Day 3 or Day 5 Embryo transfer
6 Replies
suzie - September 3

Hi there,

This is my first time posting here but I'm so glad I found you. I have a few questions I was hoping you could answer for me.
A little history...
I have PCOS and my DH has a very low sperm count (I am 37 and he is 38) The nurse said in any given sample, my husband has about 50,000 sperm they can work with, ICSI was our only option.
I have done IVF before (8 years ago) and had twins boys. When I was trying that time, I had done IVF twice, the first time I got pregnant and m/c twins at about 7 1/2 weeks, the 2nd time I had my boys. Both times we did 3 day transfers and our egg quality with the boys was horrible, the were both c quality and had only split to 6 and 7 cells, we didn't think we would achieve a pregnancy and we did, they are perfect.

We are now trying again and had 1 failed IVF cycle, this time we had 4 embryos make it to the blasto stage and we put back 2 'A' quality embryos but with no success.

I'm worried about 2 things, #1 it took me 14 days to stimuate, does that have an inpact on implantation; is my uterus to far ahead? and #2 my doctor has me on strict bed rest for 4 days, he doesn't want me to shower or even sit up. When I had my boys, I was told to rest that day (after the transfer) and then I was back at work the next day. Is resting for 4 days a bad idea? I've read articles saying it's almost bad to be still for that long, blood flow to the uterus etc...

Now we are getting ready to start our next cycle and I'm wondering if it takes 14 to get mature folicles, should we consider a day 3 transfer or will day 5 be ok? AND..the best rest, 4 days? Can you help us?



B. Jacobs, M. D. - September 4

Typically, we perform a day 5 transfer of 2 blastocysts. Occassionally, we do not have many qualty embryos on day 3, and we will perform a day 3 transfer. There is no real evidence that bed rest is necessary after embryo transfer. I used to have patients remain at absolute bed rest for 2 hours after transfer, and then 2 days of bed rest at home. Today, we are only haveing them at bed rest for 30 minutes before returning to normal activity. I do not know that 30 minutes of bed rest is necessary, either. I guess I am treating myself. Coincidentally, my pregnancy rates have increased since decreasing the timeof ved rest, but there is no cause and effect relationship. Finally, the time intervaol from retrieval to transfer has to be synchronized. Teh embryo age has to be synchronized with endometrium based on date of retrieval. That is an automatic with fresh embryos made from your own eggs. It is a little tricky with donor egg or frozen embryo transfer.
Good luck.


suzie - September 6

Thanks so much!

So if it takes 14 to get mature folicles, is a 5 day transfer still ok? I guess I'm afraid the timing might be off?

Also, I've talked to my doctor about the bed rest and he still thinks 4 days strict bed rest is the best. I think having gotten pregnant doing IVF before with only a day of taking it easy, I'll go with my heart.



B. Jacobs, M. D. - September 6

The only timing that is important for implantation after retrieval is time from retrieval to transfer. If you have good embryos, thay need to be synchronized with number of days of progesterone exposer, not estrogen exposure priior to transfer.


SuzieM - April 1

Dr. Jacobs,
I have a quick question and I understand how hard it is for you to answer these questions when we aren't your patients :-)
We did a FET last week on Thursday and my doctor always brings you back 4 days after to check progesterone and estrogen. Of course we are on progesterone support, which includes suppositories (3 times a day), PIO (1cc with Delestrogen) and the pometrium tablets 3 times a day.
With my 2 failed fresh IVF cycles, my progesterone levels were around 120 the first time and 70 the 2nd time. This time my progesterone was at 370 (Estrogen around 900). We ended up putting back 4 embryos and we did assisted hatching time as I'm 38 year old. I know progesterone levels don't indicate pregnancy but are we off to a good start with these levels? I'm trying to decide whether we're in a little better shape this time vs last time.



SuzieM - April 7

I'm hoping you can help me. I'm 38 years old with PCOS and my Husband has a very low sperm count. 8 years ago we went through IVF twice, I got pregnant both times, miscarried the 1st time and delivered healthy twins the 2nd time. Both of those IVF cycles were a day 3 transfer. Now, 8 years later we are trying to have another baby. We've done 2 IVF cycles (both with 5 day transfer and great quality embryo's) and 1 frozen cycle and none have worked. It seems like this time for some reason the eggs aren't attaching, which was different then the problem 8 years ago which was embryo quality but we were still able to get pregnant.
I was wondering if there was a way to figure out they aren't attaching this time or should we try a 3 day transfer because that worked twice in the past? I was also looking into ZIFT; would that be something we might have better success with? I'm just not sure what to do next?



Helena - November 30

Today I got a call from my doctor office they told me that (today is day 3) I have : 1-8 cells good quality (I asked what is mean “good” they told me it is the best quality), 1-8 cells fear quality (which is mean medium), 1-6 cells good quality (which is mean not bad for day 3 with 6 cells and it is best quality),3- 4 cells fear quality, and 1- not so good. They are all still there but not all of them good quality and strong. My doctor called again after he gave me information of quality for today and he asked me if I am sure to go with day 5. He recommended to do transfer today and to transfer 3 of them which are the best and strong for day 3. Did I do right decision? What is the best in this case?
Thank you,



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