We know that transferring embryos at Blasotcyst Stage (on
Day 5) has a higher success rate as compared to transferring at 4-cell on day 2
or 8-cell on day 3.
Because the implantation rates with transferring Day 3 embryos
is lower, some doctors try to compensate for this by transferring more embryos,
to try to bump up their pregnancy rates, in the hope that one of them will
implant. However, this “ hit and miss” approach just increases the risk of a
multiple pregnancy !
A good IVF Clinic does only Blastocyst transfers routinely . Not only does this signal the fact that they
have confidence in their clinical and lab skills, it also gives the patient
peace of mind that they have received state of the art medical care !
By doing Extended Culture to Day 5, we filter out the
Embryos which are not going to implant , so that we don’t give the patient
false hopes by transferring these. Since we transfer only top quality blastocysts,
we need to transfer only 1 embryo at a time, and are still able to achieve an
equally high pregnancy rate.
At Malpani Infertility Clinic , we routinely do Blastocyst
Transfers , and encourage all our patients to do SETs (Single Embryo
Transfers).
The Cumulative Pregnancy per patient is very high with SETs,
because we can freeze the supernumerary embryos, and use these for the next
attempt if the first cycle fails – and for the next baby, if the first cycle is
successful ! The pregnancy is also much safer with a single baby, as compared
to twins ( who have a higher risk of having a preterm delivery).
However, one needs to be selective when doing SET and we
can’t always do SETs for all patients.
PATIENT’S
PERSPECTIVE
Patients usually prefer doing SET for the following reasons:
To Avoid Multiple Pregnancies:
- Some patients are scared about having a multiple pregnancy. These
patients are very sure that they want only 1 baby, as they may already have 1 ,
and are undergoing treatment for their 2nd child ; and many are
worried about their ability to be able to bring up to babies at a time . Twins
can look cute in a movie, but bringing them up can be very challenging – and
expensive as well !
For such Patients, we should strictly do SET, as it eliminates the risk
of having twins.
To be able to improve their pregnancy rates by doing multiple
cycles:
- For
patients with poor ovarian reserve, we get fewer eggs , and eventually we get
only 2 or 3 Blastocysts . Such patients usually prefer SET, as it allows them
to undergo multiple Embryo Transfer Cycles , thus improving their cumulative
pregnancy rate, because we can freeze their blastocysts, and transfer them one
at a time.
- Some
patients are extremely scared about taking injections for a fresh stimulated
cycle, and would rather do frozen transfer ( FETs), because these don’t involve
any injections at all. By doing SETs, we can offer them the luxury of doing
many cycles of FTETs
DOCTOR’S
PERSPECTIVE
At Malpani Infertility Clinic , we follow these thumb rules
while doing SET
PATIENT’S AGE:
If the patient is below 35 with a good prognosis, we offer
them the luxury of doing SET, as their Embryo Quality is usually good .
However, If the patient is above 35, then we allow them the option to transfer
2 blastocysts at a time.
Also, for patients who have failed IVF cycles earlier, we
will allow them to transfer 2 blastocysts, if they so desire.
QUALITY OF BLASTOCYSTS:
If the Blastocysts are of top quality, then it advisable to
do SET , as the chances of the embryo implanting are excellent, and
transferring 2 at a time does not improve pregnancy rates. We can preserve her
remaining Embryos for future cycles – and future babies !
Top Quality
Blastocyst
If the quality of Blastoycst is not upto the mark, then patients
may want to transfer 2 blastocysts to improve their chances.
Poor Quality Blastocyst
ENDOMETRIUM:
SET can be done
for cycles with both a good and a suboptimal endometrium.
An endometrium above 8mm
(triple layer) is considered good , and transferring only a Single Blastocyst gives
a good chance for the patient.
For Endometrium between 7mm and 8 mm , which is considered
sub-optimal, or where the texture is not trilaminar, we can still consider a SET, as we can reserve the second embryo
for the next cycle.
Howeverm if the endometrium is poor , than we suggest that
the patient should just freeze all her Embryos in the Fresh Cycle and do the ET
in the Next Cycle.
ESTRADIOL LEVELS (E2):
In Fresh cycles , if the E2 levels are too high, then we
usually freeze all Embryos and do not do a Embryo Transfer at all , as high E2
levels tend to hamper the receptivity of the Endometrium . However, some
patients insist that we do a fresh ET for personal reasons ( for example, if
are from overseas, and find it difficult to fly back to India for a frozen ET
immediately in the subsequent month) . For such patients we consider SET , and freeze their remaining
Embryos.
FRESH CYCLES VS FROZEN THAWED ETs:
For Fresh Cycles we should consider SET , as the Endometrium
is somewhat affected by the high Estradiol (E2) levels . It’s best to freeze
the remaining Embryos for future Frozen Thawed Cycles.
For Frozen Thawed ETs, We should consider SET if the Embryos
are Top Quality. However, if the Blastocysts are not of top quality, we can
consider transferring 2 blastocysts if the patient so desires.
