By H. J. Leese (auth.)

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The Voluntary Licensing Authority (VLA, page 75) also urges clinics not to exceed three, unless there are exceptional clinical reasons when up to four may be replaced. There is a general feeling that the small chance of triplets, if three embryos are replaced, is acceptable, whereas the risk of quads, quins and even higher-order births if many embryos are replaced, is not. There are a number of reasons for this. To begin with, multiple births are usually born prematurely, with increased risks to the mother and to the survival of the babies.

In most clinics, this is done without anaesthesia. The embryos are slowly expelled from the tube, and that is that. The woman rests for a while before going home. She will probably be advised to take things easy for a few days. Pregnancy Testing There are now reliable, sensitive methods to measure the hormone HCG in blood or urine samples. We will recall that HCG is produced by the embryo during early pregnancy and can be detected as early as 8-10 days after conception. It continues to increase for about 5 weeks, reaching a plateau, and then declines by the end of the first trimester.

The blastocyst remains unattached in the uterine lumen until about the sixth day following fertilisation when it begins to implant. development: A. One-cell fertilised: note that in most cases, one of the polar bodies has been lost; B. 2-cell embryos; C. 4-cell embryos; D. 8-cell embryos and early morulae; E. Blastocysts: note the blastocoel cavity, and collection of cells which comprise the inner cell mass; F. Blastocysts which have hatched from the zona pellucida. 12 Development of early human embryos from ovulation to implantation IMPLANTATION Begore it can implant, the blastocyst has to 'hatch' from the zona pellucida.

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