In vitro fertilisation has been around for several decades. Many childless couples with fertility problems have been helped with this treatment and have been able to have children. Today IVF is the most successful fertility treatment. Researchers and scientists are constantly on the quest to find better and new techniques to ensure a more successful pregnancy. They seek methods that will help the embryo to implant and grow into a healthy baby.
Over the years, many new technologies have been introduced to IVF treatment. Some have helped, and others had side effects and were discarded as not helpful.
Blastocyst is a newer technique that is now popularly being introduced in fertility treatment around the world. This technique involves the use of high-grade infrastructure and lab equipment as well as a highly experienced and skilled embryologist. It is a specialised procedure but ensures much higher chances of implantation success.
In India, it is only the larger fertility clinics like Medicover Fertility Clinic are using this technique for their fertility treatments. The technique is specialised but has proved to be very successful with no side-effects. However, not every embryologist or lab facility can culture the blastocysts.
The term blastocyst is relatively newer, and many people are not very familiar with it. It starts with fertilisation. The egg and the sperm are fertilised in a petri dish in the lab. The embryo that is formed is placed in an incubator before it is transferred to the mother’s uterus in a technique called the IVF transfer. Usually, embryos are only kept in the lab until they are 3 days old, and it has an 8 cell structure. The blastocyst is an embryo that has a complex cellular structure with about 200 cells.
The blastocyst stage is the stage just before implantation. Implantation is the process where the embryo attaches itself to the mother’s uterus. Once the embryo implants in the inner lining of the uterine wall, it can receive nourishment and develop and grow into a healthy baby.
As a part of the IVF treatment, the egg and sperm are fertilised in the lab. After the egg and sperm are fertilised, the embryo is formed. The embryo is the egg that has successfully been fertilised by the sperm. The next stage of the IVF treatment involves transferring the embryo to the uterus of the female partner.
There are a few different types of embryo transfers that are used for IVF treatment. The embryo is kept in an incubator for a few days before it is transferred to the uterus.
3 Day transfer: The most common type of embryo transfer is the 3-day transfer. This type of transfer is most commonly practiced by most clinics.
Blastocyst transfer: The blastocyst transfer is conducted after 5 or 6 days when the embryo becomes a blastocyst.
Some clinics prefer to perform a Day 3 transfer to avoid the risk of the embryo failing to become a blastocyst. If the embryo fails to become a blastocyst, it dies, and this is not a very desirable prospect for the embryologist or the patients. Some clinics like Medicover have state of the art infrastructure and highly skilled embryologist who are confident of their ability to culture the embryos to blastocysts. To a large extent, the success of an embryo becoming into a blastocyst lies in the expertise of the embryologist who can understand the embryo and provide it with the right conditions and nourishment that it requires. As the embryo develops its nutritional requirements change, and this development needs to be monitored very carefully.
There are numerous benefits to the blastocyst transfer. This is one reason it is becoming increasingly popular. Larger hospitals and clinics prefer to use a blastocyst transfer as it helps to improve their reputation.
Receptive uterus: The blastocyst transfer takes place on the 5th or 6th day after ovulation. When natural fertilisation takes place, the embryo remains in the fallopian tubes for at least 3 days before moving to the uterus on the 4th day. It is supposed that the uterus is more receptive by the 5th or 6th day as this is when implantation actually takes place. Hence the blastocyst transfer is timed in accordance with the uterus receptivity, which in turn increases the likelihood of implantation. Very often the 3rd-day transfer does not culminate in successful implantation as the uterus is not prepared for the embryo and the embryo is not able to survive till implantation.
Embryo arrest: Some embryos will arrest between day 3 and day 5. Embryos that make it past the 5th day have been able to overcome the development challenges successfully. Some embryos that do not survive usually have chromosomal abnormalities or genetic defects. By the 3rd day the embryos are at an 8 cell stage by the 5th day it has 200 cells. Transfers conducted on the 3rd day may find that some of the embryo arrests in the uterus naturally. However, with the 5th-day transfer, the embryos are past the arrest stage and have a greater likelihood of surviving and implanting.
Better selection of embryo: On the 5th day, the progress of the embryo development can be distinguished better. On the 3rd day, all the embryos look similar. By the blastocyst stage, it is much easier to identify which embryos have a better development. On the 5th or 6th day, it is much easier for the embryologist to make a selection of the healthier embryos for the IVF transfer. This ensures that the embryo will continue to develop and grow well as it appears to be a good embryo. The ability to select better embryos for transfer improves with the blastocyst method, and this leads to a greater chance of a successful pregnancy.
Reduce risk of multiple pregnancies: One of the greatest risks with the IVF treatment is that of multiple pregnancies. A number of embryos are transferred to the uterus during the IVF transfer. This is done to improve the chances of pregnancy, in the hopes that at least one embryo will implant and grow into a baby. Sometimes mothers have ended up with multiple pregnancies and had twins, triplets or even more. The number of embryos that are transferred during the IVF treatment is discussed prior to the transfer, and the couple can decide on the number they want to be transferred along with the advice of the doctor. Due to the higher probability of implantation with a blastocyst, doctors limit the number of embryos transferred to one, two or three at the most, and this depends on the age of the mother too. In a normal 3-day transfer doctors transfer between 3 to 6 embryos, or even more at a time.
Hatching assistance: Assisted hatching is a technique in which the embryologist helps the embryo to hatch by making a small hole in its outer covering just before the embryo is transferred to the mother’s uterus. An embryo needs to hatch or break out of its protective outer covering before it implants. In some cases, when implantation fails, the doctors conclude that the implantation failure was due to the inability of the embryo to hatch. An embryo begins to hatch just before implantation, which is at the blastocyst stage. When the blastocyst transfer technique is being used, the embryo begins to hatch before the transfer. This allows the embryologist to monitor the hatching capabilities and render any assistance if required. This contributes towards the success of the implantation and the IVF treatment as a whole.
Genetic screening: The blastocyst stage enables a pre-implantation genetic screening to be carried out easily. At the blastocyst stage, the embryo has 200 cells, and a few of these cells can be removed for genetic tests to be carried out. In a 3 day transfer, the embryo only has 8 cells, and hence only one cell can be removed for genetic tests. Sometimes doctors feel that one cell is not sufficient, and for a proper diagnosis, they need a few more cells. With a blastocyst transfer, the pre-implantation genetic screening enables doctors to determine which ones are the good embryos and which ones are the defective ones. This enables them to transfer just one or two good embryos with a better probability of a successful pregnancy.
Higher implantation rate: Statistics show that the implantation rate with a blastocyst transfer is much higher. They have also found that the rate of live births is greater with the blastocyst transfer. The blastocyst transfer is being preferred in India by larger fertility clinics as this assures better pregnancy success rates. With a 3 day transfer, some of the 8 cell embryos are not able to become blastocysts in the uterus and hence arrest.
Doctors have found many benefits to the blastocyst transfer and prefer to use this technique if the facility is available to them.
While there are many benefits associated with the blastocyst transfer people are curious to know what the risks are. The blastocyst transfer is gaining popularity in some fertility clinics due to its higher pregnancy rate. There are a few risks associated with the blastocyst transfer, which are:
Multiple pregnancies: Most parents do not view multiple births as a risk, but in fact, welcome the idea. Doctors are worried about multiple births are this could seriously affect the pregnancy in many ways. There are many risks associated with multiple pregnancies, including low birth weight, pre-term birth, unhealthy babies, birth defects and a few others like a miscarriage. The mother could have some health risks like high blood pressure etc. However, there have been many cases of successful multiple pregnancies that have resulted in healthy babies being born.
Monozygotic twins: The risk of having monozygotic twins seems to be slightly higher with a blastocyst transfer. Monozygotic twin is more commonly known as identical twins. This happens when the embryo divides in half and forms two separate babies. It has been found that blastocysts are more likely to split into twins rather than 3-day embryos.
Fewer embryos: Not all embryos make it to the blastocyst stage. Culturing a 3 day 8 cell embryo to a blastocyst requires a very skilled and experienced embryologist who knows exactly what he is doing. There is also the risk of the day 3 to 5 arrest stage. Many embryos tend to arrest during this stage. This is the stage when the embryo turns from an 8 cell structure to a 200 cell structure. Researchers have found that the nutritional requirements of the embryos changes after the 3rd day and this requires careful monitoring.
If the lab or the embryologist is not sure that your embryos will turn into blastocysts, it is preferable to have a Day 3 transfer as you could risk losing all your embryos before they turn into blastocysts. Labs that are not properly equipped or do not have the facility to culture the embryos to blastocysts may not be able to take care of the embryos as required, resulting in a loss of embryos.
There are relatively few risks to the blastocyst transfer, but the benefits are many. If you are sure that the lab is equipped to take care of your embryos, you can opt for blastocyst culture. If you are not sure, you can opt for a day 3 transfer as well as a day 5 blastocyst transfer. This way even if your embryos do not make it to the blastocyst stage at least the 3-day embryo has a chance to implant.
Seema had IVF treatment at the age of 42. Her ovarian reserve was found to be on the lower side. Not being totally sure of the quality of the embryos the doctors decided to transfer 3 embryos on day 3 and culture the remaining 8 embryos to blastocysts. Only 2 embryos made it to the blastocyst stage of which one blastocyst was not developing too well. The doctors decided to transfer only the better blastocyst on the 6th day. Seema got pregnant successfully and had a healthy pregnancy.
In these cases, the doctors are not sure whether it was the 3-day embryo or the blastocyst that made it, but the success of the IVF treatment is most important.
It can be quite frustrating for a couple when they have been trying IVF treatment and have not been successful so far. You ask your fertility clinic to do a blastocyst transfer because it has a higher success rate, but they refuse.
Culturing an embryo to a blastocyst is not an easy task. This is a very delicate procedure. It needs an embryologist is skilled and confident in his abilities. It is not every embryologist’s cup of tea. Usually, small clinics use an external lab facility. The embryologist cannot be bothered with taking the additional effort to ensure that the embryos get the needed attention and care to grow into blastocysts.
Even clinics who have their own labs are sometimes not confidents of culturing the embryos to blastocysts. Hence they prefer to do a day 3 transfer and get the IVF treatment over with. A clinic’s responsibility ends once the embryo transfer is completed. Smaller substandard clinics do not want to take the risk of the embryos not surviving until the blastocyst stage. Some embryos arrest before they reach day 5 and clinics do not want to take responsibility for this loss of the embryo. So they just tell the patient that a day 3 transfer is a better option. This absolves them of any further concern about the embryos and their survival.
Couples are now doing their own research and becoming more knowledgeable about such matters. When they speak with a fertility doctor, they are able to assess the quality of fertility treatment offered from the options presented to them. Advanced fertility techniques are available only in a few reputed fertility clinics like Medicover Fertility Clinic.
Medicover Fertility Clinic has a high-end lab that is well equipped with the latest technology, modern equipment and facilities. The lab technicians are highly qualified and very experienced. The Medicover lab has a full CCTV coverage which allows patients to monitor what is being done with their eggs, sperm and embryos.
Medicover follows a total transparency relationship with their patients who are apprised of every event and happening regarding their case. There are no doubts in the patients as every procedure is above board.
Medicover Fertility Clinic has improved their success rates for pregnancies ever since they introduced the option of using the Blastocysts transfer technique. A blastocyst transfer is not always suitable for IVF treatment. Sometimes the doctors may feel the embryos have a better chance of survival inside the mother’s body rather than in the lab. In these cases, the day 3 embryo transfer is carried out. The decision to culture an embryo to a blastocyst depends on the quality of the embryo and the way it responds to being in the culture dish.
Couples, who have had multiple IVF failures with the day 3 transfer have a better chance of succeeding with a blastocyst transfer. Many couples come to Medicover after having tried IVF treatment in many places. To some couples, Medicover Fertility Clinic is like a last resort. They are quite sure that if Medicover cannot help them conceive, then no one can. The success rate of Medicover has preceded its reputation far and wide.
Medicover offers the best fertility treatment options in north India. They have seven fertility clinics and have helped over 20 lac couples with fertility problems to have a baby. Medicover is part of a European brand and follows international standard treatment protocols.
Every Clinic is outfitted with modern infrastructure and caring staff. Medicover has a panel of in-house doctors. The doctors are highly qualified, internationally certified and very experienced in the field of fertility treatment.
Q: All my embryos died before they became blastocysts. Why is this? Should I try treatment at another clinic?
A: Embryo that has chromosomal abnormalities arrest during the day 3 and day 5 stage usually. It is very unusual for all the embryos to die unless the quality of your eggs is very poor. There could also be a problem with the lab facilities. You should try treatment at a reputed clinic with good lab facilities.
Q: Doctors have advised me that 3 day transfer is better for me than blastocyst. Can I try blastocyst?
A: A Doctor decides it based on your case history. If you are not in agreement, you should take a second opinion.
Q: I am trying my first IVF treatment and am very scared of IVF failure. Is blastocyst a better option?
A: The success rate with blastocyst is better. You should consult with your doctor and decide based on their advice.