Blastocyst culture

At Nurture Fertility we offer embryo transfer 6 days a week. Embryos are usually transferred anytime between day 2 and day 5. Blastocyst transfer is a selection tool which helps us to identify the strongest embryo/s for transfer and is a good technique to use where more good quality embryos have developed by day 3 than are needed for transfer.

What is Blastocyst?

This is an embryo which has been progressed from the cleavage stage and has got a fluid filled cavity and consists of two distinct cell types.

Cleavage Stage embryo

Day 2/3 of development- consists of 2-8 cells.

Blastocyst stage embryo

Day 5 of development – consists of more than 100 cells.

Who may benefit from Blastocyst culture?

  • Patients who meet the criteria for single embryo transfer
  • Patients who are restricted to single embryo transfer due to their funding
  • Patients who have had previous failed attempts at IVF/ICSI
  • Most patients do qualify for blastocyst culture.

Please note, as only 40% of embryos reach the Blastocyst stage therefore, blastocyst culture is only recommended to patients with at least 3 or 4 embryos.

Potential Advantages of Blastocyst Culture

  • Improved selection for embryo transfer
  • Increased chance of filtering out abnormal embryos
  • Better synchronisation of embryo stage with the female tract.

EmbryoGlue™

Hyaluranon is a naturally occurring substance present in follicles, tubes and cavity of the womb. Its effect is to make the fluid in these areas more viscous (sticky) and to encourage implantation of embryos.

Endometrial Scratch

At Nurture Fertility we offer a procedure called an ‘Endometrial Scratch’. Recent studies have suggested that the endometrial scratch may improve implantation rates in patients who have had multiple failed IVF cycles despite good quality embryos. Embryo implantation into the womb may fail due to poor embryo quality or abnormal embryo genetics. It can also often fail due to poor ‘endometrial receptivity’. This is where the lining of the womb is not favourable for the embryo to implant.

 

What is an endometrial scratch procedure?

The endometrial scratch is a straightforward out-patient procedure which is relatively painless (similar to a cervical smear test). The procedure involves “scratching” the endometrial lining of the womb with a very small catheter (plastic tube) prior to an attempt to get pregnant.

 

How does the procedure help with implantation?

The procedure is thought to increase the immune system cells and therefore the growth factors at the site of the endometrial scratch. This is believed to make the womb lining more receptive to embryo implantation. Studies have suggested that implantation rates may be twice as high in patients who have an endometrial scratch before attempting to get pregnant.

When should an endometrial scratch be done?

It is recommended that the endometrial scratch is performed in the cycle before you start stimulation medication. Ideally the procedure should be done between days 19 and 25 of your menstrual cycle.

What if I want to try to conceive naturally?

The scratch can be performed in the same cycle as one in which you are trying to conceive naturally.

What are the risks associated with the procedure?

The risk of a miscarriage if you get pregnant after the procedure is no more than 1%. Given the increased chance of getting pregnant, the benefits of the procedure outweigh any risks.

How is the procedure performed?

You will attend the clinic with a semi-full bladder (drink 300ml of water 1 hour prior to the procedure, and do not empty your bladder during this time). First the Doctor will perform an internal ultrasound scan to assess the shape and position of the womb. A very small catheter will then be inserted through the cervix into the womb. This catheter will be used to scratch 4 areas on the womb lining. You may experience slight discomfort as the catheter is being passed into the womb.

What should I expect after the procedure?

After the procedure, a small amount of vaginal spotting or bleeding is not unusual. You can commence an IVF cycle as normal the following month or try a natural cycle in the same month.

Premium Semen Analysis

This package involves detailed diagnostic testing to identify any issues with the sperm prior to treatment, including:

  • Full Diagnostic Analysis – assessment of the number of sperm (count), how well they swim (motility), and what percentage have a normal shape (morphology).
  • Sperm DNA Fragmentation Test – assessment of the level of DNA fragmentation. High levels of ‘fragmentation’ are associated with lower fertilisation rates, poor quality embryos and miscarriage.
  • Sperm Aneuploidy Screen – assessment of the percentage of chromosomally normal sperm. Chromosomal abnormalities or ‘aneuploidies’ increase the risk of miscarriage; PGS or donor sperm may help in such cases.
  • HBA Test – The ‘hyaluronic binding assay’ looks at the maturity of the sperm and identifies whether pICSI is required.

Time Lapse Monitoring

Time lapse monitoring provides 24/7 monitoring of your embryos whilst they are in culture. Photos of the embryos are taken every few minutes and these are then linked together to create a video sequence’s showing how your embryos have developed. This provides us with much more detailed information about your embryos than can be gained using standard monitoring. The information can be analysed using specialised computer algorithms which helps the embryology team choose which embryos have the highest potential to implant and therefore result in a pregnancy.

Time lapse is particularly useful for patients who have had previous unsuccessful attempts at IVF  or experienced one or more miscarriages. It is also useful for those who have had or expected to have, any compromise in the quality of their embryos, which will reduce their chance to implant.

If you would you like to find out more about time-lapse monitoring, please ask to speak to a member of the embryology team.

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Tuesday 21 November

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