To blast or not to blastTo blast or not to blast

Blastocyst culture and Blastocyst culture and transfertransfer

Minh N. Ho, M.D., Minh N. Ho, M.D., F.A.C.O.G.F.A.C.O.G.

XPERT FERTILITY CAREXPERT FERTILITY CAREOf CaliforniaOf California

www.ivfdoc.comwww.ivfdoc.com

Board Certified in Reproductive Endocrinology

OutlineOutline

► OverviewOverview► Why blastocysts ?Why blastocysts ?► How ?How ?► Plus and minusPlus and minus

BlastocystBlastocyst DevelopmentDevelopment

Blastocyst DevelopmentBlastocyst Development

Ovulation InductionOvulation Induction

►2 cell theory2 cell theory►Agonist or antagonistAgonist or antagonist►Flare or not flareFlare or not flare►Patient selectionPatient selection►Embryo transferEmbryo transfer►Luteal supportLuteal support

Criteria for blastocyst c&tCriteria for blastocyst c&t

►Number of embryoesNumber of embryoes►Quality of embryoesQuality of embryoes►Age FactorAge Factor►Uterine FactorsUterine Factors►Reproductive historyReproductive history

Blastocyst CultureBlastocyst Culture

► Co-cultureCo-culture► Blastocyst mediaBlastocyst media

Plus and MinusPlus and Minus

► Reduce multigestationReduce multigestation► Increase implatationIncrease implatation► Not for everyoneNot for everyone► Issue with Issue with

cryopreservationcryopreservation

Ecetera…Ecetera…

►Spontaneous monozygotic twinsSpontaneous monozygotic twins►Sex ratioSex ratio► ICSI ‘ed blastocystsICSI ‘ed blastocysts►2- step ET2- step ET►Day 5 or day 6?Day 5 or day 6?

What’s nextWhat’s next