Day 6 Assisted Hatching at SGFC

[Anonymous]

I recently had a day 6 transfer at Shady Grove. The doctor doing the transfer told me we would know later that day how many, if any, embryos survived for freezing. I called a couple times but didn't receive an answer until several days later (none survived).

In the meantime, the financial person called to tell me I owed money for assisted hatching. No one had told me they had done assisted hatching in the first place. The doctor confirmed they had when I spoke with her.

Is this normal?

I'm frustrated as well because when the nurse called to tell me it would be a Day 6 and not Day 5 transfer, she made it sound like it was good news since it meant I had so many great embryos they could afford to wait until the next day. I'm wondering if that's why she didn't tell me they would do assisted hatching-- when I responded saying it was my understanding that Day 6 was reserved for slow growing embryos she immediately told me that was "outside her area of expertise" and that I could talk to the doctor.

I thought I liked Shady Grove. But (and perhaps it's the hormones talking) I am starting to feel mistreated.

[Anonymous]

You actually signed a consent form for IVF that included whether or not you authorize Assisted Hatching on your embryos. At each ER, the doctor doing retreival goes over what is in your records (and consent) with regards to ICSI and Assisted Hatching. If your doctor didn't indicate that you always get AH on your embryos, then the lab has the discretion to do it based on the appearance of your embryos at the time of transfer (i.e. if the zona (or outer shell) of the embryos appears thick) - as long as your consent indicated that they could do AH. If you didn't have AH authorized in your consent, then they couldn't do the procedure. Your nurse would have had no insight into whether or not AH would be done on the embryos. Also, AH would have been marked on the sheet you signed at transfer indicating how many embryos you had and how many were transfered. You might not have noticed it, but it was on there. You will get a copy of the document in the mail sometime in the future - sometimes a couple of months after transfer.

Day 6 transfers are also not reserved for slow growing embryos. I had a day 5 transfer at SG with one blast and 2 morulas, which were definitely slow growing. If you had a large number of embryos that were similar in appearance/quality, then they would let them grow out another day to see if they could get an indication of which ones were the best. And, SG has high quality standards for freezing embryos, so your remaining embryos likely did not meet freeze criteria.

[Anonymous]

Thanks for the explanation, which is helpful. Yes, we definitely signed the form -- if it was necessary we wanted them to do assisted hatching, and are very glad they did! I was just surprised that they didn't tell us explicitly from a medical perspective that had occured. You are right I probably didn't examine the form carefully the day of the transfer. Getting a call from a financial person for a procedure I wasn't aware of was surprising nevertheless.

None of the embroys had made it to blastocysts as of Day 5, unfortunately. So I think in our case they were slow growing.

Thanks again

[Anonymous]

PP here. I do understand your surprise at getting the call from a financial person. I have a standing order for AH, so I know it is going to happen and pay for it upfront in my cycle. My RE normally does my transfers (I am a Rockville patient) and also indicates they are going to do the AH before the embryos come back in the catheter. Maybe the doc doing your transfer forgot to mention it for whatever reason. It stinks that they didn't tell, but they also know they are covered by the form. Good luck on this cycle - hope it's a success for you!

[Anonymous]

I have to disagree a little bit about Day 6 transfers. There are good studies showing that day 3 and 5 are the two best days to do transfers to maximize success. So if OP had a blast on Day 5, that should have been transferred while allowing the others to get to blast to access for freezing. So I think OP should get a better explanation about what happened.

[Anonymous]

I understand your frustration and had the same thing happen to me, only the bill came for AH the day I got a BFN, so I was even more upset and frustrated. Sure enough, when I looked at my paperwork, I had consented to AH if needed.

Later, in talking to the RE and getting a game plan for round #2 (which did work, by the way - we did a 3 day transfer that time), the RE said that AH is routinely used on Day 6 embryos. In our case, with that first round, we also did not have blasts at Day 5, whcih is why we were pushed to Day 6.

I hope this cycle works for you! Hang in there!

As an aside, it's always a good thing to scrutinize your bill. With our second cycle, we were charged for AH, even though it was not used. I called and got it straightened out, but only with the intervention of my RE, who confirmed that AH was not done the second cycle, even though the paperwork stated that it had been done.

[Anonymous]

I thought she said that nothing had make it to blast on day 5.

Good luck OP -- I hope teh extra $$$ for AH is worth it and you get a BFP!

[Anonymous]

This is the OP. Thanks for such support. And I am so sorry you received the bill the day you heard you weren't pregnant! What insult to injury! That's great that it worked the second time around though.

That is correct that no embryos made it to blast on Day 5. I think what I'm having trouble reconciling is that I was told they were "top grade" blasts (on Day 6) that were in the "top rating" for inner cell mass and trophectoderm, and they had expanded (I guess now through AH). Do all these go together?

Does the fact that I was on lupron an extra day and later found to be oversuprresed factor into any of thuis?

Basically, this waiting just sucks.

[Anonymous]

Has your doctor called you? My RE (Widra) used to call a couple days after transfer to check in and review how things had gone and how I felt going into the 2WW. if your RE hasn't done this, I'd give him/her a call to check in.

[Anonymous]

I had a similar experience with day 6 transfer, but I was more upset to find out that I was pushed to day 6 because the schedule was too full on my day 5, and I also received the bill for AH the day after my BFN. IF sucks.

[Anonymous]

Wow. Okay, I was upset that I was on Luperon longer than I should have been (and wound up oversuppressed, not that they could have guessed) because they were too full. Wow.

[Anonymous]

Seriously, 16:16, what did you do? If you would have had a greater chance of success on Day Five and they knew that, I would ask for my money back!!!

[Anonymous]

"I think what I'm having trouble reconciling is that I was told they were "top grade" blasts (on Day 6) that were in the "top rating" for inner cell mass and trophectoderm, and they had expanded (I guess now through AH). Do all these go together? "

Yes, but slower growing blasts that don't make it to transfer until Day 6 has a lower degree of success because your uterus is not at the same place to accept them as it is on Day 5. There are some studies out of Japan showing that freezing Day 6 blasts and doing a FET in a subsequent cycle when your body is at the Day 5 timeframe is more successful than transferring on Day 6, but I don't know if any American clinics do that.

[Anonymous]

PP 16:16 here, I changed to another practice.

[Anonymous]

I also had only morulas on day 5 and went to a day 6 transfer.

I was told that at SG they routinely do day 6 transfers partly because unlike smaller practices they do not schedule PM transfers if things are going a bit slow. They are a very large and succesful practice, I trust they know their statistics since their goal is to get us pregnant. I was also told that they always do assisted hatching on day 6 if the embryo has not hatched by itself. I read something about slower embryos running out of energy sometimes to hatch by themselves.

By the way, all practices time your BCPs and lupron with scheduling.

Also, transferring a day later does not mean that implantation will happen a day later. However, if developement is behind (for example, fertilization happened a day later), this could be an issue.

Good luck OP!