Day 3 transfer or risk it?

[HW25]

Hi folks, just looking for some advice. This is our second round of ICSI this year. I have endo and a blocked tube. No male factor. My AMH is 21 and I’m a short low dose protocol. Last cycle I had 14 eggs collected but only 6 were mature. All 6 fertilised and looked ‘perfect’ at day 3 but by day 5 we had nothing. This round they were meant to have pushed me longer but they only went 1 day longer and my stim scan on day of trigger was about the same as last time. Out of 11 eggs collected yesterday only 2 were mature 😔 Thankfully both fertilised overnight. Embryologist called today to say they have provisionally booked me in for a day 3 transfer but they might push me to day 5. I feel really strongly about having a day 3 transfer this time, ideally with both if they are both still going. I’ve read that 2 at day 3 is the same success rate as 1 at day 5. I know why they push to day 5 but I’m not sure I want to rush it- what if they do better in me than in the lab? And how would they ever know that a day 3 embryo that survives would always have made it to day 5- they can’t prove that so it’s unknown. Just looking fir some advice. Anyone been in this situation before?

[Shelleybean]

I’ve had several day 3 (and one day 2) dual embryo transfers (due to poor embryo quality/ development), which they gave us low chances of working but somehow did manage to get pregnant 2 out of the 4 times (mmc at 8-9 weeks the first time and currently almost 18 weeks with 1 baby).

The clinic did try to push us to go to day 5 transfer the last couple of cycles to be able to assess the embryos more fully and have a better idea of if they would implant or not, but I declined as felt I’d have been more devastated having nothing to transfer than if had given them a chance and ended up with a negative.

I do feel that day 5 transfers have a role where you are lucky enough to have several good quality embryos to choose from, but it’s not usually a bad idea to trust your gut as if it fails you at least may feel more at peace with the decision you made.

I’m not very knowledgeable about a lack of mature eggs, but think that your clinic should definitely be explaining to you after this cycle (whatever the outcome) why they feel so many were immature and what can be done differently in the future. If you’re not satisfied with their response then could think about having a consultation with another clinic to get another opinion on this.

Wishing you lots of luck with your decision and the 2ww! 🍀🤞🙏🏻 xx

[SharlyWarly]

I would agree, they are better with you on day 3, after all it's a natural environment for them. I had my daughter on a day 3 transfer as never got any blastos. Don't let clinic push you, it's your treatment not their's. Best of luck

[Itisajourney in reply to SharlyWarly]

Hi. I have seen this post and conscious that it's quite old but can I ask you a question? Have your eggs stop developing at all from day 3 or were they developing slowly? Mine have stopped to develop at all after day 3 so wondering if there is hope for me.

[Jjjjtk]

Go with your gut! Among 5 fresh cycles, i had 3 BFPs with 2-3 day transfers. Blastos never took. (2 MCs, now almost 14 weeks). Would your doctor consider an interval transfer? For two cycles, i had one transferred at 3 days and one at 5 days in the same cycle. This way you’re at least transferring one for sure. Wishing you the best.

[Che3]

I have had 3nr unsuccessful day 5 transfers and I’m currently 6w2d pregnant after a day 3 transfer. I’m no expert but I truly believe that the embryos are better off inside of you. They should only push for day 5 if there are too many to choose from at day 3.

[Hidden]

I would definitely go day 3. My consultant is quite vocal about the fact that we never used to do blasto until a few years ago so always did day 3 and still had great IVF results .. he is slightly cynical about the fact that whilst there are some encouraging results its often more revenue for clinics too. I would definitely go early - they have a super chance when they are in their natural environment

Good luck! x

[Tiddly1984]

I would go Day 3. It’s all well and good a clinic observing the embryos but how much does the waiting impact on the possibility that they may have had a different and perhaps better fate inside of you. Good luck...x

[AcuFertilityDoc]

Just to play devil’s advocate, I can give you some reasons as I understand them not to transfer at day 3.

Day 3 blastos would typically be at home traveling down the Fallopian tube at 3 days, not in the uterus.

The uterus may not be optimal at three days and your blastos will have to hang out for a couple more days before they’re ready to implant.

Some believe that when you transfer two blastos of different qualities the body tends to favor the weaker of the two, and so both are sometimes lost due to the weaker one.

If you have an early pregnancy that is destined to fail, it can take your body a while to recover before your next try, whereas in vitro that blasto may have shown itself incapable of further growth prior to transfer.

In the US it’s becoming more commonplace to freeze blastos to allow a cycle or more to pass naturally before transfer, so that the uterus and reproductive organs can return to a natural healthy drug free state. Is this an option in the UK?

Best hopes and wishes to you.

[Tiddly1984 in reply to AcuFertilityDoc]

Hi, yes freezing blastos and transferring them at a later date is a natural frozen egg transfer and something I had. I would advocate this all day long where possible...x

[Bungleboo]

On my first round of IVF, I had one poor quality blastocyst at day 5 out of 5 fertilised eggs. This time, I transferred 2 at day 3 and am 17 weeks pregnant with a singleton. I’m a fan of day 3! Good luck x

[Hidden]

I also have a problem with immature eggs and for my first cycle I got exactly the same results - 14 eggs, 6 mature, nothing on Day 5. Devastating!

Have you done a sperm fragmentation test? Our doctor said that is the main cause of the embryos not developing.

For your second cycle, what protocol were you on?

For immature eggs, doctors seem to prefer a double trigger (using supercur), delayed trigger (38 hours) and between 12 - 14days of injections.

They do say that egg immaturity is due to egg quality and poor response, but it also depends on your age.

I would go for Day 3 if you have the choice ❤️

[HW25 in reply to Hidden]

Hi Anna, I'm sorry you've had to go through the same issues. I did look at that but then my partner is on proxseed anyway and has made some changes and really they would just do ICSI which is what they've done for our last 2 cycles. We've had 100% fertilisation each time-just not enough mature eggs. They kept me on the same low dose short protocol and wouldn't change me (Nhs). 150 meriofert(was menopur last time) and the standard cetrotide. They said they would go longer but on the day of trigger I had less follicles over 18 than my last scan. I only had 2x 20mm the rest under 17. Obviously my 2 mature eggs were from those follicles! As much as I'm grateful for the free Nhs rounds, I think if they refuse to change anything again then 'll go private - I'm 35 in February. I hope you find some answers Soon Xx

[Hidden in reply to HW25]

35 is super young, so there must be a solution!

I would really look into getting your husband a fragmentation test - when all embryos have good fertilisation and die off around day 3 it indicates he could have sperm fragmentation. My partner has fantastic sperm (fast, good shape etc) but only with a fragmentation test did we discover there there was another issue.

The maturity rate is obviously another issue. I would definitely go private if you can or maybe ask to change doctor? You shouldn’t be made to do the same protocol every time....I always change mine to see what works and what doesn’t ❤️