Seven-day Blastocyst Question

Anonymous
I heard seven-day embryos have lower pregnancy rates and live birth rates. However, if one successfully gets pregnant with a 7-day blastocyst and delivers a baby, is the baby more likely to have developmental delay or smaller stature than babies conceived from 5-day or 6-day embryos?
Anonymous
Didn't know they let embryos go to day-7.
Anonymous
Our embryologist told us you can't go past six and really should not go past five.
Anonymous
Shady Grove freezes five, six, and seven day embryos.

From what I read, some research showed seven day embryos had less success rate. Others showed similar success rate compared to five and six day embryos. Most research showed similar success rate between five and six day embryos.

A lot of clinics don't freeze seven-day embryos. But I'm surprised if they don't freeze six-day embryos.

Anonymous
http://www.ncbi.nlm.nih.gov/pubmed/16935284

Clinical PRs were similar between blastocysts cryopreserved on day 5 and blastocysts cryopreserved on day 6 (32% vs. 28%). The clinical PR was lower for blastocysts cryopreserved on day 7 (15%), but this difference was not statistically significant after accounting for the number of embryos per transfer (P=.15).
CONCLUSION(S):
Viability and implantation potential are similar for day 5 and day 6 blastocyst cryopreservation. Viability may be reduced for blastocysts cryopreserved on day 7, but not to the extent suggested by reports of fresh transfers. These results suggest that reduced success rates associated with fresh transfers of later developing blastocysts may be the result of asynchrony with endometrial receptivity instead of poorer embryo quality.
Anonymous
I have a blast frozen on Day 7 and would love to know the answer to OP's question. OP, I'm not sure prior posters understand what you are asking.

Here's my totally unproven, unscientific theory, which is making me a bit nervous about transferring my day 7 blast: By the time a super-slow growing embryo (meaning one that makes blast on day 7) is ready to implant in a natural cycle, hormonal changes might have already caused the lining to deteriorate. Thus, when natural selection is left to do its thing, very few day 7 blasts would turn into babies due to a lack of synchrony between the timing of implantation and endometrial receptivity. A frozen transfer in which a day 7 blast is transferred on day 5 can overcome this asynchrony, but what does that mean for post-natal outcomes? Do slow-growing embryos turn into kids with sub-optimal health or intellectual capacity? Is it good to mess with natural selection in this way?

I doubt anyone has researched this. In fact, I've never seen any research that attempted to associate in vitro development rate (reflected in when the embryo made blast) with pediatric health outcomes (incidence of birth defects and genetic and metabolic problems). I do recall reading a study once that found a correlation between in vitro development rate and gender. Males are disproportionately represented in blasts that develop most quickly, i.e. blasts graded 4 or 5 on day 5. But no one has ever suggested that gender separates day 5 blasts from day 6 blasts, or day 6 from day 7.

I do recall my RE once saying that poor quality blasts don't make poor quality babies, they make no babies. Also, mitochondria inherited solely from the mother must power division of an embryo until implantation is complete; that's partly why the eggs of older women don't implant as often (mitochondrial energy in the eggs diminishes with age). So maybe once the embryo is fully implanted, the sub-optimal mitochondrial energy that made for slow in vitro growth becomes a non-factor, such that day 7 embryos turn into kids that are no less healthy than kids born of day 5 embryos.

P.S., I have no science background--just curiosity--so this is all pure conjecture. Would love to know if anyone has every studied this.
Anonymous
PP, thank you. I had quite a few blastocysts on Day Five. The doc told me on day 5 when he was doing the fresh transfer that all of my blasts were of the highest grade and he asked me how many I wanted to transfer. I elected to have only one transfered. But apparently if I chose to transfer two, they'd do that on day five. I later learned none of the blasts that I chose to freeze were frozen on day 5. The majority were frozen on day 6. The rest were frozen on day 7. What I don't understand is why the blasts were frozen on day 6 and 7 if they were all of the highest grade on day five as I was told.

Anonymous
"I do recall my RE once saying that poor quality blasts don't make poor quality babies, they make no babies."

SOOoooooo not true. The whole grading thing is BS. My friends who tested, without exception, their normal blasts were NOT the best-looking ones. And more than once, they were the poor-looking ones.

I wish clinics would admit that you really can't tell by looking, and would freeze more blasts. I think it's a crime to throw away the embryos of especially an older woman--you never know by looking at them which would have been the one to take. Then again, for most older women, their embryos get transferred fresh anyway.

One reason I went to GW was because they freeze everything that is still alive--so every one of my mature eggs had a chance to be transferred, and grow inside me where it's meant to. I don't believe that the lab is the right test--and certainly no lab technician can predict viability with any accuracy. Both the labs with which I discussed genetic testing, Blastogen and Natera, confirmed this--the beauty contest at the lab means nothing.
Anonymous
Capsule:
Embryos cryopreserved after reaching blastocyst stage on day 7 were compared to those cryopreserved on days 5 and 6. Day 7 blastocysts have lower but clinically important pregnancy rates.

Authors:
George Kovalevsky, M.D., Stacy M. Carney, B.A., Linda S. Morrison, M.B.A., Caitlin F. Boylan, B.S., Adrienne B. Neithardt, M.D., Ronald F. Feinberg, M.D., Ph.D.
Volume 100, Issue 4, Pages 1008-1012, October 2013

Abstract:
Objective:
To compare pregnancy rates (PRs) using blastocysts cryopreserved on day 7 with those cryopreserved ondays 5 and 6.

Design:
Retrospective observational cohort study.

Setting:
Infertility center performing IVF.

Patient(s):
Eight hundred women with infertility undergoing frozen ET.

Intervention(s):
Blastocysts cryopreserved on days 5, 6, and 7 after retrieval were thawed and transferred.

Main Outcome Measure(s):
Ongoing PRs (pregnancy developing appropriately into the second trimester). Thaw survival, implantation rates, and clinical PRs were also calculated.

Result(s):
A total of 1,406 embryos were thawed with a survival of 90.7% for day 5, 83.7% for day 6, and 78.7% for day 7. Implantation rates were 43.3%, 28.9%, and 28.9%, respectively. Ongoing PRs were 43.9%, 32.9%, and 26.7%, respectively.

Conclusion(s):
Blastocysts cryopreserved on day 7 have a lower, but clinically important potential. Embryos that do not achieve blastocyst stage on day 6 should not be universally discarded, but should be observed in culture 1 more day as 27% may result in an ongoing pregnancy.
Anonymous
I had embryos frozen on day-5 and day-6. My RE told me they will preserve only for day-6 and will not go beyond that. This was not at Shady Grove.
Anonymous
I was at SG and had some frozen on day 6 and 7. Dr Widra emphasized that he felt there was no need to worry about them being frozen on day 7 versus 5 (they weren't blasts yet at 5 days). But that does seem to contradict the studies that PPs have found.... I guess we won't know until we try for the FET!
Anonymous
I have a day-7 embryo frozen at CCRM. It tested genetically normal. The doctor said he would estimate the chances of success with that embryo at 20%, vs. 50% for a day five genetically normal embryo and 35% for a day 6 genetically normal embryo. These rates are informed by the fact that I was 40 and 41 when I went through IVF. A day 7 embryo from a younger woman would probably have a higher success rate.

I understand your concern, OP. I too am concerned that the day 7 embryos might have a higher chance of turning into a child with genetic issues or developmental delay. I don't think there is any data right now that addresses this.
Anonymous
I too am concerned that the day 7 embryos might have a higher chance of turning into a child with genetic issues or developmental delay. I don't think there is any data right now that addresses this.


If you already know your embryo is chromosomal normal than I wouldn't worry about genetic or development delays. I believe the concern is that the growth media really only supports embryos until about day 5-6 and then they really require the nutrients/environments of the uterus to maintain growth. At day 7 you have pushed the limits of the growth media to support the embryo and they may become weaker and not survive the thaw/transfer. If the embryo survives this process then it is one strong embryo and I would assume produce a perfectly healthy baby. Not that long ago they couldn't even get an embryo to day 5 in culture so they have come a long ways in culturing embryos.
Anonymous
thank you its all very helpful
we are waiting to see if our early blast become blast tommorow on day 7
Anonymous
I had a 7 day blast who is now in second grade and of my three kids she is the brightest and has an incredibly appealing spark about her. Everyone loves her and life is just magically easy for her. Her brother and sister are also great kids-smart, funny, etc--but the 7 day blast kid has that special something. I love them equally but I watch the world around us just adore her.
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