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On Afghanistan, a negative shift Afghan president Hamid Karzais visit to the White House this week arrives as the publics take on the war there has tilted back to negative, according to a new Washington Post-ABC News poll. A majority says the war in Afghanistan is not worth its costs, marking a return to negative territory after a brief uptick in public support in the wake of the announcement of the administrations new strategy for the conflict. Despite the shift in views on the war, President Obamas ratings for handling the conflict have remained positive since the unveiling of the new strategy - 56 percent approve, 36 percent disapprove. Views on the wars value have be more negative among both Democrats and independents. In the new poll, 56 percent of independents say it is not worth fighting, up from 47 percent in December. Among Democrats, 66 percent say its not worth it, including half who feel that way strongly.

Republicans are solidly behind the U. S. involvement in Afghanistan, with 69 percent saying the war is worth its costs. Q. All in all, considering the costs to the United States versus the benefits to the United States, do you think the war in Afghanistan has been worth fighting, or not Do you feel that way strongly or somewhat 10/18/09 was and has been wording half sampled. Previous was. By Jennifer Agiesta May 9, 2010 4:56 PM ET

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IVF - In Vitro Fertilization is a last resort for many couples. Most couples starting IVF have already been through long months of trying to conceive naturally, failed IUI - Intrauterine Insemination - cycles, multiple tests, a lot of stration and disappointment. When excess embryos created in the process of IVF are not transferred to the uts, they can be frozen for future cycles. As eSET (elective single embryo transfer) bes more prevalent, as is seen in a current worldwide trend to try to prevent birth of multiples as a result of IVF, frozen embryo transfer cycles will increase in popularity. The pregnancy rate following the fresh transfer of a single embryo followed by, if necessary, the transfer of a single thawed embryo is remarkably similar to that of transferring two fresh embryos, while eliminating the risk of twins almostpletely. In a Frozen Embryo Transfer cycle, the uterine lining may be prepared using hormones or the transfer may be performed using a natural cycle. The embryo(s) is/are thawed and transferred to the uts in the same process as in a fresh IVF cycle. It is said that frozen embryos are less successful than fresh embryos, however some women who have been successful with frozen embryos feel that some factors actually make it more likely to succeed: The preparation stage, which is emotionally draining, is much simpler It is easier to control the thickness of the uterine liningThere is no egg retrieval process -- another high-stress point Related Stories: Rachels story - IVF, FET (Frozen Embryo Transfer) Lias story - IVF, Frozen Embryo Transfer to surrogateTHE REALITY OF BLASTOCYST TRANSFERS Mark Perloe, M. D. Michael John Tucker, Ph. D. Introduction The first thing that usuallyes to mind when people hear the term, infertility treatment, is the risk of multiple births.

This worry has been fueled by the recent highly publicized multiple births in Iowa and Texas. While such cases are rare, the incidence of triplets or higher-order births as a result of assisted reproductive technology is of great concern to all infertility practitioners and patients. For countless couples, deciding against treatment may mean abandoning their dream of having a child. But what if there was a way to reduce or even eliminate the risk of multiples Not only would that help more couples be parents, it would also decrease maternal and neonatal risks. That possibility is bing a reality, thanks to a new technique known as blastocyst transfer. With blastocyst transfer, fewer embryos are transferred while maintaining and even increasing pregnancy rates.

This technique virtually eliminates the risk of triplets or greater. The Significance of Blastocyst Transfer In a typical non-blastocyst in vitro fertilization (IVF) cycle, a womans eggs are retrieved and fertilized. If all goes well, the embryos are transferred into the uts three days later. Due to the fact that it is difficult to predict on day three which embryos are more likely to produce a pregnancy, four or more embryos are frequently transferred in hopes that at least one will result in a live birth. Until now, this has been a reasonable approach in order to achieve acceptable pregnancy rates. The downside is that sometimes all the embryos be ongoing pregnancies and the result is high-order multiple gestations (triplets or greater). In such pregnancies, there are considerable medical risks as well as financial and emotional considerations. So the couple is faced with the agonizing decision of whether to opt for selective reduction (the removal of one or more embryos) or to continue with a risky pregnancy.

Although everyone agrees that every possible safeguard should be in place to avoid such unfortunate situations, the distressing reality is that multiple pregnancies sometimes do occur. However, with blastocyst transfer, only two or three embryos are transferred, practically eliminating the possibility of triplets or greater. And the same pregnancy rates are achieved as would be expected when four or more embryos are transferred on day three. Some centers report achieving even better pregnancy rates with blastocysts. Implantation rates of 48-50 and pregnancy rates of up to 66.3 have been reported in patients who responded well to gonadotropins.

What is 1 Blastocyst A blastocyst is a highly developed embryo that has divided many times to a point where it is nearly ready to implant on the walls of the uts. A blastocyst hase a long way from its beginning as a single cell. During maturation, an embryo rests inside a protective shell called a zona pellucida. You can think of this protective shell as being much like a chicken egg. But, unlike chicken eggs, human embryos do not remain inside a shell. Instead, the embryo hatches (breaks out of the shell) on the fifth or sixth day so it can attach to the uterine wall (implantation). Just prior to hatching, an embryo bes a blastocyst. Embryos developing to the critical blastocyst stage have a much greater chance of implanting successfully and resulting in an ongoing pregnancy.

That is because these embryos have passed an important test. During the first few days, the embryo relies on the mothers egg for all its nutrients. However, in order to 15 survive past day three or four, the embryo must activate its own genes. Not all embryos are successful. In fact, only about one-third of the embryos be blastocysts. Yet these embryos are more highly-developed, healthier, and stronger, and have a higher rate of implantation whenpared to day three embryos. Due to the higher probability of survival, we transfer fewer back into the uts. Getting to Day Five For many years, infertility practitioners have known that day three transfers were too early whenpared to what is physiologically normal. In naturally conceived pregnancies, a day three embryo resides in the fallopian tube, not in the uts. The embryo does not even reach the uts until the fifth or sixth day. Yet traditional IVF has always transferred on day three because, up until now, we have not been able to delay the transfer to day five. Previous laboratory culture media could only sustain an embryos growth for three days.

Now we have the ability to develop an embryo to the blastocyst (day five) stage. What has made the difference is the recognition that the nutritional requirements of the embryo change as it develops. That knowledge led to the development of different laboratory culture media for the embryos specific developmental stages. This so-called sequential media attempts to reproduce the natural environment of the maternal reproductive tract. The nutrients are designed to meet the requirements of the rapidly developing embryo and have led to the development of blastocysts with better viability and higher implantation rates.

Redefining Developmental Potential The ability to develop embryos to the blastocyst stage allows clinicians to have greater certainty about which embryos are more likely to implant. Interestingly, no correlation has been found between what is traditionally considered a good embryo on day three and a good blastocyst on day five. Previously, Dr. Tucker reported a significant disparity between the two stages in embryo viability estimates, meaning that even the best embryologists cannot tell which day three embryos have the potential to develop into a blastocyst. While the quality of blastocysts is determined by examining morphology and development, it is important to point out that blastocyst grading standards are currently under development. Although the ability for the embryo to grow into a blastocyst is a milestone, other factors also play a role in its further development. In the near future, we believe we will be able to accurately predict which blastocysts are destined for success. When that happens, single blastocyst transfers will be considered the norm, and IVF will likely be considered the first-line infertility treatment.

Who Does it Help Determining who is a good candidate for blastocyst transfer is another rapidly evolving area. As more information bes available and our knowledge base grows, guidelines based on actual clinical experience will be developed. Until then, we can offer some preliminary observations. In general, blastocyst transfer is more advantageous for patients who develop a number of eggs and embryos. A significant correlation has been reported between the number of eggs and the number of blastocysts developed, as well as the number of day three embryos and the number of blastocysts developed.

Other candidates for blastocyst transfer include those who would not consider fetal reduction or those in whom delivering multiple pregnancies would be of particular concern. Blastocyst transfer is probably not advantageous for patients who develop few eggs or embryos. A side benefit of a blastocyst transfer is the fact that the ability to generate a blastocyst provides important information about the likelihood of pregnancy. In general, pregnancy rates are higher in those whose embryos grow to the blastocyst stage. Conversely, pregnancy rates are lower in those whose embryos do not develop into blastocysts. Maternal Age and Blastocyst Development Does maternal age have any bearing on the production of blastocysts Although some studies have shown advanced maternal age to be a factor in blastocyst production, Schoolcraft found no correlation between percentage of blastocyst formation and increasing maternal age in a population of women who responded well to gonadotropins.

However, implantation rates and pregnancy rates in this study decreased with maternal age, with women over 40 faring the worst. What Happens When Embryos Do Not Be Blastocysts Because only a few embryos develop to the blastocyst stage, it is possible to have no embryos survive to day five to transfer. This is especially e if the cycle begins with only a few fertilized eggs. When no embryos survive to be blastocysts, it is a tremendous disappointment.

The looming question then bes, Would the embryos that did not survive to be blastocysts have implanted if transferred at day three Unfortunately, we simply do not have enough clinical data at this time to answer that question. In our opinion, pregnancy would have been unlikely in that situation. But since that oue is not a certainty, day three transfers may still be a reasonable option for some patients. Gic Testing And Blastocysts Frozen Blastocyst Cycles Blastocysts tend to have a very good survival rate after cryopreservation (freezing). Menezo and his colleagues have reported that the recovery after thawing is equivalent, if not superior to, that of thawing of earlier embryonic stages.

Because blastocysts are superior to earlier stage embryos in terms of development, they are easier to freeze, store, and thaw. Additionally, because blastocysts have higher implantation rates, it is possible for a couple to go through IVF once and have enough blastocysts for the current cycle as well as any future cycles.

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