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When attempting in vitro fertilization, the level of response of the ovaries varies greatly when women take the injectable FSH drugs for ovarian stimulation .
Before we stimulate the woman with the FSH containing drugs, antral follicle counts are the best predictor of the response the ovaries will give, and the number of eggs that will be retrieved. To a great extent, the more eggs we have to work with, the greater the chance that IVF will be successful. Women that respond well to the stimulation drugs sometimes also have better egg quality - and therefore could be more likely to have some high quality embryos. Women under 38 in our IVF program have acceptable live birth rates even with only 3 - 6 eggs, do better with more than 6 eggs, and do best with more than 10 eggs. From the beginning of our IVF program in 1986, we have had a very unique philosophy regarding embryos.
The IVF team is also made up of embryologist, Michele Haas, BS, and embryology assistant, Mindy Purcell, CMA. The embryo transfer process is usually carried out three days after retrieval with the aid of ultrasound visualization to assure the embryo transfer catheter is correctly located in the uterine cavity. Our patients are accommodated in the office for about two hours after the transfer, and then go home to bed rest for an additional twenty-two hours. Serving the greater Pennsylvania areas of Reading, Philadelphia, Pottsville, Lancaster, Lebanon, Harrisburg, Allentown and Scranton with unmatched infertility and IVF services. Though In Vitro Fertilization (IVF) and other fertility procedures are quite common these days, there are a few risks involved in these procedures. In countries like the United Kingdom, there is an official regulation which restricts the number of embryos (only one embryo per cycle) being put into the woman’s uterus. During the entire IVF (or other fertility procedure) cycle, a woman has to take a combination of fertility medication and injections to stimulate ovulation and produce mature eggs. The sings of an ectopic pregnancy include abnormal bleeding, amenorrhea, tenderness in the breasts, and signs of rupture such as fainting, pressure in rectum, severe lower abdominal pain etc.
We have been doing day 5 blastocyst transfer since 1998 at the Advanced Fertility Center of Chicago, IL.
Couples with infertility often express a desire for delivering twins instead of a single child. When they are fully aware of the risks to the children if delivery is premature, some couples no longer prefer a multiple pregnancy.
The psychological, social, and economic stresses involved with caring for twins is substantial, but patients often say they would welcome facing those stresses if they were so blessed. Compared to a singleton, a twin is about five times more likely to die in the first year of life. The report for IVF cycles in 2013 is currently available on the SART website, the CDC report lags behind the SART report - 2012 data is the most recent available from CDC. These annual reports show the trend in the United States toward transferring fewer embryos. However, over the same period of time, no progress was made with regard to reducing the rate of twin pregnancies, which remained at about 32% of births.
Over that 4-year period, US IVF centers transferred less embryos, resulting in higher success rates, a lower percentage of triplets, but no change in the percentage of twins.
In general, European infertility clinics are transferring fewer embryos as compared to American IVF centers.
In the United States, couples with insurance coverage for IVF services are more likely to prefer fewer embryos for transfer. In 2009, the American Society for Reproductive Medicine (ASRM) published revised guidelines regarding the appropriate maximum number of embryos to transfer.
These guidelines have been helpful in limiting the number of embryos transferred, particularly in patients with the most favorable prognosis.
Couples with a very high chance for pregnancy can be identified on the day of embryo transfer and can be offered the option of transferring one or two embryos.
In my experience, if a couple has high-quality embryos available for transfer on day 5 and they are offered the options of transferring one embryo with a 50% expectation for pregnancy (almost all singles) or two embryos with an 75% expectation for pregnancy (about 50% twins, 50% single, and about 3% triplets), very few patients choose to transfer only one. They want the higher chance for pregnancy and are accepting (even welcoming) the risks of a multiple pregnancy.
A blastocyst is an embryo that has developed for 5 to 7 days after fertilization and has just started to differentiate. In past years, the majority of embryo transfers were done on day 3 (after the egg retrieval) at the "cleavage stage" when the embryos have four to eight cells.
The other problem with transferring on day 3 is that many embryos at that stage do not have the capacity to continue development and become high-quality blastocysts. When embryos are cultured from day 3 to day 5, some will stop developing and others (usually 25% to 60%) will continue to become blastocysts. In the past it was difficult to get good numbers of high-quality blastocysts with in vitro culture systems. The ultimate outcome of the cycle may be exactly the same either way (a failed cycle), but patients would probably prefer to have an embryo transfer and then not be pregnant as opposed to being called and told that their embryos have stopped developing and therefore they will not have an embryo transfer at all.
In our IVF program, we (currently) usually perform day 3 transfers for couples with less than 4 day 3 embryos that look "good", and day 5 transfers for couples with 4 or more high grade day 3 embryos.


Yes, in most published studies, and in the experience of many IVF programs, pregnancy rates are higher with blastocyst transfers when a given number of embryos are transferred (e.g. However, the issue is complicated because some IVF centers have seen no improvement or even lower pregnancy rates with blastocyst transfers. Therefore, it is not surprising that extended culture and transfer of two embryos on day 5 can show excellent pregnancy rates in some centers and significantly lower results in others.
Because blastocysts have a significantly higher implantation potential than day 3 embryos, the physician can transfer only two embryos and keep pregnancy rates high (over 50% per egg retrieval procedure in some programs for women under age 40) and triplet pregnancy rates down in the 2% to 4% range (one of the two embryos can split into identical twins to make triplets). Transferring only two embryos on day 3 results (on average) in an even lower rate of twin and triplet pregnancies (a good thing), but this happens at the cost of a substantially lower overall pregnancy rate. Because of the very high implantation potential of quality blastocyst embryos, we should be cautious about the high potential for twins. In conclusion, blastocyst culture and transfer of one or two embryos in IVF centers that are proficient with this technique currently offers the best balance between the chances of any pregnancy ensuing and the risks involved with a multiple pregnancy. As women age, we need more eggs to be able to make IVF work - because of the lower quality of the eggs. So when the expected drop-off occurs as some embryos arrest their development (a normal process) - we will still have one or 2 "good" ones for transfer back to the uterus. There are only a few people involved in the day to day care of the IVF patients.This has allowed us to develop close relationships with our patients, while keeping their situation finely tuned. All normally fertilized and developing embryos have always been transferred into each patient several days after the eggs were removed from her ovaries.
If embryos are hoped to be preserved by freezing, then most of the retrieved eggs will be inseminated. We have Barbara Zieckler, Cindy Cavalieri and Johanna Larese who do our sperm processing and blood testing. We feel we have maintained a very superior program, and bring to it a very personalized atmosphere.
Usually, in order to improve a couple’s chances of success during an assisted reproductive procedure, more than one embryo is transferred into the woman’s uterus.
However, in these developed countries, infertility treatments are covered by government healthcare policies.
They may think; "we want kids, and all this treatment is expensive and unpleasant, so let's just have 2 kids and get it over with".
These expectant mothers face an increased risk for developing complications of pregnancy such as gestational diabetes, pre-eclampsia, preterm labor, hemorrhage, and other complications. Centers for Disease Control and Prevention (CDC) and the Society for Assisted Reproductive Technology (SART) gather, tabulate, and publish annual national summaries and clinic-specific reports of IVF statistics. On average, they have lower pregnancy rates and a lower percentage of multiple births than clinics in the United States. In some European countries, physicians are restricted by law so that they cannot transfer more than two embryos.
By comparison, couples who must pay out of pocket for IVF often request that more embryos be transferred. The ASRM guidelines suggest a maximum number of embryos to transfer based on the day of transfer (cleavage stage vs.
However, many couples in the other categories who choose to have more than two transferred could still be at high risk for multiples, including triplets. The few who do choose to have a single embryo transferred almost always have excellent insurance coverage for IVF and often have at least one child already. One problem with this is that day 3 embryos normally are found in the fallopian tubes, not in the uterus. We do not have reliable methods to determine which of the day 3 embryos will be viable long-term.
Therefore, by choosing the best blastocysts for transfer on day 5, we can choose much more reliably those with the best potential for implanting and making a baby.
However, advanced culture media have been developed that provide the proper balance of nutrients at the various stages of early embryo development.
One of the issues with this is that a small proportion of couples will have embryos that are growing on day 3, but by day 5, all of their embryos have stopped developing. Most IVF centers (including ours) that perform day 5 transfers have selection criteria for deciding which cases are transferred on day 3 versus day 5.
This has been working well for us with very rare cases having no embryos available for transfer on day 5. This is because blastocyst culture and transfer is technically more complicated and difficult as compared to day 3 transfer.
This concept is well-understood in the embryology world, but it is not widely discussed in public forums.
Transfer of two excellent blastocysts can result in twin pregnancy rates as high as 50-60%. Our IVF patients are very carefully screened to eliminate the presence of underlying conditions that might diminish their chances for pregnancy.
Fehnel will perform the egg retrievals and embryo transfers in all patients planning embryo freezing.


Please ensure that your doctor informs you of the risks and side effects and you know understand them completely well before going ahead with one. While this increases the chances of success, it also comes with the risk of multiple births. Due to lack of such facilities in India, couples spend their own money to undergo an infertility treatment. These drugs carry the risk and complication of hot flashes, enlargement of the ovaries and ovarian hyper-stimulation syndrome. The foetus will not survive an ectopic pregnancy and the cells must be removed to ensure the safety and well-being of the mother. The risks to the fetuses and children are mostly related to premature delivery and can be very severe.
They tend to be fearful of failure because of the high financial costs associated with repeating the IVF process. Also, patients with embryos that have a high potential for implantation might have a high risk of twins if they have two transferred.
Therefore, the tendency has been to transfer more embryos on day 3 in an attempt to achieve good pregnancy rates. Proper culture techniques with these new media formulations yield excellent blastocyst formation rates.
These patients could have had a day 3 embryo transfer, but because their embryos were kept in culture and arrested after day 3, they will not have an embryo transfer at all. The criteria often involve a minimum number of fertilized eggs or a minimum number of good-quality embryos on day 3.
Individual factors such as the age of the female partner, information from previous IVF cycles, etc., can play a part in our decision regarding the best day to do the transfer in an individual case. Some laboratories are not able to maintain the stable and exacting culture environment for 5 days that allows the optimal development of the embryos. Therefore, transferring only one should be considered in young women (or in egg donation cycles) with high-quality blastocysts.
In this scenario, the number of embryos transferred is limited by controlling the number of eggs inseminated.
This type of procedure usually takes about 20 minutes and our patients are kept very comfortable by the anesthesia staff. The embryo implantation process begins about 3 days later, after blastocyst formation and hatching have occurred.
This has been reported to occur in about 5% of cases if all patient's embryos are cultured for 5 days.
Pregnancy rates with single embryo transfer (SET) in these patients can be in the 40-50% range with a very low risk of twins (perhaps 2%) and almost zero risk for triplets.
Our patients are not placed into predetermined protocols, but are all studied and handled individually.
The number is determined by a mutual decision between the IVF team and the couple, taking into account the female's age and the clinical situation. Spouses are not permitted to be present in the egg retrieval room but are encouraged to be at the embryo transfer.
Fortunately, with current embryo transfer policies, pregnancies beyond triplets are rare with IVF.
Shortly after hatching from the shell, it should begin to implant into the lining of the mother's uterus. A low drug dose stimulation is used for almost all patients, unless the clinical situation requires otherwise.
For those couples who choose embryo freezing, the advantages include a decreased potential of multiple pregnancy, as fewer embryos are replaced, along with typically not having to subsequently repeat the entire IVF process since there will hopefully be frozen embryo embryos for their future use. We have a monitor arranged so that our couples can see exactly what we see on our ultrasound during the cycle monitoring.
It is our feeling that this produces better egg quality and enhances the potential of pregnancy.
In this process, it is statistically unlikely for more than 50% of the transferred embryos to develop into fetuses. In the usual situation of inseminating four eggs, this would mean that three embryos will probably be available for transfer and one or two fetuses will result if pregnancy occurs. It would be rarely possible for all the inseminated eggs to fertilize and then all subsequently develop into multiple fetuses. Our multiple pregnancy rate has been 30% over all of our years, with most of these being twins. This thus avoids the moral questions raised by potentially discarding frozen embryos that are not needed in the future, as is reported to occur with up to 70% of all frozen embryos nationwide.
The situation has been totally avoided by limiting the number of eggs that are inseminated to begin with.



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