Choosing Between Day 3 vs. Day 5 Embryo Transfer

Margaret Graf Garrisi, M.D.
Dr. Garrisi ART

“You have to be in it to win it.”

With all seriousness, I am saying that if no embryo(s) are transferred into a uterus in a fresh IVF/ICSI cycle, there can be no pregnancy (I am excluding embryos biopsied for genetic testing for hopeful thaw and transfer of a normal embryo in the future).

I am referring to IVF/ICSI cycles with no plan for genetic testing who plan for a fresh embryo transfer. Historically, decades ago, almost all fresh embryos were transferred on day 3, not day 5, since laboratory capability could not grow embryos in culture to blastocyst at that time. Currently, most IVF labs can culture embryos to blastocyst for fresh transfer or biopsy for genetic testing. Pregnancy rates with day 3 vs. day 5 embryo transfer are comparative; transferring 2 day 3 embryos has the pregnancy rate of 1 day 5 embryo but carries an approximately 20% chance of twins.

As we all know, there is great biologic variability in women’s cycle response to quantity and quality of embryo number and development. In women with few embryos in the lab, it is often better to do a day 3 transfer rather than “push” these few or sub-optimal embryos to day 5 for a blast transfer; these embryos may “arrest” and so there is no transfer on day 5.

Many hundreds of thousands of children have been born after transfer of day 3 embryos, and this is also true for patients today. With all respect to my Embryology colleagues, a woman’s uterus is still a better “incubator” than a laboratory; many day 3 embryos can thrive and implant in a woman’s uterus for a pregnancy that just cannot survive in a laboratory environment.

If you have done an IVF/ICSI cycle and received the sad phone call on day 5 that all of your embryos have “arrested” and you will not have a transfer, seek a second opinion before your next cycle. You could become pregnant with an embryo transfer on day 3.

Dr. Margaret Garrisi brings more than 25 years of experience and achievement in Obstetrics, Gynecology and Infertility to her position as Medical Director of Assisted Reproduction in the Division of Reproductive Endocrinology at IRMS NJ. Prior to joining IRMS, Dr. Garrisi practiced at the Center for Reproductive Medicine and Infertility at Cornell University Medical Center, and served as an Associate Professor of Obstetrics and Gynecology at Cornell Weill Medical College, where she had completed her residency training in obstetrics and gynecology. Dr. Garrisi completed her fellowship in reproductive endocrinology at Mount Sinai Medical Center in New York. An attending physician in IVF for over two decades, she is board certified in obstetrics and gynecology, as well as reproductive endocrinology.

To book a consult with Dr. Garrisi or any of our other wonderful team of female doctors, please drop us a line on our contact form or call us at (973) 322–8286.

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