Day 3 or Day 5 Transfer with Few Embryos? Or Wait and Do FET?

[Anonymous]

We just got news that we have 3 fertilized eggs and are trying to decide if we should do a day 3 or day 5 transfer. Or if we should freeze and do a FET after my body has a chance to recoup from the stims. This is our third IVF attempt and the prior two ended with a BFN. We transferred 1 on day 3 for the first cycle and 2 on day 3 for the second cycle. Nothing left over to freeze.

I'm leaning towards at least a day 5 transfer so we can see how the embryos are developing. We have MFI and low ovarian reserve issues. On prior cycles, everything looked great on day 3 so it's not clear why things aren't sticking. We're also doing immune treatments with this round to try and address possible implantation issues. We were told that there might be diagnostic value in letting the embroyos grow to day 5 to see if there are sperm issues causing development problems. We've also been told that success can be higher with a FET because it gives the body time to let the stim drugs get out of the system.

Anyone have any experience with this? Thoughts and prior experiences would be greatly appreciated.

[Anonymous]

I had 2 on day 3 and MFI, but we only wanted to transfer one, so we waited until 5 days. both made it, transferred 1, BFP, though later miscarried due to an extra maternal chromosome.

In your case I would wait until 5 days, but i think many others here wouldn't.

[Anonymous]

If you are comfortable with the possibility of having no embryos to transfer this cycle, Day 5 is certainly the way to go. There is a diagnostic value to waiting until Day 5, because you will get more data, but diagnostics are only of value to you if you will be continuing treatments after this cycle fails. I would think most REs would want to transfer on Day 3 if you only have 3 embryos available.

[Anonymous]

I did immune treatment as well and we decided to freeze everything and do the FET. Transferred one day 6 embryo and got a BFP.

[Anonymous]

I recently went through this and decided to implant all 3 on day 3. I got a BFP (with 1).

[Anonymous]

OP here. Thanks to all for sharing! If this cycle doesn't work out, we will end up doing more cycles so I do think there's something to be said about the diagnostic value of waiting (but also hoping there's no more cycles!). I think the big decision will be doing a fresh transfer on day 5 or doing an FET later. I know the risk of having nothing left on day 5 but I think I'll end up wondering if we could have learned something from waiting if we do a day 3 and end up with a BFN again.

[Anonymous]

I would listen to what the doctor advises. I was in the same boat, with only 3 embryos, although it was my first try and I did not have the BFN experience coloring my view. The doctor advised doing a day 3 transfer of one embryo that looked the best, and cautioned that waiting until day 5 would mean risking losing all 3. I went with his advice and am now expecting a baby in early spring!

I don't really agree that there is "diagnostic value" to waiting until day 5. Even a perfectly good embryo that could survive inside the womb might not make it to day 5 in the lab environment. As good as your lab may be, it can't exactly replicate the womb, which is the best possible place for the embryo. (This is how my doctor explained it to me.)

[Anonymous]

Agree with PP. The best place for the embryo is in the womb. I transferred 3 day 3s and have 1 dc.

[Anonymous]

OP here. In response to 13:56, this process already takes you to the lab and none of it replicates perfectly what would happen without medical intervention. It's wonderful that you did not have to go through BFNs to find success.

However, for those of us who are still trying with multiple cycles under our belt, gaining some diagnostic information at every step of the way is incredibly valuable since it can help modify future cycles (if necessary) and hopefully pinpoint problems to correct and increase our chances for sucess - especially if there's no real detriment in doing so. Day 5/6 transfers are as common as day 3 transfers and there's no indication that waiting is harmful.

At the end of the day, each of these decisions are hugely personal and everyone has to weigh the risks and benefits of each choice for themselves. Are there risks of losing embryos in waiting past day 3? Sure. And we knew that. But there's also a risk that they wouldn't have survived in the womb anyway - they didn't for our last two day 3 transfers.

Our current doctor also agreed with us that there was value for us in waiting to see how the embryos developed. We did learn that our embryos can get to blast stage, which we did not know before. Given our extensive list of issues, that is incredibly useful information for us. For someone with fewer issues, maybe that's not necessary.

The first two cycles we were nervous and our prior doctor gave us the "womb is better environment" speech, which was partly why we did day 3 transfers. However, after two failed cycles, we were left with little information about why things didn't work and were told to just "keep at it." Although that may be an option for someone with an unlimited budget, we could not afford to just keep stumbling in the dark without more information to guide our treatment.

Just speaking from our own experience, the more information you can get from each cycle, the more helpful it is if you have to go through this awful awful process again. I routinely question my doctor about her advice and she has modified my treatment plans based on information I actively bring to her attention. I do this so I can fully understand the protocols and make sure we're all on the same page - sometimes weren't. Doctors, like all of us, are not infalliable. You have to be your own best advocate in this process.

Best of luck to everyone out there.

[Anonymous]

It sounds like you waited then, OP? How did it go? I really hope this can be your last cycle (at least your last cycle for this child).

[Anonymous]

OP here. It was a BFN.

[Anonymous]

I am so sorry....

[Anonymous]

I am so sorry....