cannot survive the freezing and thawing process as well as day 3 embryos do, and you might end up losing most or all of the embryos in the process.

Risks of IVF blastocyst transfer 

The primary risk of attempting blastocyst transfer is that some embryos will die in the laboratory. Therefore, the total number of embryos available for transfer and freezing will be less. Unfortunately, some couples undergoing blastocyst ivf treatment will have all their embryos die in the laboratory and will not have any embryos available for transfer.  BET does not guarantee a normal pregnancy. It is expected that some pregnancies will miscarry and some babies will develop birth defects similar to that which occurs in couples that are able to achieve pregnancy naturally. Excess blastocysts may be frozen and some of them will not survive the freeze-thaw process when utilized for a later attempt at achieving pregnancy. This is a similar risk to transferring embryos at earlier stages.

In this field of medicine, continued refinements and change offer greater opportunity for infertile couples. Blastocyst culture is one important step and one at which specialists at Indira Infertility Clinic has expertise.  We  offer our patients this promising state-of-the-art technique, as it provides us the ability to balance the success versus risk in favour of couples,  when we assist them in their pursuit of parenthood says Dr. Ajay Murdia, Scientific director at Indira IVF Clinic. Our doctors and embryologists will advise on whether blastocyst transfer is possible and this will depend on the number and quality of embryos available on day 3. Otherwise normal IVF is recommended. Whether day 5 or 6 transfer is recommended for you, it is a decision made by the experienced and expert clinical and laboratory teams aligned to give you the best individualized advice for a safe and successful outcome. Let us help you decide your journey of parenthood.

You can contact the team of experts at Indira IVF at http://indiraivf.com/ or you can fix up an appointment with us at 0 766 500 9965





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