February 21, 2018

Embryo transfer. Is day 3 or day 5 better?

Dear Dr. Lee. I’m glad I found your blog. I have had 3 failed iui’s and my first IVF failed. I am 41 don’t know if I should try again or not. In my IVF I got 6 eggs and transferred 4 embryos on day 3. I’ve been reading that day 5 transfers have better success. I asked my doctor why he didn’t transfer on day 5 and he said he would try and do that this second cycle. What is your opinion on what is better? Day 3 or day 5

Lakita from Massachusetts

This is a very interesting question. Whenever we do IVF, we hope to have embryos from which to choose. Just as with other things in life, it’s always good to have a choice. So for example, a patient undergoes egg retrieval and gets 4 eggs and only 1 fertilizes. We put that sole embryo in because we have no choice. Her chance of pregnancy is not that good. As another example, let’s consider a patient who produces 15 eggs and 12 fertilize. Then out of those 12, we wait and wait until day 5 and choose the best-looking one. Even though we are still transferring just one embryo, her odds of success are much higher than for the first patient. So back to your question of day 3 vs day 5, the general answer is that the optimal day of transfer depends on how many embryos the patient has. Why? Because in general, the earlier you get the embryos out of the lab and into the woman’s body, the better, at least on a “per embryo” basis. This means that for any given embryo, it’s better to put that embryo back sooner than later. However, the advantage of waiting is that we get more information. Let’s go back to this second patient who had the 15 eggs and 12 embryos. Suppose on day 3, we see that she has 12 embryos. If we wanted to do a single-embryo transfer on that day, we would have to estimate and guess which one of the 12 are the best, based on how they look that day. However, if we waited two more days, then we might see that out of those 12, 4 look excellent, 6 look average and 2 died on day 3 and stopped growing. Now we are able to narrow down the choices to those 4 excellent embryos. So overall, D3 transfers can result in higher survivability and D5 transfers enable better selectivity. Also in general, patients with good prognosis (younger, more eggs, non-egg diagnosis) will do better with D5 transfers while patients with poor prognosis (older, fewer eggs, egg quality issues, previous failed cycles) would do better with D3 cycles. Therefore, you should really have a detailed discussion with your RE before doing a 2nd cycle, so that you are in agreement about the plan. Good luck!

  • carol

    Dear Dr Lee,
    I would really appreciate your help and advice.Here´s my infertility story.My husband and I have been trying to conceive actively for the last 4 years.18 months ago we got pregnant naturally but it was a blighted ovum and I miscarried at 9 weeks.I had to have an emergency D&C as I was bleeding a lot.
    Last January we decided to go to a fertility clinic and after testing they said that I seem to be healthy ,despite my age (38).My FSH level was 4.55 and my LH was 2.62.
    My husband was diagnosed with sperm issues.His volume was 2ml,ph-8.5,concentration 12 ml per million and total spermatazoids 24 million.His mobility was 11% of a and b quality.Swim up rate was 0.1 million per ml.70% were alive.

    We decided to go directly to ICSI and we started the first cycle in -march.I had 15 mature ovums,of which 10 fertilised and 4 went on to develop into 2 A grade embryos and 2 grade B embryos.
    We transfered the best two but were unsucessful.In May we did a frozen cycle which was again negative.

    We decided to jump right back in and started a new fresh cycle in the beginning of June. I responded well to stimulation and produced 17 ovums of which 15 were mature.14 were fertilised and on day 3 according to the clinic we had 12 good looking embryos.But today on day 5 we have only 2 remaining blasts which are grade B.The embryologists´ first words to us were basically to tell us that there is a problem with our embryos and that probably we would have to think of alternatives,while at the same time saying that they would do the transfer just in case.
    I have never felt so depressed in my entire life.I went into the transfer thinking basically that it was a waste of time.
    My questions are the following:
    Is it nomal to have only 2 blasts out of 12 embryos?
    Should we assume, as the embryologist insinuated that we can never have our own children?Although in the same breath she also said that we could try a third or fourth attempt.Then she also said that if it didn´t work we could investigate implantation issues.ALL THIS WAS TODAY AND AT THE MOMENT I AM FEELING TERRIBLE.
    What explanation could there be for the arrested development of the embryos?
    What can or should we do next?

    Thank you so much in advance for your time and attention Doctor.

  • Chinnerymichelle

    had my transfer 13days ago today 11th day i bleed heavly for one day i was worried so the next day i done a test and it was negative could i still be preganat?

  • S R Roberts

    I have had 3 IVF’s. The first 2 was a day 5 transfer, and at I was 41 had 3 blasts put back. None took, next time it was 2 on day 6. The last time they advised that we replaced on day 3 for fear of loosing them. i just thought they wanted them back in and it was going to be a negative again. I had 2 replaced on day 3 and found out a few days ago I am pregnant. Therefore, despite it not being natural on a day 3 in the womb, obviously it will find a way. Now I am wondering if it is actually more unnatural to wait until day 5 in lab conditions. I think that at a guess if you have a good embryo it will make it on day 3,and perhaps day 5 too.

  • http://profile.yahoo.com/M7GPMGAWIPLC7NTRBZWCXE3CH4 Janika

    I have had 3 recent donor egg IVF cycles that failed.  The egg donors were young (in their 20s). They were all day 3 transfers. My clinic does not do day 5 transfers.  They said they monitor the embryos for 3 days to “see how they are doing”, though. I am not sure if that does any good. I don’t know if I should insist on day 5 transfers from now on. Let me know, thanks in advance for reading this.

  • AmyDonald

    This is the most common concerns of patients having IVF whether to transfer embryo on Day 3 or Day 5. There are lots of explanations that frequently show higher pregnancy rates in Day 5 transfers. Since there will be longer incubation of embryos which helps healthy embryos to grow and perhaps result in a better pregnancy chance. Yes it is one of the most important concerns which should be done according to your physician’s opinion. Even you can take help of this site: http://www.livechatwithdoctor.com/qa/index.php/7468/when-does-embryo-implant-after-transfer-in-ivf and ask your queries to experts in the various medical fields. I hope it helps.