My daughter in law has had one failed IVF in March of 2005.The RE had
implanted 3 blastcysts.  shortly thereafter she became pregant without
assistance.  Unfortunatley she miscarried in June. Now it seems she
had 1 oocyte transfer Sept 4, which also failed...what is the medical
reasoning for this...she has had one live birth 3 years ago, no
problems, I guess this is what you call second pregnancy infertility. 
She is also a materal aged woman 39.  Just looking for some answers to
this second procedure....

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Request for Question Clarification by tutuzdad-ga on 23 Sep 2005 17:27 PDT

About nine years ago my wife and I were trying to have a baby and had
difficulty. In time we succeed but she subsequently had two
miscarriages. She was in her mid 30?s at the time and had a child ten
years previously with no problems.

To her credit my wife (a nurse at the time) did her own research and
eventually found a physician who was open to trying her own plan of
therapy. With the help of this fantastic doctor my wife began a
regimen of progesterone vaginal suppositories that (as my wife
expected) substantially enhanced the vascular presence the uterine
lining, thereby increasing the blood supply in preparation for
potential implantation of a fertilized egg. Instead of shedding this
lining in the form of menstruation and subsequently losing of the
fertilized egg as she did twice before, the oocyte was released from
the ovarian follicle, was successfully fertilized without the aid of
artificial insemination or implantation (i.e. the natural way) and the
rest is seven year-old history. Viola! I am now (and have been for 7
years) Tutu's dad.

I?m not a doctor but would you like to know more about this therapy
(of which I obviously have first hand knowledge) as an answer?

Tutuzdad-ga

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Clarification of Question by cuccina-ga on 24 Sep 2005 04:29 PDT

Thanks for the information and I really think that makes alot of
sense, however the answer to my question has not been answered.  My
daughter in law is using the head RE at Cornell Weill in Manhattan,
Dr. Zev Rosenwaks, and of course being a mother in law you are not
allowed to say anything, this whole infertility thing has been so
painful.  I still would like to know why they switched from the new
method of blastcyst to ooctye transfer.  THe dr that your wife had has
made so much sense, but I think my daughters in laws problem is her
age, and she must have "A few Good Eggs" left, but I will always keep
that response in my head

Hello and thank you for your question.

I should note that Dr. Rosenwaks is a leading authority in IVF and the
Cornell Weill group is one of the world leaders in the field. 
Blastocyst transfer is currently more common than oocyte, but it's
reasonable to assume that he has good reasons for the change in
approach.

As to your question, the oocyte v. blastocyst choice is a choice
between viability (the longer the fertilized egg grows in vitro the
greater risk something will go wrong, which probably explains why Dr.
Rosenwaks tried the earlier implant) and reducing multiple births (the
sooner the fertilized egg is implanted the greater the chance it will
multiply into separate embryos, i.e. twins, triplets, etc.).

Here's what a good survey article (worth reading in its entirety) says
about the choice:
Extended embryo culture
"During the past few years the increasing success rates associated
with IVF have led to an increased interest in reducing the incidence
of multiple-gestation pregnancies. As laboratory techniques have
advanced, extended embryo culture has been adopted by most IVF centers
with embryo transfer occurring now most routinely on the third day
after oocyte retrieval. Commercially available media that permits
embryo development beyond the 8-cell stage has led to some clinics
extending embryo culture to the blastocyst stage (day 5 or 6 after
oocyte collection). The potential benefit of extended culture would be
the reduction of multiple births through improved embryo selection
[90]. However if clinics routinely transfer more than 2 blastocysts,
then the potential benefit of extended embryo culture may not be
realized. Blastocyst transfer may also increase the rate of
monozygotic twinning (including monoamniotic twins) [91,92].
Furthermore, patients whose embryos fail to reach blastocyst in
culture may have conceived with a traditional day 2 or day 3 embryo
transfer [93]. Although blastocyst culture remains promising, the
ideal means by which to integrate blastocyst culture into an IVF
program awaits further refinement [94].
90. Langley MT, Marek DM, Gardner DK, et al.: Extended embryo culture
in human assisted reproduction treatments. Hum Reprod 2001,
16:902-908.
91. Peramo B, Ricciarelli E, Cuadros-Fernandez JM, et al.: Blastocyst
transfer and monozygotic twinning. Fertil Steril 1999, 72:1116-1117.
92. Sheiner E, Har-Vardi I, Potashnik G: The potential association
between blastocyst transfer and monozygotic twinning. Fertil Steril
2001, 75:217-218.
93. Racowsky C, Jackson KV, Cekleniak NA, et al.: The number of
eight-cell embryos is a key determinant for selecting day 3 or day 5
transfer. Fertil Steril 2000, 73:558-564.
94. Gardner DK, Schoolcraft WB, Wagley L, et al.: A prospective
randomized trial of blastocyst culture and transfer in in-vitro
fertilization. Hum Reprod 1998, 13:3434-3440.

Here are links to research related to this issue in which Dr.
Rosenwaks' research is cited.
http://scholar.google.com/scholar?hl=en&lr=&q=fertility+ivf+blastocyst+oocyte+rosenwaks+extended

Search terms used (in scholar.google.com ):
fertility ivf blastocyst oocyte rosenwaks

Thanks again for letting us help.

Google Answers Researcher
Richard-ga

thanks so much for the great answer it really has answered my
question.  Your first response about your wife was also a wonderful
eye opener, I would hope that sometime I might explain that to my
daugher in law, it does make so much sense.....

Thank you for the generous rating and tip!
Google Answers Researcher
Richard-ga