Dr P - 2 Qs re: ICSI and which day to biopsy

[RedCanoe]

Hi Dr. P,

I've contacted Lori and Tanya at your clinic about cycling with you early next year. But in the meantime, I have 2 questions:

1. Lori said that you routinely do ICSI for PGD patients to maximize the number of embryos. If DH's sperm analysis comes back normal, is it possible to choose to opt out of ICSI? My concern is that there is still so much we don't know about the long term risks of all these procedures and I'd prefer to do only what is strictly necessary (of course I may change my mind if I end up with a no transfer, sigh).

2. I'm reading a lot on these boards about biopsy done on day 3 vs day 5 and the benefits/risks of each. Do you offer both? What do you recommend for someone like me (first time IVF, 34 years, 3 kids) or would you need more info (pretesting, etc) to be able to make a recommendation?

Thanks!

[Dr. Potter]

Hi Dr. P,

I've contacted Lori and Tanya at your clinic about cycling with you early next year. But in the meantime, I have 2 questions:

1. Lori said that you routinely do ICSI for PGD patients to maximize the number of embryos. If DH's sperm analysis comes back normal, is it possible to choose to opt out of ICSI? My concern is that there is still so much we don't know about the long term risks of all these procedures and I'd prefer to do only what is strictly necessary (of course I may change my mind if I end up with a no transfer, sigh).

2. I'm reading a lot on these boards about biopsy done on day 3 vs day 5 and the benefits/risks of each. Do you offer both? What do you recommend for someone like me (first time IVF, 34 years, 3 kids) or would you need more info (pretesting, etc) to be able to make a recommendation?

Thanks!We routinely do ICSI because of DNA contamination that occurs when we do not. This results in fewer embryos with results. Regarding day 3 versus day 5, I will post my recently accepted abstract that details our initial experience with day 3 transfer. The results are very compelling for day 3. We do day 5 in certain circumstances and can certainly do this in your case if you like but there is no advantage using our technology. Other techniques, particularly aCGH and WGA or sequencing not using parental information, do not give accurate results on day three and so are really only suitable for day 5 use. For example, a recent paper by Scott et al had only a 35% pregnancy rate with day 3 biopsy using their technology. This contrasts to our experience (65% in all comers all ages transferring just one day 3 biopsied embryo). Our results on day three are superior to the results with these other techniques on day 5 at this time looking at both pregnancies per cycle initiated and pregnancy per transfer. There are fewer transfers with day 5. The advantage to day 5 would be that there would be less mosaicism. One must keep in mind that the majority of mosaics are mosaic for two abnormal lines and are not suitable for transfer. So the day 3 test is accurately identifying the embryo as one that should not be transferred despite mosaicism being present. We are also developing a rapid turnaround protocol for GSN (Natera) that will allow us to perform day 5 biopsies with a fresh transfer. This will be available in Newport Beach in the first half of 2012. At that time we will be able assess the utility of day 5 transfer when using GSN (Natera) Parental Support technology.