Day 3 vs Day 5 embryos

[lucieloos]

I am due to cycle again next week. I never seem to get many eggs only 2-3 which luckily so far have fertilised and I have 4 hatching blasts frozen as I'm embryo banking. However this time around I will be having a fresh cycle and transfer and can't decide if I only get a couple of eggs again is it worth putting them both back at day 3 or growing them onto blasts again and then transferring as at least then we will know they have good potential? What have you done and what was the outcome?

Hello lovely luci. You might recall we've spoken on here before. Feels like a long time ago - must feel an even longer period of time for you if you've been struggling with this infertility saga all this time. If I remember rightly, your first IVF produced 6 eggs and I thought you went ahead with transfer so you must have started the embryo banking since then. Then the second cycle you had 11 follicles but the cycle was cancelled because the Dr didn't start you on the Cetrotide to stop ovulation until day 9 by which time it was too late! Sounds like the dramas haven't ended there if you've done repeated IVF cycles since to get a few embryos banked up and are now only producing 2-3 eggs.

Anyway, you ask what others have done and what was the outcome. My first IVF clinic only did day 2 transfer and after 3 embryo transfers with no positive result, I moved on to a clinic that did day 5 transfer so that I could know if the issue was that the embryos were not implanting, or were not making it to day 5 in the first place. The first time I had just one embryo and the clinic recommended that if I had less than 4 embryos alive at day 3, I should do a day 3 transfer rather than wait until day 5. However, I decided to wait until day 5 because that was one of the reasons I moved to this clinic to see that the embryo could make it that far. Sadly, it didn't and I got a call on the morning of day 5 as I was about to head in that it had arrested overnight. The next time I had two alive at day 3 and decided to do a day 3 transfer since it didn't survive to day 5 the previous time. I also tried acupuncture pre and post transfer after reading a study showing statistically significant higher pregnancy rates when doing this. The result was an early miscarriage. The last cycle (my 11th IVF attempt!) again produced just two embryos and again I had them both transferred at day 3 and repeated the acupuncture. This time one took and I am now 36 weeks pregnant.

So day 3 definitely worked for me, although obviously that is no guarantee that it will for others. It's a tough call. When the day 5 embryo didn't make it, I was left wondering 'would it have survived better if it was transferred at day 3? Would I now be pregnant?' If the day 3 transfers didn't take, I would have been left wondering if I was having an implantation issue or if the embryo just wasn't genetically normal and didn't make it until day 5 inside me!

Hi shell, wow you remember everything so well! Yes our first cycle we had 6 fertilised, 2 blasts transferred but bfn. We haven't had a transfer since then. As you rightly say I chose to cancel the second cycle and I then decided to embryo bank partly because I want to give us the best chance of 2 babies and don't think things will work out so well if we start this again a couple of years down the line and partly because I am afraid that I get premature lutenisation which causes progesterone to rise too early and leaves the lining out of sync. I have no evidence to back this up but it's just something I think could have been a possibility on the first failed cycle.

So I've since had 3 more cycles and it's been a long old process. I'm not sure why we are now only collecting 3 eggs a time. On my last collection there were 7-8 follicles between 18-21mm at egg collection and a couple smaller but still only 3 collected so something is going wrong somewhere but anyway I now have 4 hatching blasts frozen which I'm quite pleased with. My turn has come up on the NHS and I get 2 free cycles with them the first of which begins next week. Obviously I can't embryo bank with them so I'm going to have to have a fresh transfer. I don't really expect it to work on the NHS if I'm honest but in some ways it makes it a lot easier as I have very little in the way of expectations and of course have my frosties as back up. If it doesn't work I will do 1-2 mini ivfs in an attempt to increase the number of frozen blasts to 5 or 6 before beginning transfers.

Anyway I digress! It's a really tough decision isn't it. The day 3 transfers have obviously worked out well for you. I have always been of the mindset that if they don't make it in the lab they won't make it back inside you either and part of me thinks that I already have those 4 blasts to try with so maybe I should try a day 3 transfer just so I can say that's something else that we've tried. Even if they make it to day 5 still 50% of the blasts at my age won't be viable so even if they don't implant it wouldn't necessarily indicate an implantation issue. I just don't know what to do although I'm assuming a lot of things here at the moment. Maybe we won't even be lucky enough to have any day 3s to transfer. I guess I will have to wait and see how it goes and decide nearer the time.

Hope all is well with you. You can't have long to go now?

Can totally understand you wanting to 'embryo bank' now so that you don't have the stress of needing to repeat IVF down the line when you are older and the chances are lower, especially if you are now already only collecting 3 eggs per cycle. I had 11 IVF attempts, of which 7 went to egg collection and after my first few cycles, I started having exactly the same issue as you - that I would have several decent size follicles but only a couple of mature eggs. I had one cycle where I injected the trigger at an angle based on instructions I got with the trigger that were not given to me previous cycles. It hurt like hell going in and I had a big hard lump which perhaps was the trigger medication just sitting there and not getting into my system to make my eggs mature, as that cycle I only got 1 mature egg from 8 mature follicles. I think it was my second last cycle that the trigger went smoothly and after having read a study (which I can't find now) showing that women with normal weight range had hCG levels about 350 at 12 hours post trigger compared to obese women having levels at only about 150, I decided to test my hCG levels 12 hours after my trigger. Surprisingly my results were only 140 even though I was not in the obese category. I mentioned my concerned to my IVF Dr, and she said I could take the Synarel nasal spray in addition to the hCG trigger, to purge my brain of it's own FSH/LH hormones in addition to the trigger. My last scan on day 15 of my last and finally successful IVF cycle showed 19 18 15 13 10 10 and 4 less than 10mm, and I got 4 mature eggs on day 18 EC so at least my mature follicle count and number of mature eggs were in sync.

Also like you, we both seem to be research orientated as a way of working through our IVF journey. Not many others know about premature progesterone rise in an IVF cycle causing the lining to be out of sync and reducing implantation success. According to a few studies I read like this one, premature progesterone rise only has a detrimental effect if the embryo is transferred on day 3 but no effect if day 5 transfer is performed, which I guess makes sense as in a natural cycle, the embryo would still be travelng down the fallopian tube and not yet exposed to progesterone on day 3. I had a very empathetic acupuncture Dr who would give me as many blood tests as I wanted so I could get my blood tested the day before and the day of trigger to compare and see if my progesterone did prematurely rise in order to help me make a practical decision about day 3 versus day 5 transfer rather than just wondering and worrying.

You say that 'at your age' 50% of the embryos won't be viable. Is it rude to ask how old you are? It is amazing that you managed to get 4 hatching blasts frozen from 3 IVF cycles of producing only 3 eggs per cycle. I wish you well with your upcoming NHS cycle. Will be interesting to see how it compares to the treatment you received privately. Will the protocols be any different? Love to hear how you get on if you have the strength to come on here and update. xox.

Hi shell, that's really interesting that you also has the same problem with empty follicles. I have been wondering if it was something to do with the trigger. I did 2 Ovitrelle injections last time instead of the usual one but that didn't help. I am a normal weight. I was wondering if changing to Pregnyl might make a difference but now you mention about the synarel I wonder if I should self medicate with this cycle and use some left over buserelin that I have as well as the hcg. Surely it won't do any harm even if it doesn't work?

I will have to look at the premature progesterone rise some more as I thought if it had started to rise early it would mean that the lining would be ready earlier so if you transferred on day 5 the window for implantation might have closed 2 days earlier because of the early rise and even if you transferred on day 3 the window would still be missed as the embryos wouldn't be blasts and therefore wouldn't be ready to implant.

You ask about my age, I am 36 years old. I know it's not particularly old in the IVF world but still only 50% of blasts have the correct number of chromosomes at this age. Although even at age 30 it's something like 65%. I have been extremely fortunate as you say in getting 4 hatching blasts from the last 3 cycles and I thank my lucky stars each day for that as I know things could be a lot worse. We have had practically the same results for each of the 3 cycles. 3 eggs collected, 2 mature and fertilised. The first cycle both embryos made it to blast and were frozen which was amazing and on the second and third cycles 1 made it to blast each time. Even when I got 6 embryos on day 3 on my first ever cycle still only 2 made it to blast so my numbers seem to be fairly consistent regardless of how many eggs are collected. I'm pleased with that although it does make the wait to day 5 a lot more nerve wracking with low numbers!! If I could get through a few more cycles with 1-2 blasts I would be very happy and would feel like we've tried our best.

I will update on how my NHS treatment goes if you are interested to know. I am having my baseline scan this morning which I am a little nervous about as I haven't had one before with any of my treatments so I hope they don't find anything which will stop me from going ahead or really low follicle numbers. I will then pick up my medication if everything is ok and can get going. All I know at the moment if that I'm on a short protocol but hopefully find out more later.

Sorry shell also what protocol were you on when you used the synarel trigger? Would it work as well with short antagonist where Cetrotide is being taken to block LH?

I believe the synarel trigger only works with antagonist protocol where an agonist isn't already being used

However I know Dr sher is very against this as he says it compromises egg quality as the eggs don't sufficiently mature - I believe it's normally used in cases where there is a high risk of OHSS and an hCG trigger would be too dangerous

He is also very anti ovitrelle but I did fine on both rounds with it as trigger. He also says short antagonist protocol gives rubbish eggs and so by his reckoning my protocols were total crap - he seems to say anything but his AAC/P protocol risks duff eggs. I did very well on an antagonist protocol with ovitrelle trigger despite my crap AMH and FSH so I'm not sure absolutes are that helpful

I entirely agree with everything you've said about day 3 embryos and wish you tonnes of luck with your baseline and this cycle xx

First cycle I only had a couple of eggs and one embryo so had it put back on day 2 with a negative result, cycle 2 I had no eggs still don't know how this happened I think I was kept stimulating to long as had lots of big follies on last scan I think thy became over mature. Cycle 3 went for short protocol had 19 eggs and went to day 5 where I had 2 perfect embryos that resulted in twins.

If your only getting a small number of eggs I wouldn't risk waiting until day 5.

I had buserilin as a trigger in my mild Ivf cycle last April due to high ohss risk. It seemed to work out ok as I got 16 eggs of which 13 mature

It was the only option really as I had so many follicles they wouldn't entertain a hcg trigger or fresh transfer. I don't know if perhaps it affected the quality of eggs/embryos though

Thanks Banana; I wouldn't use synarel on its own but I wonder if it might be a nice little boost to use it with hcg as well?

I followed dr shers a/acp protocol to the letter on my last cycle whilst there were plenty of mature sizes follicles the outcome was no better so I don't take what he says as gospel anymore.

Doubledaff; thanks for the info and brilliant news that you got twins from your day 5s. I'm quite looking forward to trying a normal short antagonist cycle again as its the one I did best with on my first ever IVF which gave me 7 eggs. Although I have tried it once since and it only gave me 3 eggs but hey ho.

Waiting, did you take your 13 mature eggs to blasts? What were the numbers like?

I have been doing some reading and am not sure if you can do a fresh. Cycle with buserelin / synarel trigger? Apparently it might affect the lining although shell has done ok with it. Will have to look into it some more.

No, sadly not. Not all fertilised/fertilised normally and we ended up with 2xday 2 embryos frozen and 1xday 3

Had the day 3 embryo transferred last October and bfn, was meant to have both day two embryos transferred on Friday but only one survived the thaw so I'm now in 2ww but in all honesty I'm trying to stay positive but I think it's unlikely it will stick. It was a 5 cell grade 2. Hoping for a little miracle but very aware I may need to start again

I don't think you can do a fresh with non hcg trigger, did shellster have it alongside hcg ? Maybe that's a possible plan to combine them (if you can)

Sorry to hear that waiting but definitely try and stay positive. I had a 4 cell on day 3 which I had given up on but it made it to hatching blast by day 6. I don't know if it will give me a bfp but there's definitely hope. Keeping everything crossed for you.

I think shellster combined hcg and synarel so maybe that works out differently?

Yes, I combined the hCG with the Synarel - not Synarel alone. I took Pregnyl as my trigger medication. What protocol did I do? I took 4mg estrogen (2mg twice daily) from day 21 of the cycle prior to my IVF cycle until day 1 of my IVF cycle). I then took 450 Puregon daily (which again I split into two doses just so I could have a steady stream of the drug in my system). I then added Luveris when the lead follicle reached a certain size as the Dr said this mimics what happens in a natural cycle where the LH rises as the follicle starts to mature and added the antagonist injection to stop me ovulating. The one thing I did without the Dr's knowledge was give myself one last dose of FSH along with the Pregnyl trigger injection after reading this study. My IVF Dr was not familiar with this but I felt convinced it was the right thing to do as this study clearly showed it produced higher fertilisation rates and higher pregnancy rates. Also, again it mimics what happens in a natural cycle where our FSH surges before ovulation.

You're probably confused more now than every before luci!! There is so much contradictory info on IVF protocols and outcomes even with studies giving conflicting results! So now you have read everyone's different advice, you are probably more confused!

Will wait to hear how you get on with your scan.

Thanks Shell, I had my baseline scan today which was fine. The lining was nice and thin and the ovaries looked good so they were happy to start me. They have put me on short flare protocol so basically I take 0.5ml suprecur everyday which for the first 3 days causes my own natural fsh to rise sharply hopefully recruiting some extra follicles and it also stops ovulation. I'm then on 300iu Menopur a day. I have done this protocol before and again only had 3 eggs collected, 2 mature and fertilised but this was the protocol where both of my embryos made it to blast so who knows maybe we might get lucky again.

Seeing as I'm going to be using suprecur through my cycle it's not going to work as a trigger so that's that one decided. They haven't given me the trigger shot to take home yet so at my next scan I will enquire about whether I can try Pregnyl instead of Ovitrelle to see if that makes any difference. Can't believe I'm getting going again. My next scan is next Tuesday and they are thinking egg collection may be 2 weeks today!

Glad to hear your scan went well. I tried that flare protocol once myself, but I was given Synarel nasal spray instead of Suprecur, but does the same thing of purging my pituitary gland of all it's hormones to try to give my ovaries a kick start. It's hard to compare isn't it. Even though you've done this protocol before, there are no guarantees it result will be anything similar this time. I've done the same IVF preparation and preparation with estrogen priming and sometimes had 15-16 follicles at my baseline scan, while other times I only had 7-8 so who knows.

Almost seems like an easier decision knowing that Suprecur isn't going to work as a trigger, rather than stressing yourself out umming and ahhing about it over the next two weeks.

Most people seem to get their BFP within the first couple of cycles, and I didn't think there were many on par with me at 11 IVF attempts. But you are up there luci! Here you go yet again... will be counting down to Tuesday with you.

Haha thanks Shell, yes I am on cycle number 6 now if I include the cancelled one but I would hope had I been having transfers I would be pregnant by now but who knows. I will be glad to get these bits over and get on with doing the transfers although I have to keep reminding myself I'm actually having a transfer this time!!! It's been a long old journey doing the embryo banking and I'm really looking forward to having something put back and having that little bit of excitement and hope rather than moving straight onto the next round of treatment.

I know all too well that no cycles are the same. On my first cycle I got 7, collected and 6 fertilised and then when I repeated the same cycle a little down the line I got the 3 collected, 2 fertilised that has become standard for me now but of course this is a different clinic and anything could happen but I hope I manage to get something.

I count my cancelled cycle in my 11 IVF attempts so I definitely think you are allowed to count the cancelled cycle in your tally of 6. Just because we didn't get knocked out for EC, the cycle was just as emotionally grueling - in fact I found it more emotionally devastating because I was cancelled for responding poorly and so not only did I have to kiss goodbye to my baby dream for that cycle, but it made me feel no hope for any future IVF attempts working while I waited to recover from the drugs of that cycle so I could try again and feel less hope with a few more months added to my age.

I keep saying to Dh we've had three attempts now and he says no it's def two but I am counting the mild IVF cycle plus two FET cycles. Dh only considers it an IVF attempt if there was ET ?!?

I am kind of a little bit the same as your dh waiting but can see it from both sides. I don't really count my cancelled cycle as a proper go because we didn't make it all the way through and cancelled after only a few days of stimms. I can see why you would count it as a go though because you invested the time and did the stimms etc and it didn't work so you are saying that's a failed round which I totally get. For me personally though I kind of feel unless I've gone all the way through with a cycle and had a transfer and it's failed it doesn't count. I know that's probably weird lol.

I consider myself to have had two cycles because I had two retrievals, but my Dr considered my second cycle as part 1 of 2 because the first was banking only. As a first transfer he considered it a first attempt at IVF, because we hadn't had a failed cycle until that point!

That makes sense banana for the second cycle to be considered part B as you were banking only in the first. For me, it counted because the reason I never did a full cycle was because it failed along the way (either my ovaries didn't respond or the embryo died before ET) and it felt just as emotionally devastating knowing that the cycle was another BFN at that point. I guess whatever we count, it's the length of time that we are suffering that is the hard part.

Shell, what were your progesterone levels when you had them done on trigger day?

I had egg collection on a Wednesday and two embryos transferred on the Friday, so day 2 transfer. I'm now 25 weeks pregnant so early transfer worked for us. It was my first cycle and it was on the NHS. Why do you have concerns your treatment on NHS won't work? The treatment I had was second to none and can't imagine being treated any better if we'd received private treatment. My clinic was amazing. Good luck with your treatment and I'm sure the clinic will make the best decisions with you.

Shellster52, how can you be 36 weeks already!?

Hello again Osirus. Yes, actually I'm 37 weeks today. Weird how every day leading up to an IVF cycle seemed like an eternity, but the pregnancy has flown by. Hope you are feeling well and relaxed now that you are 25 week sin.

luci, I have a whole folder of blood test results after my obsessive tracking during my 11 IVF cycles. So I will dig my records out tonight and see which progesterone levels relate to the day of trigger and report back.

Hi Osirius and congrats! Unfortunately my NHS clinic hasn't received such glowing reviews and I've read of a lot of people not so happy with things but so far I have found them ok so we will see.

Shell, that would be great thanks. I'm debating whether to pay for a private test but I've read a lot of reports say it's quite controversial and some doctors believe it can affect implantation and others don't so if it was higher than average I'm not sure how much value my clinic would place on it.