in vitro fertilisation (ivf)

Role of Blastocyst Transfer in IVF Treatment - Advantages and Success Rates

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Medically Reviewed by Dr. Deepika Tiwari - MBBS on 10 Dec 2018 - Written by Dr. Ragini Agrawal - MBBS - Grammatically Approved by Dr. Kavita Jaggi Agrawal - MBBS

Blastocyst transfer is a medical procedure performed under IVF treatment. The blastocyst transfer success rates vary from 35% to 50%. The advantages of blastocyst transfer include better selection of embryos for implantation, higher implantation rate in the uterus, and aids in genetic screening.

A blastocyst is a human embryo that is five or six days old. Usually day-3 embryos were routinely transferred into the womb during IVF treatment. Most clinicians believe that transferring better developed embryos or those that have reached the blastocyst stage is more likely to increase pregnancy.

Transfer of an embryo at the blastocyst stage is very common in the practice of assisted reproduction. It has been associated with higher implantation rates. Blastocyst formation begins about five days after fertilization, when a fluid-filled cavity opens up in the morula (a ball of cells). The blastocyst has a diameter of about 0.1 to 0.2 mm and comprises around 200 to 300 cells following rapid cleavage (cell division). About 1 day after blastocyst formation (5–6 days post-fertilization) at this point the blastocyst usually reaches the uterus and then begins to embed into the endometrium of the uterine wall where it will undergo further developmental processes, including gastrulation (early phase in the embryo development). Implantation of the blastocyst into the endometrium requires that it hatches from the zona pellucida, which prevents attachment to the oviduct as the pre-embryo makes its way to the uterus. The blastocyst is completely embedded in the endometrium only for eleven to twelve days after fertilization.

The use of blastocysts in IVF involves culturing a fertilized egg for five days before implanting it into the uterus. It can be a more useful method of fertility treatment than traditional IVF. The inner cell mass of blastocysts is an important source of the embryonic stem cell.

Cases when Blastocyst Transfer is Required

Blastocyst Transfer can be a good option for:

  • Those who have a uterine issue, blastocyst transfer may be a particularly useful option.
  • In general, blastocyst transfer is more advantageous for patients who develop a large number of oocytes and embryos. 
  • Patients with an adequate ovarian response who failed to conceive in at least three IVF/ET cycles
  • Genetic disorders
  • Patients with advanced maternal age
  • Other candidates for blastocyst transfer include those who would not consider fetal reduction or those in whom delivering multiple pregnancies would be particularly unsafe.

Blastocyst transfer is probably not useful for patients who develop only a few oocytes or embryos unless they wish to utilize extended culture to the blastocyst stage as a diagnostic indicator of embryo quality.

Stages of Development

Immediately after fertilization, an egg starts to divide and develop into an embryo. The stages of development are as follows:

  • the pronuclear stage on the first day (fertilized egg)
  • the two to four-cell stage on the second day
  • the eight-cell stage on the third day
  • the morula stage on the fourth day and
  • the blastocyst stage on the fifth day

blastocyst stage

A doctor usually inserts one or more embryos in a woman’s uterus after two to three days of egg retrieval. This process is called embryo transfer. The embryos can also develop in an incubator up to the fifth day that is called the blastocyst stage. It is known as blastocyst transfer if the doctor transfers such developed embryos into the woman’s uterus

Significance of Blastocyst Transfer

In a traditional non-blastocyst IVF (In Vitro Fertilization) cycle, a woman's eggs are retrieved and fertilized. If everything goes well, the resulting embryos are transferred into the uterus after three days. It is very difficult to predict which day embryos will become an ongoing pregnancy, therefore three or more embryos are transferred in hope that at least one will implant and result in a live birth.

blastocyst transfer

However, blastocyst transfer involves fewer embryos. Some centers have reported achieving even better pregnancy rates with blastocysts. Implantation rates of 48 to 50 percent and pregnancy rates of up to 66.3 percent have been reported in patients who responded well to gonadotrophins and received transferred blastocysts. Blastocyst implantation through IVF is a safe and painless procedure. Under this method, a catheter is inserted into the vagina. It is guided through the cervix via ultrasound and into the uterus where the blastocysts are inserted into the womb.

Advantages of Transferring a Blastocyst

Transferring a blastocyst has the following advantages:

  • It makes a better selection of embryos possible. Embryos which reach this stage offer a better implantation capacity because they have overcome possible development hurdles which are frequently produced in the early stages. It is for this reason that transfers are limited to 1 blastocyst or a maximum of 2, reducing the risk of multiple births.
  • It allows a more physiological synchronization between the responsiveness of the endometrium and the embryonic phase.
  • Blastocyst facilitates the correct supervision of embryo development 
  • The transfer of only the selected embryos helps in reaching an optimum state of development, which in turn allows for a higher implantation rate.
  • Blastocysts can also be used for genetic screening.

One of the drawbacks of blastocyst transfer is that there may be fewer or no surplus embryos to freeze. Freezing of embryos for another attempt is often tactically overlooked by IVF patients. The fact is that frozen embryo transfers, particularly those patients who use blastocysts are more successful. If there are two blastocysts, freezing one and transferring the other may be sensible for certain patients.

The Success Rate of Blastocyst Transfer

The chances of conceiving after blastocyst transfer are very high. This method is known to increase the chances of a live birth. The chance of conceiving is more for women over the age of 20 to 25 years as compared to women over the age of 30 years or more. The success rate is between 45 and 50 percent for women between the ages of 29-30 years. The success rate is 35 to 40 percent for women over the age of 39 to 40. Also, women with low egg count and quality may benefit from a day-3 transfer, in which the embryos are inserted in the mother’s uterus at an earlier stage.

Blastocyst and In vitro Fertilization

A recent breakthrough for IVF (In Vitro Fertilization) is the use of blastocysts. A blastocyst is implanted five to six days prior to fertilization. After this, it is much easier to determine which embryos will result in healthy live births. Knowing which embryos will prosper allows just one blastocyst to be implanted. This helps in cutting down dramatically on the health risk and expense of multiple births. It is much easier to give embryos the correct nutrients to sustain them into the blastocyst phase since the nutrient requirements for embryonic and blastocyst development have been determined.

Fertility treatment involves much more than a treatment plan and diagnosis. It involves selecting treatments according to particular health conditions, right timing, correct selections of doctor and many other essential steps. At Elawoman, we can help you on all matters relating to your decision to undergo fertility treatment. Elawoman can inform you about the opportunities and risks of the individual treatment steps and our specialists are there to support you in all your questions about fertility treatment. If you are interested in getting extensive information regarding fertility treatment and the process as a whole, you can follow Elawoman blog. Call us at +917899912611.

Dr. Ragini Agrawal

Written by

Laparoscopic Surgeon, Gynecologic Surgeon
Gurgaon

Dr. Ragini Agrawal is an infertility specialist and laparoscopic surgeon who completed MBBS from the University of Allahabad in the year 1985 and MS in Obstetrics and Gynaecology in 1989. She is a skilled gynaecologist and obstetrician with vast experience in treating women with different health disorders. She is a member of the Federation of Obstetrics and Gynaecological Societies of India (FOGSI) and Association of Gynecologic Oncologists of India. She has an expertise in Dilatation and Curettage (D and C), Tubectomy and Hysterectomy, Intrauterine Insemination, In-Vitro Fertilization (Test Tube Baby). She is an IUI specialist and practices at W Pratiksha Hospital in Gurgaon. You can get the contact details of Dr. Ragini Agrawal at elawoman.com

SOURCES AND REFERENCES:


1.  Most in demand infertility treatments for couples with high success rates  IVF, Elawoman - 2017
2.  What are the steps in embryo transfer procedure in ivf treatment?  ET, Elawoman - 2017
3.  Microscopic anatomy of uterus and functions of uterus in women and pregnancy  uterus, Elawoman - 2017
4.  Steps to check cervical position and cervical mucus  cervix, Elawoman - 2017
5.  Cryopreservation techniques - embryo freezing and egg freezing procedures  Freezing of embryos, Elawoman - 2018

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Prayag Jayakar

Dec. 10, 2018, 5:42 p.m. 4.5

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