Day 3 transfers vs. Day 5 transfers

[HopeIsAllIHave]

Hi everyone,

I was wondering how many of you have done a day 5 transfer. Just from reading a lot of the stories on here, it sounds like most do a day 3 transfer. My RE is suggesting a day 5 transfer of a blastocyst. According to what I have read, transferring of two excellent blastocysts can result in twin pregnancy rates as high as 50-60%. Although I would LOVE twins, RE discourages from multiple pregnancies because of the risks involved (gestational diabetes, pre-eclampsia, preterm labor, etc.). So she's encouraging to only transfer 1.. but that results in 50% chance of pregnancy. I kind of like the 75% chance better of having a singleton or twins. I have also read that blastocyst stage embryos do not handle the freezing process too well, so if IVF were to not work (or for future pregnancies), I could have very few or no embryos to transfer for the next cycle. And of course, not all embryos will develop to the blastocyst stage, so I may be very limited to the number of embryos to transfer on day 5 or none at all. I am just all sorts of confused and don't know which option to pick.. day 3 or day 5? if day 5, then either transfer 1 or 2? sigh.. in fact, I don't even know if my clinic does day 3 transfers..

[babydreamz]

Hope, This is our 3 attempt at IVF/ICSI, and this time it was highly recommended to us that we do 5 day transfer. In fact, we were not really given a choice Our RE and clinics success rate in 5 day transfer is VERY high compared to 3 day transfer.
We got a BFP this time !! As far as reasoning is concern, do chk out the links below.
I personally would go for 2 embies, ( and we did) maybe thats just me

http://www.sharedjourney.com/articles/3vs5.html

http://www.advancedfertility.com/blasto ... yrates.htm

All the best!

[riogirl71]

SD had very good points.

Here is my story, no infertility issues, DH has poor motility recommended that only IVF with ICSI will work. NOrmal FSH but medium to low antral follicle count. #1 IVF retrieve 10 follicles, 7 eggs, only 4 mature, they all fertilized and we decided to transfer all 4 on day 3. I was 36, we had one healthy boy. IVF #2 my response is worse I am 39 and I get 6 follicles, 3 mature eggs, all fertilize and we decided to transfer 3, I had an ectopic pregnancy. I go to a new clinic. THey will not do they 5 transfers unless you have more than 6 god looking embryos on day 3! SHe said the attirtion rate is 50% so you don't want to risk having no embryos on day 5. Better to transfer on day 3 than to take chances. IVF #3, still 39, retrieve 14 eggs, 5 mature, 5 fertilize and we decided on putting in 4, we figured that our chances would be good for a singleton. We are now pregnant with twins! I know it is risky but we made the decision that 2 were better than none because we could not afford another cycle if this one failed.

If you end up with wonderful embryos on day 5, more than 6 then for sure go to day 5. If you end up with 5 good ones or less I would say go for 3day transfer.

[HopeIsAllIHave]

Thanks babydreamz, SD, & Rio for the pointers. I'll definitely take all those into consideration. I think the hardest part for me is that I'm really not sure what I'm getting myself into, but ecstatic about the opportunity of finally being anywhere close to being pregnant.

babydreamz, that first link you posted was very interesting and informative. Thanks for sharing!

[Klm]

I too was in a similar situation just a week and a half ago with our first IVF that we actually got to go all the way through with. As far as 1 vs. 2, my husband was nervous about twins and my doctor mentioned it once, but I was pretty adamant about increasing our chances. I'm like you and would love twins. It would mean only going through and paying for all of this one time. However, the others make good points about just one. We decided to put in two. One early blastocyst and one nice blastocyst. We find out soon if it worked!

Day 3 vs. Day 5 really stressed me out. When my clinic called and said only 4 of my 9 fertilized with ICSI I was really worried and figured they would for sure do a day 3 for fear of them not surviving. However, my doctor wanted to do a Day 5 so we went with it. As you have read, the Day 5 statistics are much better. I know cases can be made for each side and I was a nervous wreck waiting to hear how the 4 were doing (they all turned out great). However, the more I read, the more I was glad my doctor wanted to do a day 5. He said they could tell much better on Day 5 the two that were the best to transfer. Also, it seems like if they don't make it to day 5 in the lab then chances are they probably wouldn't have made it in the uterus either. I know there are some cases that say they are better off in the uterus, but it seems more recent research suggests day 5 is best.

Good Luck!

[summit]

Hopeisallihave:

Most RE's determine whether or not to do a day 3 or day 5 depending on the number of embryos you have and the quality of the embryos. At my clinic, if you have several embryos of a good quality that are developing well they are likely wait to do a day 5 to see which embryos are of the highest quality. If you have few embryos or have many of poor quality they are likely to do a day 2 transfer, because they feel that the embryos will have a better chance of survival being transferred instead of waiting until day 5.

I have done day 2 transfers for both of my cycles based on my doctor's recommendation. We have produced a good amount of embryos during each cycle, but the quality of the embryos has been an issue. At my clinic they will only freeze embryos that make it to the blatocyst stage. Unfortunately, we have had no viable embryos for freezing.

I think that it is a very personal choice on how many embryos to transfer. During my first cycle my RE said we were only going to transfer 1, but on the day of the transfer she suggested we transfer 2 due to the quality of the other embryos we produced. My husband and I decided only to transfer 1, because we knew that we had 2 more tries through my insurance. On our 2nd cycle we did transfer 2. Looking back I wish I would have attempted 2 on the first try, since all of our cycles have been unsuccessful thus far. It all depends on what you are comfortable with and I think your financial situation makes a big difference as well.

I wish you well during your first cycle,

[patatina]

These are all really good points. Regarding how many embryos to transfer, I would add that you should consider how stimulated your ovaries are. Even mild OHSS can negatively affect implantation, and in a fertile/young female it may be wiser to freeze everything and suspend the transfer until estrogen is down and the ovaries are ready to sustain a pregnancy. Our RE considered canceling the transfer due to OHSS, but since we were borderline we all opted to go for it. On day 5 they transferred 2 of our 7 high-quality blastocysts and froze the other 5. We were hoping for twins, but only one implanted, evidently quite late. Naturally we're very happy to be knocked up, but we're a little sad to have wasted that other good blastocyst on a cycle in which I had OHSS. I don't fault our RE, because of course we were impatient to do the transfer. But I didn't realize that OHSS could hurt our chances of having twins, or even our chances of any pregnancy at all.

Sorry to add to your dilemma!

Wait, I appear to be mistaken--see Ghost's answer below.

[HopeIsAllIHave]

Thanks, SD! We got married exactly 2 months ago!

Klm, Summit, & Patatina (&everyone else) You ladies are just so ridiculously nice and helpful! I really appreciate your stories and support. The more I read about it, the more comfortable I am with the day 5 transfer. I just hope my eggs/embryos cooperate!

Klm, when are you going in for your beta? best of luck!!

Summit, so sorry to hear about your unsuccessful cycles! Lots of baby dust to you for your cycle planned for January 2011!

Patatina, sorry to hear you lost a perfectly good blastocyst, but happy that one stuck! Thanks for sharing your story on OHSS; I hope I won't have to go through that, as it will be really hard to cancel the cycle if it was left to my discretion. However, I will try my hardest to think with my head and not my heart

[angeinhull]

Just want to say we did 2 cycles. For both we transferred 1 5 day blast. 1 cycle was BFn and the 2nd resulted in our baby boy. We had no choices as it is highly regulated in the UK but you can see that 1 blast can work.

Good luck

[MamaBoo]

I was just reading your post. If I read it correctly, you were saying that transferring 2 five day blasts has a twinning rate of 50-60%. I actually think that is the total success rate for live birth. There is actually a 20-30% chance of twins in this case. I think I am remembering the numbers my RE gave me correctly. I did an FET in March 09 and there were 2 five day blasts put back. Although both implanted, one did not make it. We saw both at about 7 weeks on u/s, the second one only measured around 6 weeks at the time. It continued to decrease in size and my RE said it would eventually reabsorb.

However, that being said, there IS an increased chance for twins when transferring 2. With twins there are increased risks to both the babies and the mother. Therefore, you need to have a very serious discussion with your doctor and weigh the options carefully. At least that is my opinion.

[Ghost]

These are all really good points. Regarding how many embryos to transfer, I would add that you should consider how stimulated your ovaries are. Even mild OHSS can negatively affect implantation, and in a fertile/young female it may be wiser to freeze everything and suspend the transfer until estrogen is down and the ovaries are ready to sustain a pregnancy. Our RE considered canceling the transfer due to OHSS, but since we were borderline we all opted to go for it. On day 5 they transferred 2 of our 7 high-quality blastocysts and froze the other 5. We were hoping for twins, but only one implanted, evidently quite late. Naturally we're very happy to be knocked up, but we're a little sad to have wasted that other good blastocyst on a cycle in which I had OHSS. I don't fault our RE, because of course we were impatient to do the transfer. But I didn't realize that OHSS could hurt our chances of having twins, or even our chances of any pregnancy at all.

Sorry to add to your dilemma!

OHSS does not reduce the chance of implantation, although the techniques some clinics use to try to avoid OHSS just might have that effect.

[Sunshine1576]

Ladies I really like this thread! Last Sept. we went through day 5- Blastocyst. Found out on transfer day that another made it to blastocyst so instead of one we would have two. We quickly decided that we would like to increase our chances to the "possibility of having twins." We both felt every child needs a sibbling since we both have two brothers and have always been close to them. I remember being thrilled and scared at the same time, thinking do I really know what this means at one time? I was also nervous because right before the transfer I found we had no frozen embies so we knew this is it. Usually there is a higher success rate with Blastocyst.. Unfortunately my estrogen was too low, and the meds didn't respond like they should of. Lupron made the follicles/eggs respond a little slower in developing. Mentioned something about antagonist, a different med to speed the developing follicles. So if we decide to try second round of IVF in February, he's going to switch some things around and "tweak everything" for our second attempt. It's all about trial and error.

[patatina]

OHSS does not reduce the chance of implantation, although the techniques some clinics use to try to avoid OHSS just might have that effect.

WOW!! I must have really misinterpreted what I heard from the RE. They didn't coast me but halved my dose of HCG. What kind of OHSS-avoidance techniques can hurt implantation?

Thank you, Ghost!

[Ghost]

OHSS does not reduce the chance of implantation, although the techniques some clinics use to try to avoid OHSS just might have that effect.

WOW!! I must have really misinterpreted what I heard from the RE. They didn't coast me but halved my dose of HCG. What kind of OHSS-avoidance techniques can hurt implantation?

Thank you, Ghost!

Cutting the hCG dose by half will not reduce implantation rates, except in some extremely obese patients in which that dosage might be inadequate to mature the eggs.

Cutting the hCG dosage to zero and triggering with Lupron has been shown to reduce implantation when the luteal support protocols for hCG-cycles is used. That level of luteal support is inadequate for Lupron-triggered cycles because Lupron triggers kill the corpora lutea, ending OHSS risk but also ending progesterone and estradiol production.

[txcplforivf]

Hello! I just wanted to add some info on here. I go in two days for my ER. I am brand new to all of this. This is our first cycle. My RE whom is very highly recommended and qualified, and rates are outstanding does not do 3 day transfers unless it is necessary. I am 28 and i have PCOS he said because of my age and the risk for mulitples he will do a 5 day transfer. Basically it is up to the Embryologist, you dont really get to choose. If they look good enough to go 5 days they will and if they dont and they think they will be better back inside you, then they will go ahead and put them back in. Best of luck to you!!!! A 5 day is the best way to go!!! My opinion!