Seriously... day 3 or day 5 is better?

[Anonymous]

RE 1 says that clinics insist on growing embryos to day 5 because they want their stats to be better and it's easier to weed the incompetent embryos out first so that success rates will be high. For someone like me, with DOR, they think that's a very bad thing.

RE 2 says that RE 1 only says that because their lab sucks. And everyone should grow out their embryos to Day 5, even if you have very few, because you only want to transfer embryos that have a good chance of implanting.


Who is right?!

[Anonymous]

I don't think anyone really knows yet OP.

From my experience (8 years ago) and the readings I've kept up with, there is certainly some truth to being able to be more confident about potential success of blasts that make it to day 5. Day 3's simply don't show enough info yet to know.

And I had an RE who believed that blasts stood a better chance in the uterus than in being frozen.

So we transferred the two best looking 3 days we had, as a fresh transfer, and let the rest grow. We ended up with two more frozen blasts (3 good looking ones never made it to day 5).

My fresh 3 days both failed and the 2 frozen 6 day blasts both resulted in a healthy child.

So I think that despite all the amazing science there is still a huge amount of luck and hunchwork involved.

Which sucks.

FWIW, I don't regret trying the 3 day fresh transfer - it's what my RE thought was our best shot. She was genuinely surprised they didn't "take" as they looked perfect. But she - and we - were doing our best, and that's really all I felt was guaranteed.

Good luck!

[Anonymous]

Agree. No one really knows. The best evidence of this is that two of the top clinics with some of the best DOR success disagree:

CCRM is adamant about pushing to Day 5 and PGS testing.

Davis at Cornell is a proponent of Day 3 transfers.

They're both best of the best. I think you just have to pick one philosophy and if it doesn't work, be prepared to change approach or change clinics if necessary. I'm in the process of using my few Day 5 PGS normal embryos, but if no luck, I'll be pushing to do Day 3.

[Anonymous]

Anonymous wrote:Agree. No one really knows. The best evidence of this is that two of the top clinics with some of the best DOR success disagree:

CCRM is adamant about pushing to Day 5 and PGS testing.

Davis at Cornell is a proponent of Day 3 transfers.

They're both best of the best. I think you just have to pick one philosophy and if it doesn't work, be prepared to change approach or change clinics if necessary. I'm in the process of using my few Day 5 PGS normal embryos, but if no luck, I'll be pushing to do Day 3.

emotionally would you rather have them tell you an embryo arrested or wait 2 weeks and get a BFN?

[Anonymous]

I had DOR. I typically only had one embryo to transfer by day 3 so waiting until day 5 wouldn’t have helped identify the best embryo — there was only one available for transfer anyway!!! So for DOR I think a push to day 5 may not make sense. For another problem (like male factor) waiting to day five likely makes sense.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Agree. No one really knows. The best evidence of this is that two of the top clinics with some of the best DOR success disagree:

CCRM is adamant about pushing to Day 5 and PGS testing.

Davis at Cornell is a proponent of Day 3 transfers.

They're both best of the best. I think you just have to pick one philosophy and if it doesn't work, be prepared to change approach or change clinics if necessary. I'm in the process of using my few Day 5 PGS normal embryos, but if no luck, I'll be pushing to do Day 3.

emotionally would you rather have them tell you an embryo arrested or wait 2 weeks and get a BFN?

Yes but some percentage of the embryos that arrest on day 4 would have lived in your body. The problem is that no one can identify those embryos and no one knows what that exact percentage is. But there is every reason to think it is more than 0%.

[Anonymous]

I don't think anyone knows, but if you have dor, you might as well transfer them at day 3 and have a chance vs having a cancelled cycle because there is nothing left to transfer. Some women's embryos just don't grow in culture well. I have had very few blasts in lab (literally less than 2% and many cycles with zero blasts). I have had a much higher percentage form blasts internally (they were losses). I don't know what they would have done in a lab, but given my history, I assume they would have never made it

[Anonymous]

I just started at SGF and noticed it seems like no one does day 3 transfers. My previous clinic had an excellent lab and at the time (4 years ago) they would have you tentatively down as a day 3 transfer until the lab report showed that there were still plenty of embryos growing. I wonder if SGF philosophy is possibly tainted by the Maryland IVF insurance mandate and that "attempts" are classified by transfers?

[Anonymous]

Anonymous wrote:I just started at SGF and noticed it seems like no one does day 3 transfers. My previous clinic had an excellent lab and at the time (4 years ago) they would have you tentatively down as a day 3 transfer until the lab report showed that there were still plenty of embryos growing. I wonder if SGF philosophy is possibly tainted by the Maryland IVF insurance mandate and that "attempts" are classified by transfers?

maybe... or they want to keep their stats high?

[Anonymous]

I’ve been dealing with sgf too. Not once have they suggested a 3 day. They actually had me do a 6 day to grow embryo more and I did get a bfp, but had a miscarriage.

[Anonymous]

Anonymous wrote:I’ve been dealing with sgf too. Not once have they suggested a 3 day. They actually had me do a 6 day to grow embryo more and I did get a bfp, but had a miscarriage.

this is also why i think that maybe the clinics doing day 3 transfers are just not as confident in their lab as SGF and CCRM are

[Anonymous]

You've hit on one of the many things with ART that can be based on an RE's experience, rather than good data. In other words - many of the REs form treatment preferences based on the limited cases they see (and often the successes that stick out in their minds) and it amounts to superstition. It happens in other areas, and even sometimes where there's good data to show what course has better outcomes.

SGF did look at their day 3 vs day 5 outcomes and they base their day 5 preference on the fact that while day 3 has higher BFP rates, day 5 has higher live birth rates. When I was there, the did bend the rules a bit - I did a day 4 and then also transferred on day 5, even though nothing was at the blast stage yet. I think day 5 is where the data is going. Dominion also will not do day 3 transfers (at least when I was last there about a year ago), for the same reasons as SGF. The stats don't tell you everything, though - you can never know on an individual basis what is best. With day 3, you run a higher risk of miscarriage (so higher potential for waste of $ and emotional upheaval). For DOR or poor egg quality where you get few blasts, I certainly wouldn't rule out day 3 (although I wouldn't PGS test even if I went to day 5).

At these top clinics, I don't think lab quality is a big concern. It was a MAJOR concern a number of years ago, but they've improved the culture media and other techniques, such that the major clinics are all on pretty much the same footing now. Clinics will still promote lab quality, but I think it's only relevant when you're comparing the top tier to others.

Cornell's DOR stim protocol (which is essentially a mini-IVF, although they don't want to call it that), was better for me - I have poor egg quality. Other REs will do it, if you ask, but most want to start with high stim doses. I think with poor egg quality and DOR, it's just harder to figure out what works best for the specific person. If you look at the success rates for 40+, you can get something of an idea about how a clinic does with what is likely to be DOR and/or poor egg quality, but it unfortunately, there's no good info on success based on diagnosis. I do think Cornell is probably the best for DOR, though.

[Anonymous]

I have DOR, and my RE said they didn’t see any substantive difference is 3 vs 5 day, so they did 3 day to get them in faster.

[Anonymous]

Anonymous wrote:You've hit on one of the many things with ART that can be based on an RE's experience, rather than good data. In other words - many of the REs form treatment preferences based on the limited cases they see (and often the successes that stick out in their minds) and it amounts to superstition. It happens in other areas, and even sometimes where there's good data to show what course has better outcomes.

SGF did look at their day 3 vs day 5 outcomes and they base their day 5 preference on the fact that while day 3 has higher BFP rates, day 5 has higher live birth rates. When I was there, the did bend the rules a bit - I did a day 4 and then also transferred on day 5, even though nothing was at the blast stage yet. I think day 5 is where the data is going. Dominion also will not do day 3 transfers (at least when I was last there about a year ago), for the same reasons as SGF. The stats don't tell you everything, though - you can never know on an individual basis what is best. With day 3, you run a higher risk of miscarriage (so higher potential for waste of $ and emotional upheaval). For DOR or poor egg quality where you get few blasts, I certainly wouldn't rule out day 3 (although I wouldn't PGS test even if I went to day 5).

At these top clinics, I don't think lab quality is a big concern. It was a MAJOR concern a number of years ago, but they've improved the culture media and other techniques, such that the major clinics are all on pretty much the same footing now. Clinics will still promote lab quality, but I think it's only relevant when you're comparing the top tier to others.

Cornell's DOR stim protocol (which is essentially a mini-IVF, although they don't want to call it that), was better for me - I have poor egg quality. Other REs will do it, if you ask, but most want to start with high stim doses. I think with poor egg quality and DOR, it's just harder to figure out what works best for the specific person. If you look at the success rates for 40+, you can get something of an idea about how a clinic does with what is likely to be DOR and/or poor egg quality, but it unfortunately, there's no good info on success based on diagnosis. I do think Cornell is probably the best for DOR, though.

how come you wouldnt pgs test even if you went to day 5?

[Anonymous]

Anonymous wrote:

maybe... or they want to keep their stats high?

I'd definitely think that'd be a motivating factor, but aren't stats based off of live birth per retrieval?


I'm curious, if you don't have any embryos to transfer, you get a partial refund if paying OOP?