Day 3 transfer?

Day 3 transfer?

SMRC
SMRC

December 16th, 2011, 4:49 pm #1

We're scheduled for a day 3 transfer today at 1:45 with no other information given. Can't help but think this isn't a good sign re development? I know the day 3 vs day 5 issue has been raised on the board before, with factors weighing both ways. Ugh! SMRC
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Joined: August 18th, 2010, 6:45 pm

December 16th, 2011, 6:44 pm #2

My donor took too long to get to trigger and because of the holiday lab closure I am being told that I must have a day 3 transfer.

Our reason for wanting a day 5 (blastocycst) tranfer is outcomes - they can put in the best single blastocyst and significantly reduce the risk for twins. They know more about the viability of the embryos once they make it to day five. At day three the embryos can be graded on the appearance and number of cells but they have not yet made certain developmental benchmarks so it is more of a guessing game to know which ones are best. Also overall outcomes are, (very) generally speaking, lower at day three compared to day 5.

In our case, we really do not want twins so we absolutely want to do a single blastocyst transfer. But at day three, because they know a lot less about which ones to put back, they generally put in more than one.

I looked it up for my clinic. If I want the best possible odds of getting pregnant with a day 3 transfer I have to put back in 2 embryos (55% clinical pregnancy rate) and that is the most common type of transfer that they do on D3. With that comes a 27% twinning rate. Importantly a two-embryo day 3 transfer clinical pregnancy rate is still lower than a day 5 single blastocyst transfer (65% clinical preg rate).

There is some self-selection bias going on in the data because, generally speaking, they do a day 3 transfer when there are fewer embryos to work with and/or less than two or three look like they will make it to day 5 (low grade on day 3) and they don't want to risk not having a transfer. For my clinic, the cut off for an in-town patient is three or less grade 1 embryos at day 3. For OOT town patients they will try for a day 5 transfer even if 2 are grade 1 on day 3.

My doctor explained to me that the predominant reason to do a day 3 transfer with a single embryo is because only one looked good enough on that day or that was all they had. He said that in my case it was rare that they would be forced into making the call for a day 3 transfer because they typically tell all OOT patient to expect a day five transfer.

Needless to say I am not happy. I feel I got sold a bill of goods - we choose our clinic because of their "culture" of preferred single blastocyst transfer. This entire cycle has been mismanaged from the start and delayed for months because of their mistake. As a result, I am now not getting what I paid for. Also my DH is utterly and completely against transferring more than one so now we are fighting about this. Argg!

I hope that info was what you were looking for. Your clinic could have great stats with day 3 transfer. I know I should not complain/worry because a 55% pregnancy rate with a day 3 transfer is quite good! But I am obviously biased about what I think is best so take my rambling for what its worth.

Good luck!
Last edited by Seymo on December 16th, 2011, 7:03 pm, edited 1 time in total.
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Joined: September 30th, 2007, 7:22 pm

December 16th, 2011, 8:04 pm #3

We're scheduled for a day 3 transfer today at 1:45 with no other information given. Can't help but think this isn't a good sign re development? I know the day 3 vs day 5 issue has been raised on the board before, with factors weighing both ways. Ugh! SMRC
and none of my day 5 transfers resulted in BFPs.

there are some RE's (especially at cornell) that prefer day 3 transfers. there are embies that do much better inside you than sitting out waiting another 2 days. you are the best incubator there is. you just need to decide how many to put back. you'll get the embie report when you get there. good luck. this is NOT a bad thing, i promise.
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Joined: August 18th, 2010, 6:45 pm

December 16th, 2011, 8:38 pm #4

I hope you don't mind me asking, how many did embryos they transfer?
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Anonymous
Anonymous

December 16th, 2011, 9:06 pm #5

We're scheduled for a day 3 transfer today at 1:45 with no other information given. Can't help but think this isn't a good sign re development? I know the day 3 vs day 5 issue has been raised on the board before, with factors weighing both ways. Ugh! SMRC
...my clinic only does day 3 and i got pg on the first try!
Good luck!
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Mrs. M
Mrs. M

December 16th, 2011, 9:47 pm #6

My donor took too long to get to trigger and because of the holiday lab closure I am being told that I must have a day 3 transfer.

Our reason for wanting a day 5 (blastocycst) tranfer is outcomes - they can put in the best single blastocyst and significantly reduce the risk for twins. They know more about the viability of the embryos once they make it to day five. At day three the embryos can be graded on the appearance and number of cells but they have not yet made certain developmental benchmarks so it is more of a guessing game to know which ones are best. Also overall outcomes are, (very) generally speaking, lower at day three compared to day 5.

In our case, we really do not want twins so we absolutely want to do a single blastocyst transfer. But at day three, because they know a lot less about which ones to put back, they generally put in more than one.

I looked it up for my clinic. If I want the best possible odds of getting pregnant with a day 3 transfer I have to put back in 2 embryos (55% clinical pregnancy rate) and that is the most common type of transfer that they do on D3. With that comes a 27% twinning rate. Importantly a two-embryo day 3 transfer clinical pregnancy rate is still lower than a day 5 single blastocyst transfer (65% clinical preg rate).

There is some self-selection bias going on in the data because, generally speaking, they do a day 3 transfer when there are fewer embryos to work with and/or less than two or three look like they will make it to day 5 (low grade on day 3) and they don't want to risk not having a transfer. For my clinic, the cut off for an in-town patient is three or less grade 1 embryos at day 3. For OOT town patients they will try for a day 5 transfer even if 2 are grade 1 on day 3.

My doctor explained to me that the predominant reason to do a day 3 transfer with a single embryo is because only one looked good enough on that day or that was all they had. He said that in my case it was rare that they would be forced into making the call for a day 3 transfer because they typically tell all OOT patient to expect a day five transfer.

Needless to say I am not happy. I feel I got sold a bill of goods - we choose our clinic because of their "culture" of preferred single blastocyst transfer. This entire cycle has been mismanaged from the start and delayed for months because of their mistake. As a result, I am now not getting what I paid for. Also my DH is utterly and completely against transferring more than one so now we are fighting about this. Argg!

I hope that info was what you were looking for. Your clinic could have great stats with day 3 transfer. I know I should not complain/worry because a 55% pregnancy rate with a day 3 transfer is quite good! But I am obviously biased about what I think is best so take my rambling for what its worth.

Good luck!
This seems unfair, there should be some contingency plans made for OOT DE patients to allow for a 5 day transfer. At my old clinic, I had elected to transfer two 3 day embies on an FET but when we showed up they did not updated the treatment plan and only thawed one embryo. That was the transfer that I did get the BFP. The first RE that I worked with for OE felt very strongly about 3 day transfers and sometimes did two day transfers b/c she felt the "natural" uterine environment is where embies did best. Sorry for the arguing with your husband. Is your transfer still scheduled for Thursday.
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Anonymous
Anonymous

December 16th, 2011, 9:52 pm #7

My donor took too long to get to trigger and because of the holiday lab closure I am being told that I must have a day 3 transfer.

Our reason for wanting a day 5 (blastocycst) tranfer is outcomes - they can put in the best single blastocyst and significantly reduce the risk for twins. They know more about the viability of the embryos once they make it to day five. At day three the embryos can be graded on the appearance and number of cells but they have not yet made certain developmental benchmarks so it is more of a guessing game to know which ones are best. Also overall outcomes are, (very) generally speaking, lower at day three compared to day 5.

In our case, we really do not want twins so we absolutely want to do a single blastocyst transfer. But at day three, because they know a lot less about which ones to put back, they generally put in more than one.

I looked it up for my clinic. If I want the best possible odds of getting pregnant with a day 3 transfer I have to put back in 2 embryos (55% clinical pregnancy rate) and that is the most common type of transfer that they do on D3. With that comes a 27% twinning rate. Importantly a two-embryo day 3 transfer clinical pregnancy rate is still lower than a day 5 single blastocyst transfer (65% clinical preg rate).

There is some self-selection bias going on in the data because, generally speaking, they do a day 3 transfer when there are fewer embryos to work with and/or less than two or three look like they will make it to day 5 (low grade on day 3) and they don't want to risk not having a transfer. For my clinic, the cut off for an in-town patient is three or less grade 1 embryos at day 3. For OOT town patients they will try for a day 5 transfer even if 2 are grade 1 on day 3.

My doctor explained to me that the predominant reason to do a day 3 transfer with a single embryo is because only one looked good enough on that day or that was all they had. He said that in my case it was rare that they would be forced into making the call for a day 3 transfer because they typically tell all OOT patient to expect a day five transfer.

Needless to say I am not happy. I feel I got sold a bill of goods - we choose our clinic because of their "culture" of preferred single blastocyst transfer. This entire cycle has been mismanaged from the start and delayed for months because of their mistake. As a result, I am now not getting what I paid for. Also my DH is utterly and completely against transferring more than one so now we are fighting about this. Argg!

I hope that info was what you were looking for. Your clinic could have great stats with day 3 transfer. I know I should not complain/worry because a 55% pregnancy rate with a day 3 transfer is quite good! But I am obviously biased about what I think is best so take my rambling for what its worth.

Good luck!
I would be very upset at this too n/t
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Joined: September 5th, 2011, 12:16 am

December 16th, 2011, 11:00 pm #8

We're scheduled for a day 3 transfer today at 1:45 with no other information given. Can't help but think this isn't a good sign re development? I know the day 3 vs day 5 issue has been raised on the board before, with factors weighing both ways. Ugh! SMRC
I responded in another post before I saw this one. Hope all went well today!!
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Joined: August 18th, 2010, 6:45 pm

December 16th, 2011, 11:27 pm #9

This seems unfair, there should be some contingency plans made for OOT DE patients to allow for a 5 day transfer. At my old clinic, I had elected to transfer two 3 day embies on an FET but when we showed up they did not updated the treatment plan and only thawed one embryo. That was the transfer that I did get the BFP. The first RE that I worked with for OE felt very strongly about 3 day transfers and sometimes did two day transfers b/c she felt the "natural" uterine environment is where embies did best. Sorry for the arguing with your husband. Is your transfer still scheduled for Thursday.
I had a very honest discussion with Dr. Chang about everything and there is not much they can do. My DH wasn't with me at the time so the doctor also called him to go over the stats with him and how to make a decision about how many embryos to transfer, etc. Tonight I hope to have a long talk to get to an understanding. Interestingly Dr. Chang kept using the word "if" as in "if there were embryos to transfer". That was not reassuring.

We have been trying to have a child for about six years now and Dh and I have never had an argument or even a strong disagreement until this.

Blerg. Too much stress! I hope you are having a better week than I am.
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Mrs. M
Mrs. M

December 16th, 2011, 11:57 pm #10

Why is she saying "if" ? If the donor had 18 measurable follicles the other day and it was a 2 way split, I would think you would get at least 5 or 6, and maybe 10 if you are lucky, even if you are the second recipient. Have you had any add;l updates on donor?

I'm feeling a little better. Got an email back from my nurse that she sent the monitoring orders for the mock. Called the clinic (my old clinic) today and scheduled appt and confirmed they had the orders.
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