IVF-Blastocyst Culture 


Blastocyst culture is the most advanced infertility treatment which involves in vitro fertilization and embryo culture for 5 to 6 days until it reaches the blastocyst stage – a final stage of embryo that is ready to implant in to the uterine wall and becomes pregnancy. Transferred into the uterine cavity after they have been diagnosed for any chromosome abnormalities to ensure of having normal chromosome babies before implanting them into the uterus.

What is Blastocyst ?

A blastocyst is an embryo that has developed for 5 to 6 days after fertilization. At this point the embryo has two different cell types and a central cavity. It has just started to differentiate. The surface cells, called the trophectoderm, will become the placenta, and the inner cells, called the inner cell mass, will become the fetus. A healthy blastocyst should begin hatching from its outer shell, called the zona pellucida by the end of the sixth day. Within about 24 hours after hatching, it should begin to implant into the lining of the mother's uterus.
 


The ultimate goal of Blastocyst culture and transfer is to provide high quality embryos which are capable of continued normal development, ready to implant and result in live births.

Blastocyst culture and transfer is the most advance in the ART technique. Traditionally, IVF technique, embryos have been transferred to the uterus on the second or third day of development after in vitro fertilization and initial embryonic cell division. This day of embryo transfer has been a compromise between maximizing the degree of embryo selection available through longer culture in the IVF Lab versus minimizing the exposure of the embryos to culture media which, in the past, could only sustain growth for 2-3 days.

There are some advantages to culturing the embryos to the blastocyst stage of development prior to transfer.

  • The growing embryo must get over several hurdles before reaching the blastocyst stage. After five days of growth, the cells of the embryo should have divided many times over, and have begun to differentiate by function. The embryos that survive to this stage of development are usually strong, healthy. Two important factors had limited the number of embryos that will survive to this stage. First, the inherent "health" of any embryo will dictate its ability to continue to grow and divide. Several eggs may have initially fertilized, but only a few will progress to the 4-cell stage, fewer still to the 8-cell stage, and even fewer will develop into Blastocyst. These arrested and / or fragmented embryos do not have the developmental potential to become babies, so it is better to identify these embryos prior to transfer. By allowing the all embryos to grow in the laboratory for five days, they will sort themselves out.
  • The ability to grow embryos for five days to the blastocyst stage of development in the laboratory, rather than the previous traditional three days, allows clinicians to determine with greater certainty which embryos are really the "best" in terms of their potential for implantation.
  • By transferring only Blastocyst with high developmental potential, fewer embryos may be transferred to achieve the high chance of pregnancy. This means fewer multiple gestations (twins, triplets, etc.).
  • Another advantage is that the blastocyst stage of development is the appropriate time to transfer embryos back into the uterus since the developing embryos usually spend their first 4-5 days of life in the fallopian tubes, not the uterus. Thus the environment for the embryos is appropriate.
  • But blastocyst culture and transfer technique also has a down side; it may be that none of the embryos develop to the blastocyst stage. In that case there will be no embryo transfer. Although that would be a very sad story, but anyway it is better than the high anxiety waits for the first pregnancy test.

Is Blastocyst culture and transfer for everyone?

The indications for a blastocyst transfer are:

(1) Young or old patient who has approximate 10 eggs per stimulation will have good prognosis.
(2) Patients with one or more failed many treatment cycles, since this would answer the question of whether or not those persons’ embryos are capable of growing to the blastocyst stage.
(3) Unexplained infertility.
(4) Patients who do not want to run the risk of multiple gestations.
(5) Patients who have fewer oocytes retrieved, fewer fertilized or fewer dividing embryos by day three in culture have little advantage using blastocyst culture, since little is to be gained in further embryo "self selection".

Program Summary for Patients Undergoing Blastocyst Culture and Embryo Transfer

Blastocyst culture and related procedures require the following steps:

  1. Patient selection
  2. Pre-cycle evaluation
  3. Ovulation induction and monitoring
  4. Egg retrieval
  5. Sperm Processing
  6. In-vitro fertilization
  7. Embryo transfer
  8. Post transfer management

 

1. Patient Selection:

A complete evaluation of fertility factors (These are egg, sperm and uterine cavity) is important prior to considering Blastocyst culture and transfer technique. The following conditions can be successfully treated with Blastocyst culture and transfer technique.

  • Tubal Disease Patients with tubal blockage or severe pelvic adhesions, or who have not conceived after tubal surgery are good candidates for Blastocyst culture technique.
  • Moderate to Severe Male Factor The ability to treat sperm in the lab by various techniques, along with the ability to concentrate large numbers of motile sperm around eggs makes Blastocyst culture and transfer technique a potential treatment for couples whose infertility is due to poor semen quality.
  • Endometriosis As endometriosis often results in pelvic anatomy distortion and adhesion, the Blastocyst culture and transfer technique procedure allows the egg and sperm to meet and fertilize in an environment free of endometriosis and be transferred directly into the uterus.
  • Immunologic Infertility Blastocyst culture and transfer technique allows fertilization outside the body, away from the destructive actions of anti-sperm antibodies.
  • Unexplained infertility that has not responded to other types of therapy Blastocyst culture and transfer has successfully treated such couples. Blastocyst culture and transfer can demonstrate the ability of the sperm to fertilize eggs become to growing embryos and grow to the final stage "the Blastocyst". Rarely, unexplained infertility may be due to defects in gamete function.

2. Pre-Cycle Evaluation:

To achieve good success rate, it need to meticulous evaluation of three factors (egg, sperm and uterine cavity) that contribute to a favorable outcome with blastocyst culture and transfer.

  • The first of these is the woman's ability to respond to fertility drugs. While age affects this parameter, measurements of FSH and Estradiol help us estimate a woman's ability to produce extra eggs in response to fertility drugs. In general, women with high FSH levels and/or early high estradiol are more resistant to ovarian stimulation.
  • The second factor to evaluate is the uterine environment. It is recommended that the woman undergoes a one-time office hysteroscopy prior to beginning a Blastocyst culture and transfer procedure. The hysteroscopy allow us to look inside the uterine cavity and make sure there are no fibroids, polyps, or scar tissue that could interfere with implantation. If the woman has had a recent hysterosalpingogram (HSG), and the uterine cavity appears normal, the hysteroscopy can be waived. Besides, the uterine lining is evaluated prior to ovulation using a sonogram. Certain patterns of uterine lining development especially when the lining is thin are associated with poor pregnancy rates. These sub-optimal patterns can sometimes be improved with estradiol supplementation.
  • The third factor is the male factor. This requires a semen analysis. In addition, sperm antibodies are measured in both partners. High levels of sperm antibodies can interfere with fertilization in the laboratory, and special techniques are employed to correct this problem.

Couples undergoing Blastocyst culture and transfer are screened for syphilis, hepatitis and HIV. Patients who have major medical, surgical, or psychological problems are required to be treated before the starting cycle.
In addition to the above medical evaluation, couples contemplating Blastocyst culture and transfer are informed of the availability of a counselor. The licensed counselors are familiar with the emotional impact of infertility and infertility treatments, and can help the couple deal with this important aspect of their care.



 
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