So much a do about 2 days: d3 vs. d5 embryo transfer

For me the first IVF was somehow the easiest. I had full trust in high-tech baby making and was positive it would definitely work. Instead of asking myself questions, checking online, asking around, I just trusted the (idiot) doctor who performed my first disastrous attempt at in-vitro baby making.

Three rounds of IVF later I find myself spending weeks in trying to decide what to do for this fourth IVF round: stay with my doctor or change? Stay in the same clinic or change? Frozen or fresh? IMSI or ICSI? Day 3 or day 5? Or half and half? Long, short or antagonist protocol?

Why on earth do I – person with no medical training whatsoever – need to take this type of decision!?!??!

Good news first

After a consultation with two different infertility doctors, an embryologist and a new acupuncturist, there is full (or almost full) agreement on a few points:

  • antagonist protocol
  • do only frozen cycles, i.e. freeze everything and transfer months later (by the way, this confirms that I will not have a baby in 2014, but I said I’d try to be positive so I will shut up)
  • IMSI (my gynaecologist prefers ICSI but I trust the embryologist on this)

Bad news now

There is one question I can’t get a straight answer to: shall we push to blastocysts or transfer at day 3? This is a key question because it will determine whether I will change doctor and clinic.

What do I understand/know about this:

  • Getting a blastocyst makes it possible to select the best embryos: if they don’t survive in vitro for 5 days then they are not good enough so you avoid multiple transfers of potentially useless embryos.
  • For a transfer at day 5 it is easier to replicate the state of the uterine lining in a natural pregnancy (something a do with the time it takes to the embies to get through the tubes going from the ovaries to the uterus when you are a normally lucky fertile person)
  • Day 3 transfer can help the development of the embryos, since they better develop in uterus than in vitro (mum is better!).
  • The only time I had a minuscule positive result was on a 3-day frozen transfer (never had 5-day frozen though).

Does anyone have any information on this? Could you let me know whatever information you have on transfer/freezing day? Or on your experience so far? How many of you transferred at day 5?


Leaving you with my song of the day (little treat for the men reading, if there are any..)

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21 Responses to So much a do about 2 days: d3 vs. d5 embryo transfer

  1. Elisha says:

    I wish I had good suggestions or advice but I don’t. I did day 5…didn’t work for me but has for friends of mine. I have never done day 3 but I feel like they would do better in your own body letting your body do what it knows to do over a Petri dish. Just go with your gut… Seek God. He won’t lead you down the wrong path. Hugs!!

    • kiftsgate says:

      that’s exactly the tradeoff: day 3 I get two more days to take care of them, day 5 it’s more likely they are good quality. I wanted to decide tonight but I’ll need to sleep over it.. Thanks!!

  2. It’s so much to think about. I don’t know what IMSI is.. off I go to Google. I’m only planning round 2 and I’m already confused. Can’t imagine how confused I’ll be by round 4.

    • kiftsgate says:

      I hope you never get to round 4!!!! IMSI is simply ICSI done with a more powerful machine so that you can see the swimmers from close and better select them. It is good for men with severe teratospermia problems (weird looking swimmers). Not needed if your hubby doesn’t have problems.

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    • kiftsgate says:

      You are the sweetest thing!! Merci, ca m’a bien fait sourire ce matin de lire ca en me reveillant…
      Je sais pas si je meritais d’etre au top de la liste mais merci! Moi aussi j’ai bien aimé notre chocolat chaud. Il faudra refaire bientot!
      Parfois je me demand a quoi je passe mon temps sur le blog, puis je rencontre des gens comme toi et j’ai la reponse toute de suite!
      Merci!! Bisous.

  4. E v e l y n says:

    I’ve only ever had day 3. I’ve heard that embryos do better on the inside but how could they possibly know that. I don’t have a baby so how much worse would a day 5 transfer have been. The thing that both appeals to me and scares me about day 5 transfers is that if the embryos aren’t good quality you might have nothing to transfer on day 5 but is that better than sitting around being hopeful for 2 weeks only to have a negative test?

    I swore I’d never have another day 3 transfer when I moved clinics but that’s what the doctor insisted on. He wouldn’t even thaw the 2 day 5 embryos I had and told me that the day 3 were better quality. I understand the new clinic prefers day 5 transfers so hopefully I’ll get my wish.

    The thing I find interesting is that the doctors I’ve come across seem to feel strongly about one way or the other but women get pregnant doing day 3 and day 5 transfers. It might just ease your mind to do a day 5 since you haven’t already.

    • kiftsgate says:

      Thanks a lot Evelyn! I’ve actually had a transfer at day 5 before, which didn’t work. So, since there isn’t a definite answer, I should maybe just go with the mix of day 3 and 5.. With all the comments I’m starting to understand a bit more now what the embryologist was trying to tell me…
      Thank you!!

  5. Little Wife says:

    It as a difficult decision to make. Isn’t it possible to try for blasto and if not enough go with 3 days ?
    I tend to think that if you can get blastos it is more chance to succeed. But really I understand your dilemma.
    Did you like numerobis ? Is he for 3days or blasto ?
    Sorry to ask so many questions…

    • kiftsgate says:

      So on one hand I have a mix of day 3 and 5 (last time day 3 worked a tiny bit for me, meaning that since I had a +ve even if crappy beta, the embryo did become a blastocyst inside me). If there are enough, they would freeze a few at day 3 (the ones that are most beautiful so that they are kinda sure that they would go to day 5) and then they wait for the others to day 5 to see what happens.

      On the other hand Numerobis proposes to get everything to day 5 and even do genetic testing (never heard of this, I thought it wasn’t even allowed in France!). Did you ever hear about it?

      So we are a bit puzzled. We are very interested in the genetic testing. Numerobis also says we need to check my hubby more, which I think is great. But then I wonder, if my hubby has crap results, will it change something? He also said he wouldn’t want to do another IVF before my sweet half quits smoking.. that ain’t gonna happen soon. He’s trying but it won’t happen soon enough for IVF now…

      Otherwise he and my gynecologist agree on all the rest, so that’s reassuring (that we are going for the best protocol and best treatments and that everyone agrees that we should freeze everything and transfer later).

      So I don’t really know what to do. This morning I feel more like I’d rather stay with my gynecologist for this round (she has a sense of the doses I need so it would be reasonable to give her another shot). But I may change my mind again later…

      Did I like him? Yes, he seems super nice and was very kind. But to be honest he kept yawning and was half asleep, and I found that a bit discouraging.. maybe he was just tired.. he also didn’t have time to explain much (e.g. the genetic testing) but I guess that’s for the next appointment…

  6. lisette84 says:

    Est ce que je peux te répondre en français? J’ai cru comprendre que tu le parlais bien, mais comme je découvre ton blog, je me trompe peut être, n’hésite pas à me dire, je traduirais !

    Déjà, je comprends ton angoisse et suis de tout coeur avec toi… Comment ne pas t’inquiéter… Tu as un parcours bien difficile…

    Je crois que c’est une bonne chose l’IMSI, ça ne peut pas “faire de mal”, tu optimises !

    Mon médecin suit aussi une amie et lui avait recommandé un transfert à J1, qui a d’ailleurs été le seul à fonctionner. Pourquoi, je ne sais pas exactement, je suis désolée, mais ce que je veux dire, c’est que J3 ou J5 ne sont pas toujours les meilleures fenêtres pour tout le monde. Je crois que j1 c’est surtout quand les embryons ont du mal à se développer in vitro, donc ça ne te concerne sans doute pas. Entre j3 et j5, si tu lis les papiers médicaux, il n’y a pas de différences claires, l’un n’est pas absolument meilleur que l’autre donc dis toi que quelque soit le choix, il sera bon… Et j’imagine que ton médecin doit avoir son avis sur la question? J’aurais tendance à penser comme toi, que si accroche il y a eu à J3, ça donne envie d’y croire à ce stade…

    Je trouve ça vraiment bon que tu demandes d’autres avis, car les regards neufs peuvent aider…

    Pour la génétique pré transfert, j’avoue que je ne comprends pas trop non plus :S Y a t’il eu un souci génétique diagnostiqué chez vous? Etrange…

    Plein plein de courage et désolée pour la réponse en français…

    • kiftsgate says:

      Merci pour avoir pris le temps de m’ecrire!
      Pas de problemes sur la reponse en francais! C’est moi qui s’excuse maintenent car j’ecris super mal en francais.. 😉
      Ca m’a bien tranquillisé ton commentaire qui dit que les avantages de j3 et j5 sont pas claires.
      Non, on nous a fait feire des tests genetiques (PDS) mais tout allait bien. Si j’ai bien compris c’est pour voir si les embryons se developpent bien ou pas, car on a eu des embryons de bonne qualité mais sans acroche.. mais j’ai pas trop compris tout ca…
      Effectivement je me trouve avec deux avis differents de la part de deux medicins differents. La seule difference etant plutot sur le biologique…
      Mais deja merci beaucoup, ca m’aide vraiment ce que tu dis!!

  7. jesselyn6585 says:

    I’m a crazy hippie so I say day 3 since as you put it, “Mum is best!” However, the scientist in me likes the idea of transferring stronger day 5 bebes. I wish I had some studies to give you to help but I do not. Sending you faith and confidence instead.

  8. I’m so sorry you are going through this. It is a lot of information and you’re right–you shouldn’t have to figure all this out!

    My clinic almost always pushes for day 5. They say that blastocysts have the best odds. And I always have to do frozen, as well, since I hyperstim. The day 5 frozen is working for me so far (fingers crossed). Is PGD an option for you? I think it increases the odds considerably.

  9. Pingback: Infertility coming out at work | Today I hope

  10. Miss M. says:

    I was reading about day-5 embryos having better chances… and I remembered this post. So here you go (“culture prolongée” chapter) :

    Good luck with IVF#4

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