It's easy to describe some assisted reproductive technologies with glowing superlatives -- "miraculous" treatments with "the best" outcomes. After all, much of the science involved in reproductive medicine is nothing short of amazing and getting more so every year. Still, the educated patient knows that usable science doesn't pop out of nowhere like a rabbit out of a magician's hat. The technology that we use every day in our work results from the accumulation of many pieces of meticulously gathered information. Reproductive research aims at taking minute details and combining them to form one big picture: successful conception, pregnancy, and healthy babies.

Cavitation is an event that should occur in a developing embryo around the 4th or 5th day following egg retrieval. It refers to the formation of what is called the blastocoelic cavity, which will later go on to become the primary yolk sac after the embryo has implanted in the mother's uterus.

Patients undergoing IVF may read that different clinics transfer their embryos back to the uterus on different days. Here at HIC, we use what is called Extended Embryo Culture (EEC). More than half of HIC's embryo transfers are performed on Day 5 after retrieval.

Another related puzzle piece is that rates of aneuploidy in IVF embryos increase with the mother's age. Aneuploidy is the situation in which there are either too many or too few chromosomes in a cell, leading to any number of chromosomal-based disorders.

Putting the pieces together

So what does all of this mean to patients considering IVF?

For one thing, it's another flag that waiting to seek treatment is possibly the most self-defeating choice an infertile woman can make. No matter what detail is studied, virtually every component of the getting- pregnant process appears to function better when women are younger than mid-30's.

Additionally, this study points to choices that treatment providers can make to increase the likelihood of successful conception with IVF. For example, clinicians who routinely transfer embryos at Day 3 for reasons of efficiency may find that their patients benefit from waiting another two days. Assuming an IVF patient has a good number of healthy looking embryos, waiting until Day 5 to see how well they continue developing may result in a higher percentage of healthy pregnancies per number of embryos transferred (ET). At HIC, our policy is to perform Day 5 ET so long as a patient has at least four embryos with no more than 20 percent fragmentation on Day 2.

Narrowing down the mystery

Our patients are educated and curious to learn more. As always, I hope that you will bring your questions in for consultation. My staff and I are happy to explain how unfolding science relates to your personal infertility situation.

Sincerely,

Sonja B. Kristiansen, MD