5 day biopsy vs. 3 day biopsy and fresh vs. frozen

[pinksapphire]

Just wondering your thoughts on 5 day biopsy. I tried 4 times w/ a 3 day biopsy and think that if we do IVF/PGD again, that I should try something different, i.e. 5 day biopsy.

Also, I read about doing day 6 ET vs. freezing the day 5 biopsied embryos and doing a FET the following cycle. Again, thinking I should try something different. What are the benefits of freezing? What are the cons?

THanks!

[lindi]

Well, there are no benefits to the embryo in freezing, but depending on your circumstances there could be great benefits for you. If your body responds to the IVF meds in certain ways- high estrogen for example, or if you're over 35, my RE said that those women do better when their body has a chance to reset itself with a fresh cycle where your hormones and linign are the only thing being monitored, so you are in much better shape for a pregnancy.
I think a day 5 biopsy is also better for the embryo, but its my understanding that this is a different biopsy technique than the day 3, and so your lab needs to have lots of skill and practice with this type of biopsy, even if it is safer on the embryo.

[lindi]

oops! just saw this was for Dr Potter... sorry all this info came from my RE...? Sorry Dr Potter!

[Dr. Potter]

Just wondering your thoughts on 5 day biopsy. I tried 4 times w/ a 3 day biopsy and think that if we do IVF/PGD again, that I should try something different, i.e. 5 day biopsy.

Also, I read about doing day 6 ET vs. freezing the day 5 biopsied embryos and doing a FET the following cycle. Again, thinking I should try something different. What are the benefits of freezing? What are the cons?

THanks!

The only potential benefit to freezing is to have a completely optimal lining. With a frozen cycle you are able to completely control to amount and duration of exposure of both estrogen and progesterone. Day 5 biopsy has the potential benefit of avoiding mosaicism seen with day three biopsy. We are doing quite a bit of day 5 biopsy and have not seen this to be a huge benefit using GSN 24 chromosome. Additionally, for a day 5 (or day 6) biopsy to occur, the embryo must reach the expanded blast phase. We have had many documented pregnancies from embryos that have only reached the compacted stage (as have all centers). If we were doing day 3 biopsy, these compacted embryos could be considered for transfer. If we were doing day 5 or 6 biopsy, they would not have made it to the biopsy. Also, the day 5 biopsy is very simple. We found the learning curve for this technique to be quite short compared with both day 3 and polar body biopsies. I hope that this helps.

[jils04]

Dr P, couldn't the lab wait till the compacted embryo makes it to blast for biopsy a few days later, or do these embryos never make it to blast but have the potential to be a baby as a morula ?

[pinksapphire]

Thanks so much for the info!

I have transferred 4 compacted morulas (one cycle I transferred 2 and two other cycles I transferred 1 only) so in my non-medical opinion, I feel that i should try a day 5 biopsy as transferring compacted morulas on day 5 have not worked for me.

What is your medical opinion on that?

I've always been told my lining is excellent but again, day 3 biopsies and day 5 fresh transfers haven't worked for me 4 times. If I were your patient, would you want to try a day 5 biopsy and FET with me given my history?

Thanks for your help!