Embryo, day three transfer versus Blastocyst, day five transfer
Thursday, November 02, 2006
Carl M. Herbert, MD
Transferring embryos at the blastocyst stage may be an option for patients in an IVF cycle. As background, a blastocyst is an embryo that has undergone multiple cellular divisions with the formation of a cavity within it. A fertilized egg reaches the blastocyst stage usually 4 to 5 days after fertilization. We encourage the majority of patients in my clinic to have their transfer earlier, on day 3, when the embryos have approximately 8 cells. For most patients, the best embryos are identifiable at this time and we like to transfer them into the uterus (their natural environment) as soon as possible. Embryos that are not transferred can be frozen for later use. However, if a patient has a large number of embryos and/or the best embryos are not clearly identifiable on day 3, we may suggest waiting 2 more days and doing a blastocyst stage transfer. Waiting gives us more information on how well the embryos are developing and may allow us to make a better choice for transfer. The downside of allowing embryos to grow to day 5 is that not all will develop to the blastocyst stage and therefore there may be fewer or no embryos to freeze after the transfer. In addition, blastocysts do not tolerate the freezing procedure as well as embryos frozen at earlier stages, so your chance of pregnancy with frozen embryos may be lower.
There are advantages and disadvantages to transferring embryos or blastocysts. You may discuss the options which best suit your case with your physician or the embryologist. Issues for you to consider are listed below.
If you have any questions about the Day 3 vs. Day 5 transfer, I’d love to hear from you.
9 Comments:
At Tue Nov 14, 02:30:00 PM 2006,
Lady Bra said…
Brief resume of story so far – Hysterosalpingugram (I know that's wrong) revealed bilateral tubal blockage (from chlamydia??) leading to four failed IVF cycles. One fresh, one frozen embryo cycle (short lived chemical pregnancy), and another two fresh cycles. Each time I stimulate quickly and produce lots of eggs, between 22-25. Each time we get around ten viable embryos. I don't suffer from OHSS although I am at risk due to rapid stimulation and high follicle numbers. And each time the embryo transfer is very easy and pain-free for me, the doctors get a good view and can place the embryos very satisfactorily. But no success yet. The last cycle was a blastocyst transfer, but still no luck. All you say about day 3 vs day 5 is correct. It's hard to judge, but as a fourth attempt I decided to wait til blastocycst so that they could really see which of the ten were favourable. But what now... I don't know what's going wrong. Not antibodies as that test came up negative. Hydrosalpinx was checked for by scans during the ovarian stimulation and was not visible. I am at my wit's end and as most women in this situation, money is a factor.
Thanks
Anne
At Wed Nov 15, 06:24:00 PM 2006,
Carl Herbert, MD said…
Dear Lady Bra,
Your situation falls under the diagnostic acronym of "RIF" or repetitive implantation failure. The reasons for this are frequently difficult to figure out. Certainly, hydrosalpinges can be a factor but the ultrasound evaluation you had did not show evidence of this problem. If your tubes were blocked proximally (near the uterus) on HSG, there may not be a problem; but if they were blocked distally (out at their ends) there may be a problem even if the ultrasound doesn't show fluid in the tube. If you had distal tubal occlusion, it would be reasonable to undergo a laparoscopy for definitive evaluation and possible treatment. Other factors which might be involved include the endometrium (the uterine lining), the transfer process and egg/embryo quality although it does sound like you respond well to stimulation medications. There is a newer test to evaluate the endometrium which looks for the presence of special substances called "beta integrins".These substances are thought to be important for implantation and need to be present in adequate amounts for a successful pregnancy. The test requires an endometrial biopsy during the appropriate time of the menstrual cycle and the tissue sample sent to a special laboratory for evaluation.Other newer and unproven ideas include abnormalities in the sperm (nuclear DNA fragmentation)and/or abnormal immune factors. I hesitate to bring up these newest ideas as they are quite controversial. Currently there is very little good scientific reasearch to support the theories and the tests and treatments can be quite expensive. If all your care to date has been at one center,I suggest you find another good center somewhere near you and seek a comprehensive reevaluation in the form of a second opinion before resorting to as yet unproven therapies. Failed implantation is the most frequent cause of a failed IVF cycle and the most frustrating because we know so little of what actually takes place inside the uterus. I wish you the best with any future endeavors and encourage you to stay with your search for answers.
At Sun Jan 14, 09:40:00 AM 2007,
Demented M said…
Hi Dr. Herbert. Thanks for the post. I'm doing a day 3 transfer tomorrow and for some reason, had convinced myself Day 5 was 'better'. I've read that they think implantation rates are improved with blastocysts. Yesterday, the lab wasn't sure if I would be day 3 or 5 transfer (with 15 fertilized eggs) but today they told me I would be day 3 (which makes me think they don't believe I'll make it to day 5 with the embryos I have).
Based on what you've posted, it sounds like I should ask my clinic why, if I have 15 properly dividing day 2 embryos, we don't try for day 5?
Also, have you seen this transcript? http://www.sharedjourney.com/articles/3vs5.html It very convincingly makes it sound as if anything but Day 5 transfer is less than ideal. A rather disheartening read for someone transfering on Day 3.
M
At Tue Jan 16, 01:20:00 PM 2007,
Carl Herbert, MD said…
Dear Ms M.
Decisions regarding day 3 vs. day 5 transfers can include a number of criteria. The most important role that a day 5 transfer plays is one of selection. Choosing the best embryos for transfer will increase the imlantation rate. Whether there is something inherently better about attachment and implantation beyond the selection process is still under debate. There is no question that day 5 embryos do display higher implantation rates. Dr. Smith in the article you cited is a very strong believer that embryos incapable of successfully growing to day 5(or day 6) would never produce a pregnancy if transferred into the uterus at an earlier stage. With that approach, clinics will only do blastocyst transfers regadless of any other circumstances. Other clinics are less convinced that the growth to blastocyst is an absolute discriminator and therefore have various criteris for early (day 3) transfer. Some of these criteria include number of embryos, quality of embryos, age of the patient, outcomes during previous IVF cycles, etc. If your clinic feels the embryos you have created will have a better chance for implantation and a successful pregnancy based on a day 3, I am sure that is based on their own experience for whatever reasons. It does seem as though you had a good number of fertilized eggs so I am assuming the number of good quality cleaved embryos is low. Usually, a final decision on day 3 vs. day 5 is not made until day 3 so perhaps your clinic will clarify their decision tomorrow before transfer.
The question of day 3 vs. day 5 transfers causes difficulties for many patients. The different philosophies and clinical approaches taken by different IVF centers points out the lack of uninimity in this field. With more time and more experience, this question will be bettered answered but for now you are caught in a transition period and there are no absolute answers. Regardless,I hope the embryos you have will produce a successful pregnancy for you.
At Thu Jul 12, 01:29:00 PM 2007,
Anonymous said…
Dear Doctor
Iam 29 years old .my tubes are not blocked but my right tube is ver very mildly hydrosalpinxed(not visible in hysterosalpingogram)
this finding was through a laparoscopy.I have been pregnant twice before on clomid but very short lived chemical pregnancies.my antibodies tests came out negative and i have a retroverted uterus..
Iam doing a cycle of ivf .29 eggs were retrieved from me but only 10 normally fertilised...its day 3 today i havent heard from my doc yet...Doc what might be the reason for this low fertilization rate?Also iam really worried if those 10 embryos will make it to the blastocyst stage.....Please help with your comments on this..
Tahnks
Shalu
At Sun Aug 12, 09:12:00 AM 2007,
Anonymous said…
Dear Dr Herbert,
My husband and I have just been through our second IVF cycle. It ended in a chemical pregnancy. Fortunately, we had three zygotes frozen and one blastocyst. What do you suggest we do from here? And what kind of chances do you think we have? This is our last chance, we are out of money so we need it to be the best chance it can be!!
At Tue Oct 09, 09:10:00 AM 2007,
Purvi said…
Hello Dr. Herbert,
I just finished my 1st IVF cycle. I was given Follistim 150 IQ for 10 days and they retrieved 13 eggs. All 13 fertilized using ICSI. On Day 3, 10 embryos were of A grade with cells range from 6 to 12. Doc said he will wait until Day 5 and transfer only one Blast. We were happy and went to clinic on Day 5 morning to hear the bad news that none of the embryos made it to blast stage. Only 2 embryos were in compacting stage, which were aprox. a day and half late in development. Doc hatched those two and transferred them with almost zero chances of success. My question is what might have gone wrong that 10 good quality day 3 embryos will not make it to blast or even morula stage? Does it mean that if the embryos were transferred earlier on day 3, they still would not have resulted in pregnancy, since they didn't make it to blast? What will be your opinion on the next IVF cycle, if we decide to do?
Thanks in advance for your time.
At Mon Jan 14, 01:25:00 PM 2008,
Anonymous said…
my husband and i have a 4 year old girl we conceived naturally. my husband unfortunately underwent backsurgery 2 and half years ago and now has been dx with retrograde ejaculation. we have done 3 ivf cycles with only 2 chemical pregnancies? is there any hope.
At Sat Feb 23, 03:09:00 PM 2008,
Anonymous said…
I am a 35yr woman preparing for my first IVF cycle. I had 16 eggs retrieved and 15 fertilized. I was assuming we would go for a day 5 blastocyst transfer but received a call today that we should come in for a day 3 transfer. I have been trying to read some about the difference and I realize there are still a lot of unknowns. My doctor had told me they prefer to do day 5 transfers, so I am concerned about why we are are going on day 3. I read that day 3 does not offer anything to day 5 because if they don't make it in the lab they won't make it in utero either. Is that true? I've been told it has to do with the quality of the embryos. But it seems that of our 15 (none have been lost as of today), that some must be of good quality. I am also concerned b/c my doctor only offered to put 2 embryos in. Is that normal? I would never carry more than 2 but he knows I have no ethical issues with aborting if > 2 implant. I just want to have the best chance of having one healthy baby.
Thanks for your help- any comments appreciated.
Post a Comment
<< Home