been testing since 7DPET and gotten negative all along. Decided to bring forward the beta hcg blood test to Monday, got the results at 1pm, it's a very miserable 2.4. the nurse was still saying that it's early, and it may rise..but who the hell is she kidding?
all articles and all ivf centres in the world will concur that 2.4 is very NON PREGNANT. in fact any level below 5 is NON PREGNANT. I must admit that i am pretty annoyed at being 'entertained'
tried contact SF loh but was unable to get through to him as he was in OT all day. emailed him but didnlt get a reply either. it's frustrating, frustrating frustrating.
called kkh ivf again and was told to continue the progesterone jabs till thursday and then take another blood test on Friday. what the '1 quarter fish, 3 quarter duck' for?
hubby was optimistic, said why not....so we end up trudging to KKH early on tuesday. I then asked another the nurse manager if it's really necessary to continue on the progesterone jabs - she took a look at the chart and said ' let sf loh see you later and he will let you know'
that answers everything.
we waited 30 min to see as he's in OT (again). sf loh explained the figures and went through the egg retrival process, how many eggs retrieved (22), how many fertlised through IVF (final figure ?) and how many fertlised through ICSI. roughly half of the eggs retrieved was via IVF and ICSI.
total of 7 fertlised embroyos with 3 at grade 4 and treated with ICSI which was transferred this cycle.
The balance of 4 embroyos are frozen and mostly grade 3.
we discuss about the next cycle FET. And he still works on the premise that if so long the embroyo survives the thaw overnight, it should be transferrred, rather than waste it trying to grow it to blastocyst stage.
he said the chances that the embroyo will grow to blastocyst stage in the culture medium is so much lower than the chances that it will grow in the womb, that it is considered like wasting the embroyos.
i mentioned about the fact that if the embroyo doesn't survive till blastocysts stage after thawing , what makes him think that it will survive in the womb? he replied with some analogy about SAF men in camp training in the desert (which i so didn;t get) but anyways.....the idea is that the culture medium though the best that KKH uses is still not the real womb environment.
why did this cycle fail?
there is no specific reason. we can do only so much, the rest is still unexplained medically.
will the next cycle work?
no one can answer that question. FET has been known to have at least 10% chances lower than a fresh IVF cycle. But then there are also women who didn't get pregnant via a fresh cycle but gotten pregnant with FET. There's always hope!
Thursday, August 23, 2007
Article in ST
Fertility clinics must disclose success rates by Andy HoThe Straits Times31 July 2007
A LOWER court had awarded a middle-age couple $32,000 for in-vitro fertilisation (IVF) treatment, but the High Court reversed this recently. The couple had lost both their teenage sons in a car accident and were asking for, among other things, IVF costs as replacement expenses in their effort to have a child.
The couple may appeal, so one may not comment on the case which involved, quite unusually, a motor vehicle insurer. But this tragic case does bring into focus the need for an IVF-specific law, which must address, if nothing else, two big issues.
First, given that Singapore needs more babies, it seems odd that there isn’t a law that requires (health) insurers to cover IVF treatment - or at least to offer coverage for it.
Insurers have argued that infertility is not an illness. Even if it were, they say, IVF does not treat the illness since it does not cure the underlying infertility. And, even if it did, coverage should be left to the market. After all, most plans here do not cover dental or psychiatric services.
Mandates to provide or offer coverage would distort markets, they say. That is, people who do not need IVF would have to bear part of the costs in higher premiums.
But I am pooled together with smokers anyway, so my insurance premium is already higher than it would be if my pool was smoker-free. After all, the essence of insurance is to socialise, or share out, risks.
Moreover, the lack of coverage means that health insurers are not helping to rein in IVF fees. It also means that IVF utilisation is probably less than that which would give Singapore more babies.
If so, instead of leaving it to the courts to decide piecemeal - someone must actually bring a suit for them to even consider the issue - Parliament should debate the question of coverage thoroughly.
And while Parliament is at it, it might also consider another issue, that is, how to regulate the sector.
Comprising mainly fee-forservice procedures, the sector is currently largely unregulated. Specifically, patients have no access to reliable information to help them choose service providers optimally, so they depend on word of mouth.
Most couples go through much pain for many years before they attain success, but many do not get that far.
IVF involves using drugs to urge a woman’s ovaries to produce eggs at each menstrual cycle, surgically retrieving the eggs, fertilising them with sperm in the lab to produce embryos, and then implanting the embryos into the woman’s womb. Women endure physical pain and couples are buffeted emotionally by the trials and tribulations the process puts people through. Moreover, each cycle of IVF treatment costs about $10,000.
Also, it is risky. Unlike most medical technologies, fertility treatments were introduced with little rigorous testing, except on animals. Most governments have simply left oversight of the sector to the medical profession’s self-regulation - and the courts.
Unsurprisingly then, it was merely five years ago that scientists were able to pin down the fact that IVF babies are six times more likely to have low or very low birth weights, and twice more likely to have major birth defects. Although clearer information has surfaced in the last dozen years, much is still unknown about the technology’s risks.
True, there is always some reluctance to regulate sectors where technology is rapidly evolving, since any law enacted today will have a hard time keeping up with the science tomorrow. But perhaps regulation can be targeted specifically to help with what customers really care about: results.
So whether we eventually pass a law to mandate insurance coverage or not, a law could be passed to mandate that providers report their individual success rates.
This is important because the infertile are very vulnerable and may persist in trying even when success is very unlikely. What they need is reliable data to make informed decisions that optimise their chances of getting a healthy baby.
However, providers in Singapore do not publicly report such statistics, so patients just go by word of mouth. And in jurisdictions where clinics do report their success rates, providers have been known to manipulate their data.
For example, some clinics count pregnancies rather than live births in their ’success’ rates, but some of those pregnancies end in miscarriages. Or, clinics may compare the number of live births to the number of embryos transferred, but this leaves out those cycles that are cancelled when eggs are harvested but cannot be fertilised.
However, the number of egg retrievals done does matter because the invasive procedure involved is painful and not risk-free. Any statistic that excludes failed cycles underplays the number of painful procedures (and risks) a woman might have to bear.
What to do?
We should pass a law to require service providers to disclose their success rates, specifying also how success-rate statistics are to be presented.
An unusually good model is that found in the American state of Virginia, where the law requires that before IVF treatment can commence, the clinic must give the patient a signed disclosure form detailing its success rates in specific ways. (This law specifies three statistics: First, the total number of live births, which is what couples care about most; second, the proportion of live births per menstrual cycle of retrieving eggs - which measures the true rate of success per attempt; and lastly, the numbers of both pregnancies and live births per retrieval cycle - which indicates the woman’s risk of miscarriage.)
The provider must also break down its data by age groups, since success rates drop as women age.
I urge Parliament to consider enacting a similar law. With uniform statistics among clinics, consumers can comparison shop and optimise the quest to make babies. And while Parliament is at it, mandate coverage of IVF services as well.
A LOWER court had awarded a middle-age couple $32,000 for in-vitro fertilisation (IVF) treatment, but the High Court reversed this recently. The couple had lost both their teenage sons in a car accident and were asking for, among other things, IVF costs as replacement expenses in their effort to have a child.
The couple may appeal, so one may not comment on the case which involved, quite unusually, a motor vehicle insurer. But this tragic case does bring into focus the need for an IVF-specific law, which must address, if nothing else, two big issues.
First, given that Singapore needs more babies, it seems odd that there isn’t a law that requires (health) insurers to cover IVF treatment - or at least to offer coverage for it.
Insurers have argued that infertility is not an illness. Even if it were, they say, IVF does not treat the illness since it does not cure the underlying infertility. And, even if it did, coverage should be left to the market. After all, most plans here do not cover dental or psychiatric services.
Mandates to provide or offer coverage would distort markets, they say. That is, people who do not need IVF would have to bear part of the costs in higher premiums.
But I am pooled together with smokers anyway, so my insurance premium is already higher than it would be if my pool was smoker-free. After all, the essence of insurance is to socialise, or share out, risks.
Moreover, the lack of coverage means that health insurers are not helping to rein in IVF fees. It also means that IVF utilisation is probably less than that which would give Singapore more babies.
If so, instead of leaving it to the courts to decide piecemeal - someone must actually bring a suit for them to even consider the issue - Parliament should debate the question of coverage thoroughly.
And while Parliament is at it, it might also consider another issue, that is, how to regulate the sector.
Comprising mainly fee-forservice procedures, the sector is currently largely unregulated. Specifically, patients have no access to reliable information to help them choose service providers optimally, so they depend on word of mouth.
Most couples go through much pain for many years before they attain success, but many do not get that far.
IVF involves using drugs to urge a woman’s ovaries to produce eggs at each menstrual cycle, surgically retrieving the eggs, fertilising them with sperm in the lab to produce embryos, and then implanting the embryos into the woman’s womb. Women endure physical pain and couples are buffeted emotionally by the trials and tribulations the process puts people through. Moreover, each cycle of IVF treatment costs about $10,000.
Also, it is risky. Unlike most medical technologies, fertility treatments were introduced with little rigorous testing, except on animals. Most governments have simply left oversight of the sector to the medical profession’s self-regulation - and the courts.
Unsurprisingly then, it was merely five years ago that scientists were able to pin down the fact that IVF babies are six times more likely to have low or very low birth weights, and twice more likely to have major birth defects. Although clearer information has surfaced in the last dozen years, much is still unknown about the technology’s risks.
True, there is always some reluctance to regulate sectors where technology is rapidly evolving, since any law enacted today will have a hard time keeping up with the science tomorrow. But perhaps regulation can be targeted specifically to help with what customers really care about: results.
So whether we eventually pass a law to mandate insurance coverage or not, a law could be passed to mandate that providers report their individual success rates.
This is important because the infertile are very vulnerable and may persist in trying even when success is very unlikely. What they need is reliable data to make informed decisions that optimise their chances of getting a healthy baby.
However, providers in Singapore do not publicly report such statistics, so patients just go by word of mouth. And in jurisdictions where clinics do report their success rates, providers have been known to manipulate their data.
For example, some clinics count pregnancies rather than live births in their ’success’ rates, but some of those pregnancies end in miscarriages. Or, clinics may compare the number of live births to the number of embryos transferred, but this leaves out those cycles that are cancelled when eggs are harvested but cannot be fertilised.
However, the number of egg retrievals done does matter because the invasive procedure involved is painful and not risk-free. Any statistic that excludes failed cycles underplays the number of painful procedures (and risks) a woman might have to bear.
What to do?
We should pass a law to require service providers to disclose their success rates, specifying also how success-rate statistics are to be presented.
An unusually good model is that found in the American state of Virginia, where the law requires that before IVF treatment can commence, the clinic must give the patient a signed disclosure form detailing its success rates in specific ways. (This law specifies three statistics: First, the total number of live births, which is what couples care about most; second, the proportion of live births per menstrual cycle of retrieving eggs - which measures the true rate of success per attempt; and lastly, the numbers of both pregnancies and live births per retrieval cycle - which indicates the woman’s risk of miscarriage.)
The provider must also break down its data by age groups, since success rates drop as women age.
I urge Parliament to consider enacting a similar law. With uniform statistics among clinics, consumers can comparison shop and optimise the quest to make babies. And while Parliament is at it, mandate coverage of IVF services as well.
Sunday, August 19, 2007
Implications of Blastocyst transfers
FEWER RISKS, NEW HOPE:
THE REALITY OF BLASTOCYST TRANSFERS
Mark Perloe, M.D.
Michael John Tucker, Ph.D.
Introduction
The first thing that usually comes to mind when people hear the term, "infertility treatment," is the risk of multiple births. This worry has been fueled by the recent highly publicized multiple births in Iowa and Texas. While such cases are rare, the incidence of triplets or higher-order births as a result of assisted reproductive technology is of great concern to all infertility practitioners and patients. For countless couples, deciding against treatment may mean abandoning their dream of having a child.
But what if there was a way to reduce or even eliminate the risk of multiples? Not only would that help more couples become parents, it would also decrease maternal and neonatal risks. That possibility is becoming a reality, thanks to a new technique known as blastocyst transfer. With blastocyst transfer, fewer embryos are transferred while maintaining and even increasing pregnancy rates. This technique virtually eliminates the risk of triplets or greater.
The Significance of Blastocyst Transfer
In a typical non-blastocyst in vitro fertilization (IVF) cycle, a woman's eggs are retrieved and fertilized. If all goes well, the embryos are transferred into the uterus three days later. Due to the fact that it is difficult to predict on day three which embryos are more likely to produce a pregnancy, four or more embryos are frequently transferred in hopes that at least one will result in a live birth. Until now, this has been a reasonable approach in order to achieve acceptable pregnancy rates.
The downside is that sometimes all the embryos become ongoing pregnancies and the result is high-order multiple gestations (triplets or greater). In such pregnancies, there are considerable medical risks as well as financial and emotional considerations. So the couple is faced with the agonizing decision of whether to opt for selective reduction (the removal of one or more embryos) or to continue with a risky pregnancy. Although everyone agrees that every possible safeguard should be in place to avoid such unfortunate situations, the distressing reality is that multiple pregnancies sometimes do occur.
However, with blastocyst transfer, only two or three embryos are transferred, practically eliminating the possibility of triplets or greater. And the same pregnancy rates are achieved as would be expected when four or more embryos are transferred on day three. Some centers report achieving even better pregnancy rates with blastocysts. Implantation rates of 48-50% and pregnancy rates of up to 66.3% have been reported in patients who responded well to gonadotropins.
What is 1 Blastocyst?
A blastocyst is a highly developed embryo that has divided many times to a point where it is nearly ready to implant on the walls of the uterus. A blastocyst has come a long way from its beginning as a single cell.
During maturation, an embryo rests inside a protective shell called a zona pellucida. You can think of this protective shell as being much like a chicken egg. But, unlike chicken eggs, human embryos do not remain inside a shell. Instead, the embryo hatches (breaks out of the shell) on the fifth or sixth day so it can attach to the uterine wall (implantation). Just prior to hatching, an embryo becomes a blastocyst.
Embryos developing to the critical blastocyst stage have a much greater chance of implanting successfully and resulting in an ongoing pregnancy. That is because these embryos have passed an important test. During the first few days, the embryo relies on the mother's egg for all its nutrients. However, in order to 15 survive past day three or four, the embryo must activate its own genes. Not all embryos are successful. In fact, only about one-third of the embryos become blastocysts. Yet these embryos are more highly-developed, healthier, and stronger, and have a higher rate of implantation when compared to day three embryos. Due to the higher probability of survival, we transfer fewer back into the uterus.
Getting to Day Five
For many years, infertility practitioners have known that day three transfers were too early when compared to what is physiologically normal. In naturally conceived pregnancies, a day three embryo resides in the fallopian tube, not in the uterus. The embryo does not even reach the uterus until the fifth or sixth day. Yet traditional IVF has always transferred on day three because, up until now, we have not been able to delay the transfer to day five. Previous laboratory culture media could only sustain an embryo's growth for three days. Now we have the ability to develop an embryo to the blastocyst (day five) stage.
What has made the difference is the recognition that the nutritional requirements of the embryo change as it develops. That knowledge led to the development of different laboratory culture media for the embryo's specific developmental stages. This so-called "sequential media" attempts to reproduce the natural environment of the maternal reproductive tract. The nutrients are designed to meet the requirements of the rapidly developing embryo and have led to the development of blastocysts with better viability and higher implantation rates.
Redefining Developmental Potential
The ability to develop embryos to the blastocyst stage allows clinicians to have greater certainty about which embryos are more likely to implant. Interestingly, no correlation has been found between what is traditionally considered a "good embryo" on day three and a "good blastocyst" on day five. Previously, Dr. Tucker reported a "significant disparity between the two stages in embryo viability estimates," meaning that even the best embryologists cannot tell which day three embryos have the potential to develop into a blastocyst.
While the quality of blastocysts is determined by examining morphology and development, it is important to point out that blastocyst grading standards are currently under development. Although the ability for the embryo to grow into a blastocyst is a milestone, other factors also play a role in its further development. In the near future, we believe we will be able to accurately predict which blastocysts are destined for success. When that happens, single blastocyst transfers will be considered the norm, and IVF will likely be considered the first-line infertility treatment.
Who Does it Help?
Determining who is a good candidate for blastocyst transfer is another rapidly evolving area. As more information becomes available and our knowledge base grows, guidelines based on actual clinical experience will be developed. Until then, we can offer some preliminary observations.
In general, blastocyst transfer is more advantageous for patients who develop a number of eggs and embryos. A significant correlation has been reported between the number of eggs and the number of blastocysts developed, as well as the number of day three embryos and the number of blastocysts developed. Other candidates for blastocyst transfer include those who would not consider fetal reduction or those in whom delivering multiple pregnancies would be of particular concern. Blastocyst transfer is probably not advantageous for patients who develop few eggs or embryos.
A side benefit of a blastocyst transfer is the fact that the ability to generate a blastocyst provides important information about the likelihood of pregnancy. In general, pregnancy rates are higher in those whose embryos grow to the blastocyst stage. Conversely, pregnancy rates are lower in those whose embryos do not develop into blastocysts.
Maternal Age and Blastocyst Development
Does maternal age have any bearing on the production of blastocysts? Although some studies have shown advanced maternal age to be a factor in blastocyst production, Schoolcraft found "no correlation between percentage of blastocyst formation and increasing maternal age" in a population of women who responded well to gonadotropins. However, implantation rates and pregnancy rates in this study decreased with maternal age, with women over 40 faring the worst.
What Happens When Embryos Do Not Become Blastocysts?
Because only a few embryos develop to the blastocyst stage, it is possible to have no embryos survive to day five to transfer. This is especially true if the cycle begins with only a few fertilized eggs. When no embryos survive to become blastocysts, it is a tremendous disappointment. The looming question then becomes, "Would the embryos that did not survive to become blastocysts have implanted if transferred at day three?" Unfortunately, we simply do not have enough clinical data at this time to answer that question. In our opinion, pregnancy would have been unlikely in that situation. But since that outcome is not a certainty, day three transfers may still be a reasonable option for some patients.
Genetic Testing And Blastocysts
Another benefit of blastocyst transfer is the ability to perform biopsies on a more highly-developed embryo in order to test for genetic diseases. In the future, immunofluorescent testing techniques will allow practitioners to remove a few cells from the blastocyst, stain them, and examine them under the microscope to detect any genetic anomalies. While that type of testing is not currently available on a day-to-day basis, we believe it will be considered routine within the next two to five years.
Frozen Blastocyst Cycles
Blastocysts tend to have a very good survival rate after cryopreservation (freezing). Menezo and his colleagues have reported that "the recovery after thawing is equivalent, if not superior to, that of thawing of earlier embryonic stages."
Because blastocysts are superior to earlier stage embryos in terms of development, they are easier to freeze, store, and thaw. Additionally, because blastocysts have higher implantation rates, it is possible for a couple to go through IVF once and have enough blastocysts for the current cycle as well as any future cycles.
The Future
We are just beginning to understand the implications of blastocyst transfer for both practitioners and patients. ,We believe infertility treatment centers will soon be able to reliably grow blastocysts and accurately assess which embryos are destined to implant and develop into an ongoing pregnancy. When that happens, the transfer of a single blastocyst will become the norm. And today's risk of high-order multiples will become a memory. The future holds much hope, much promise, and considerably fewer risks.
THE REALITY OF BLASTOCYST TRANSFERS
Mark Perloe, M.D.
Michael John Tucker, Ph.D.
Introduction
The first thing that usually comes to mind when people hear the term, "infertility treatment," is the risk of multiple births. This worry has been fueled by the recent highly publicized multiple births in Iowa and Texas. While such cases are rare, the incidence of triplets or higher-order births as a result of assisted reproductive technology is of great concern to all infertility practitioners and patients. For countless couples, deciding against treatment may mean abandoning their dream of having a child.
But what if there was a way to reduce or even eliminate the risk of multiples? Not only would that help more couples become parents, it would also decrease maternal and neonatal risks. That possibility is becoming a reality, thanks to a new technique known as blastocyst transfer. With blastocyst transfer, fewer embryos are transferred while maintaining and even increasing pregnancy rates. This technique virtually eliminates the risk of triplets or greater.
The Significance of Blastocyst Transfer
In a typical non-blastocyst in vitro fertilization (IVF) cycle, a woman's eggs are retrieved and fertilized. If all goes well, the embryos are transferred into the uterus three days later. Due to the fact that it is difficult to predict on day three which embryos are more likely to produce a pregnancy, four or more embryos are frequently transferred in hopes that at least one will result in a live birth. Until now, this has been a reasonable approach in order to achieve acceptable pregnancy rates.
The downside is that sometimes all the embryos become ongoing pregnancies and the result is high-order multiple gestations (triplets or greater). In such pregnancies, there are considerable medical risks as well as financial and emotional considerations. So the couple is faced with the agonizing decision of whether to opt for selective reduction (the removal of one or more embryos) or to continue with a risky pregnancy. Although everyone agrees that every possible safeguard should be in place to avoid such unfortunate situations, the distressing reality is that multiple pregnancies sometimes do occur.
However, with blastocyst transfer, only two or three embryos are transferred, practically eliminating the possibility of triplets or greater. And the same pregnancy rates are achieved as would be expected when four or more embryos are transferred on day three. Some centers report achieving even better pregnancy rates with blastocysts. Implantation rates of 48-50% and pregnancy rates of up to 66.3% have been reported in patients who responded well to gonadotropins.
What is 1 Blastocyst?
A blastocyst is a highly developed embryo that has divided many times to a point where it is nearly ready to implant on the walls of the uterus. A blastocyst has come a long way from its beginning as a single cell.
During maturation, an embryo rests inside a protective shell called a zona pellucida. You can think of this protective shell as being much like a chicken egg. But, unlike chicken eggs, human embryos do not remain inside a shell. Instead, the embryo hatches (breaks out of the shell) on the fifth or sixth day so it can attach to the uterine wall (implantation). Just prior to hatching, an embryo becomes a blastocyst.
Embryos developing to the critical blastocyst stage have a much greater chance of implanting successfully and resulting in an ongoing pregnancy. That is because these embryos have passed an important test. During the first few days, the embryo relies on the mother's egg for all its nutrients. However, in order to 15 survive past day three or four, the embryo must activate its own genes. Not all embryos are successful. In fact, only about one-third of the embryos become blastocysts. Yet these embryos are more highly-developed, healthier, and stronger, and have a higher rate of implantation when compared to day three embryos. Due to the higher probability of survival, we transfer fewer back into the uterus.
Getting to Day Five
For many years, infertility practitioners have known that day three transfers were too early when compared to what is physiologically normal. In naturally conceived pregnancies, a day three embryo resides in the fallopian tube, not in the uterus. The embryo does not even reach the uterus until the fifth or sixth day. Yet traditional IVF has always transferred on day three because, up until now, we have not been able to delay the transfer to day five. Previous laboratory culture media could only sustain an embryo's growth for three days. Now we have the ability to develop an embryo to the blastocyst (day five) stage.
What has made the difference is the recognition that the nutritional requirements of the embryo change as it develops. That knowledge led to the development of different laboratory culture media for the embryo's specific developmental stages. This so-called "sequential media" attempts to reproduce the natural environment of the maternal reproductive tract. The nutrients are designed to meet the requirements of the rapidly developing embryo and have led to the development of blastocysts with better viability and higher implantation rates.
Redefining Developmental Potential
The ability to develop embryos to the blastocyst stage allows clinicians to have greater certainty about which embryos are more likely to implant. Interestingly, no correlation has been found between what is traditionally considered a "good embryo" on day three and a "good blastocyst" on day five. Previously, Dr. Tucker reported a "significant disparity between the two stages in embryo viability estimates," meaning that even the best embryologists cannot tell which day three embryos have the potential to develop into a blastocyst.
While the quality of blastocysts is determined by examining morphology and development, it is important to point out that blastocyst grading standards are currently under development. Although the ability for the embryo to grow into a blastocyst is a milestone, other factors also play a role in its further development. In the near future, we believe we will be able to accurately predict which blastocysts are destined for success. When that happens, single blastocyst transfers will be considered the norm, and IVF will likely be considered the first-line infertility treatment.
Who Does it Help?
Determining who is a good candidate for blastocyst transfer is another rapidly evolving area. As more information becomes available and our knowledge base grows, guidelines based on actual clinical experience will be developed. Until then, we can offer some preliminary observations.
In general, blastocyst transfer is more advantageous for patients who develop a number of eggs and embryos. A significant correlation has been reported between the number of eggs and the number of blastocysts developed, as well as the number of day three embryos and the number of blastocysts developed. Other candidates for blastocyst transfer include those who would not consider fetal reduction or those in whom delivering multiple pregnancies would be of particular concern. Blastocyst transfer is probably not advantageous for patients who develop few eggs or embryos.
A side benefit of a blastocyst transfer is the fact that the ability to generate a blastocyst provides important information about the likelihood of pregnancy. In general, pregnancy rates are higher in those whose embryos grow to the blastocyst stage. Conversely, pregnancy rates are lower in those whose embryos do not develop into blastocysts.
Maternal Age and Blastocyst Development
Does maternal age have any bearing on the production of blastocysts? Although some studies have shown advanced maternal age to be a factor in blastocyst production, Schoolcraft found "no correlation between percentage of blastocyst formation and increasing maternal age" in a population of women who responded well to gonadotropins. However, implantation rates and pregnancy rates in this study decreased with maternal age, with women over 40 faring the worst.
What Happens When Embryos Do Not Become Blastocysts?
Because only a few embryos develop to the blastocyst stage, it is possible to have no embryos survive to day five to transfer. This is especially true if the cycle begins with only a few fertilized eggs. When no embryos survive to become blastocysts, it is a tremendous disappointment. The looming question then becomes, "Would the embryos that did not survive to become blastocysts have implanted if transferred at day three?" Unfortunately, we simply do not have enough clinical data at this time to answer that question. In our opinion, pregnancy would have been unlikely in that situation. But since that outcome is not a certainty, day three transfers may still be a reasonable option for some patients.
Genetic Testing And Blastocysts
Another benefit of blastocyst transfer is the ability to perform biopsies on a more highly-developed embryo in order to test for genetic diseases. In the future, immunofluorescent testing techniques will allow practitioners to remove a few cells from the blastocyst, stain them, and examine them under the microscope to detect any genetic anomalies. While that type of testing is not currently available on a day-to-day basis, we believe it will be considered routine within the next two to five years.
Frozen Blastocyst Cycles
Blastocysts tend to have a very good survival rate after cryopreservation (freezing). Menezo and his colleagues have reported that "the recovery after thawing is equivalent, if not superior to, that of thawing of earlier embryonic stages."
Because blastocysts are superior to earlier stage embryos in terms of development, they are easier to freeze, store, and thaw. Additionally, because blastocysts have higher implantation rates, it is possible for a couple to go through IVF once and have enough blastocysts for the current cycle as well as any future cycles.
The Future
We are just beginning to understand the implications of blastocyst transfer for both practitioners and patients. ,We believe infertility treatment centers will soon be able to reliably grow blastocysts and accurately assess which embryos are destined to implant and develop into an ongoing pregnancy. When that happens, the transfer of a single blastocyst will become the norm. And today's risk of high-order multiples will become a memory. The future holds much hope, much promise, and considerably fewer risks.
Wednesday, August 15, 2007
trigger shot and HPT
How long does it take synthetic hCG (trigger shot) to leave my body before I can test for pregnancy?
Every woman's metabolism is different, but as a general rule of thumb, you should allow 1 day for every 1,000 units of hCG you injected. The standard hCG dose is 10,000 units; thus, 10 days after the shot, the synthetic hCG should be gone and you should be able to test for pregnancy without detecting the shot. However, you should ask your doctor what the recommended protocol for your dosage is.
Some women choose to test daily to monitor the presence of the hCG in their bodies; once the synthetic hCG is gone, the tests become negative. If the hCG "comes back" and the HPT's turn positive again, it's likely due to a pregnancy and not the leftover hormone shot.
Every woman's metabolism is different, but as a general rule of thumb, you should allow 1 day for every 1,000 units of hCG you injected. The standard hCG dose is 10,000 units; thus, 10 days after the shot, the synthetic hCG should be gone and you should be able to test for pregnancy without detecting the shot. However, you should ask your doctor what the recommended protocol for your dosage is.
Some women choose to test daily to monitor the presence of the hCG in their bodies; once the synthetic hCG is gone, the tests become negative. If the hCG "comes back" and the HPT's turn positive again, it's likely due to a pregnancy and not the leftover hormone shot.
Tuesday, August 14, 2007
7 days post embryo transfer [7DPET]
Tuesday 14 August 2007
just had p4 bloodtest yesterday, result is 92.5nmol. a level sufficient enough not to increase the dosage of progesterone jabs. thank goodness for small favours.
i am feeling so much better now. i got my appetite back on Sunday. had fried bee hoon for breakfast and pizza for a very late lunch/dinner. and i didn't throw up.
yet on the other hand, the bloatedness has gone away and i feel back to normal. too normal - hiaks - got symptoms also worry, got no symptoms also worry.
i read somewhere that the earliest one can test for HPT is 10DPET - can't wait to rec the strips HPT i bought online.
just had p4 bloodtest yesterday, result is 92.5nmol. a level sufficient enough not to increase the dosage of progesterone jabs. thank goodness for small favours.
i am feeling so much better now. i got my appetite back on Sunday. had fried bee hoon for breakfast and pizza for a very late lunch/dinner. and i didn't throw up.
yet on the other hand, the bloatedness has gone away and i feel back to normal. too normal - hiaks - got symptoms also worry, got no symptoms also worry.
i read somewhere that the earliest one can test for HPT is 10DPET - can't wait to rec the strips HPT i bought online.
painful ER, drama ET, hospitalised
Wednesday 8 August 2007
was hospitalised after ER on Monday, vomitting non stop , plus bloatedness, my belly grew like 8 cm within one day but it turned out not to be OHSS but sore ovaries, disturbed lining in the abdomen area due to the ER procedure.
ET was jeopardised and it was only this morning at 6.30am when Dr SF loh gave the go ahead for ET. and even so, he warned of the risk of going ahead with ET, increased risk of OHSS etc.
very drama, in the end ET went thru at almost 10am. it went smoothly and i was discharged from hospital at about 230pm. but it's a trying 3 days from mon to today - i snapped on monday night and bloody shouted everyone at the hosptial ward as i had to wait 5 hours in excruitating pain before the attending doctor saw me at 11pm.
all in all, i realised that the response from doctors in KKH is very subjective to which doctor is available. it so happens that SF loh was not around and he has already left the hospital on Monday evening.
so a piece of advise, when facing any emergency during the course of treatment, call ahead and make arrrangements to have your doctor waiting for you before you head down to the a & e dept. right now i am crossing fingers and toes that my 2www will go on smoothly.
p/s: today at KKH IVF, i saw a couple of gals who went thru ER at the same time as i did, they all look very healthy and painfree...guess it's just my bad luck to be the 1% that suffer through like crazy after the procedure.
was hospitalised after ER on Monday, vomitting non stop , plus bloatedness, my belly grew like 8 cm within one day but it turned out not to be OHSS but sore ovaries, disturbed lining in the abdomen area due to the ER procedure.
ET was jeopardised and it was only this morning at 6.30am when Dr SF loh gave the go ahead for ET. and even so, he warned of the risk of going ahead with ET, increased risk of OHSS etc.
very drama, in the end ET went thru at almost 10am. it went smoothly and i was discharged from hospital at about 230pm. but it's a trying 3 days from mon to today - i snapped on monday night and bloody shouted everyone at the hosptial ward as i had to wait 5 hours in excruitating pain before the attending doctor saw me at 11pm.
all in all, i realised that the response from doctors in KKH is very subjective to which doctor is available. it so happens that SF loh was not around and he has already left the hospital on Monday evening.
so a piece of advise, when facing any emergency during the course of treatment, call ahead and make arrrangements to have your doctor waiting for you before you head down to the a & e dept. right now i am crossing fingers and toes that my 2www will go on smoothly.
p/s: today at KKH IVF, i saw a couple of gals who went thru ER at the same time as i did, they all look very healthy and painfree...guess it's just my bad luck to be the 1% that suffer through like crazy after the procedure.
My love will get you home - Christine Glass
If you wander off too far, my love will get you home.
If you follow the wrong star, my love will get you home.
If you ever find yourself, lost and all alone,
get back on your feet and think of me, my love will get you home.
Boy, my love will get you home.
If the bright lights blinds your eyes, my love will get you home.
If your troubles break your stride, my love will get you home.
If you ever find yourself, lost and all alone,
get back on your feet and think of me, my love will get you home.
Boy, my love will get you home.
If you ever feel ashamed, my love will get you home.
When there's only you to blame, my love will get you home.
If you ever find yourself, lost and all alone,
get back on your feet and think of me, my love will get you home.
Boy, my love will get you home.
If you ever find yourself, lost and all alone,
get back on your feet and think of me, my love will get you home.
Boy, my love will get you home,
Boy, my love will get you home.
If you follow the wrong star, my love will get you home.
If you ever find yourself, lost and all alone,
get back on your feet and think of me, my love will get you home.
Boy, my love will get you home.
If the bright lights blinds your eyes, my love will get you home.
If your troubles break your stride, my love will get you home.
If you ever find yourself, lost and all alone,
get back on your feet and think of me, my love will get you home.
Boy, my love will get you home.
If you ever feel ashamed, my love will get you home.
When there's only you to blame, my love will get you home.
If you ever find yourself, lost and all alone,
get back on your feet and think of me, my love will get you home.
Boy, my love will get you home.
If you ever find yourself, lost and all alone,
get back on your feet and think of me, my love will get you home.
Boy, my love will get you home,
Boy, my love will get you home.
Saturday, August 11, 2007
When does implantation happen in IVF?
When does implantation actually occur in IVF or normal cycles? (We're not focusing on the "window" anymore, but on when real implantation does occur)
A very good study of implantation was published in 1992 by Bergh & Navot.
They studied 33 pregnancies from ovum donation or frozen-thawed cycles with serial HCG levels on the mothers to find the time of "first embryonic signal". The HCG assay used can detect very low levels.
Average first detection was at an embryonic age of 7.1 +/- 0.28 days (range 6.6-7.4 days).
This correlates with the studies of Hertig and Rock in the 1950's (hysterectomy studies) that showed the day of implantation to be day 6.
They did not find any evidence to support the concept of an embryonic diapause in humans.
A very good study of implantation was published in 1992 by Bergh & Navot.
They studied 33 pregnancies from ovum donation or frozen-thawed cycles with serial HCG levels on the mothers to find the time of "first embryonic signal". The HCG assay used can detect very low levels.
Average first detection was at an embryonic age of 7.1 +/- 0.28 days (range 6.6-7.4 days).
This correlates with the studies of Hertig and Rock in the 1950's (hysterectomy studies) that showed the day of implantation to be day 6.
They did not find any evidence to support the concept of an embryonic diapause in humans.
Friday, August 03, 2007
IVF - Puregon - 2nd scan
Friday 03 Aug 2007
2nd scan done today - right ovary - 13 follicles ranging from 7.5 to 14mm. left ovary - 6 follicles ranging from 9.5 to 14.5mm. was told to do ER on Tuesday and ET on Thursday
Then rec call from KKH IVF in the afternoon that ER have to be done on Monday instead, as the doc will be away on Thursday., so ET will be on Wednesday.
2nd scan done today - right ovary - 13 follicles ranging from 7.5 to 14mm. left ovary - 6 follicles ranging from 9.5 to 14.5mm. was told to do ER on Tuesday and ET on Thursday
Then rec call from KKH IVF in the afternoon that ER have to be done on Monday instead, as the doc will be away on Thursday., so ET will be on Wednesday.
Wednesday, August 01, 2007
IVF - 1st scan after stimulation
After being on Puregon for 7 days, I had my first scan, manage to see 9 follicles on right side from 7.5mm to 9mm, and 3 follicles on right side from 9mm to 12mm. Hope to see more follicles on Friday, I rather risk OHSS than not have enough eggs to fertillise.
although having said that the doc did advise that with the no of follicles so far and the nausea, there's a high tendency of 20-30% that the cycle have to be cancelled due to OHSS. the reasoning is that although it may be beareable now...after ET, the OHSS will worsen.
although having said that the doc did advise that with the no of follicles so far and the nausea, there's a high tendency of 20-30% that the cycle have to be cancelled due to OHSS. the reasoning is that although it may be beareable now...after ET, the OHSS will worsen.
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