43, how many embies to transfer, 3 or 5 day

(23 posts)(17 voices)
  1. Hi -
    After I have gone through numerous failed cycles, my DP is going to stim. She's 43 and has an FSH of 10.8 and antral follicle count of 14.

    So, the big question is how many embies to transfer and whether to do a 3 or 5 day transfer. Any thoughts?

  2. What was your response in your previous cycles ? How many embies , did you have a 3 day or 5 day transfer ? what was your embryo quality .

  3. Transfer all of them available. They will weed themselves out.
    Good Luck.

    Pachi

  4. Hope - not sure you understood. We've never tranferred DP's eggs. So, we have no idea about the quality. But, based on her age...

    Pachi - when you say transfer everything, up to how many? What if there are 14? Should we wait until day 5 and then transfer blasts? I know that RE will be conservative, since we've never used DP's eggs, but I want a good a chance as possible.

  5. Yes, if possible do a 5dt and they will weed themselves out. DP could have several on day 5 (hopefully more than 5) and I would transfer all at age 43. The chances of HOM at that age are very low. You can't really afford to be conservative at age 43. The worst case would be twins and even that is low.

    Good luck to you.

    Pachi

  6. Pachi -
    Thanks for your thoughts on this. I think DP is thinking that since she may have a lot of eggs retrieved (especially compared to me) that they are better quality. Not sure how many blasts the RE will transfer on day 5. I'll ask and see what he says. May be hard to get DP on board since she's petrified of multiples.

    Hopeful

  7. My doctor told me that 60% of 40 yo eggs are chromosomally abnormal; 75% of 43 yo eggs are chromosomally abnormal and 90% of 45 yo eggs are chromosomally abnormal.

    Sobering statistic, but maybe it will help your dp feel more comfortable about transferring the whole lot.

  8. Thanks Josie. Although based on your statistics, since we only want 1, we shouldn't transfer more than 4. Then again, based on those stats, we're not likely to get twins unless we transfer 8. So, maybe I can convince her to transfer up to 8.

  9. I think studies have shown that over 40 you should transfer 5 if you have them. I can't imagine even if she got 15 eggs that there would be more than 5 available on day 5. If you have 5 or less on day 3, transfer them ALL then.

  10. At 43, I did my 5th IVF at Cornell. We xferred 6 embies. All were awsome, 4 (8-cells), plus a 7 & a 9 or 10 cell on day 3. (Unless you have too many to xfer, apparently day 3 is the way to go - i.e you are xferring everything). All embies were very high grade. (We did their co-culture procedure).

    6 embies - that was the recommendation of one of the top REs in the country.

    Anyway, nothing stuck.

    I'd say go for what ever you have & see what sticks. That's what my dr. said. You spend so much to get these embies & they don't freeze well. Go for it all. The risk of even getting pg with one, I hate to say, is low. If you actually were lucky enough to have twins, just think of it as a real blessing! Don't worry about it.

  11. Transfer everything! At age 42, I had seven fertilized embryos and did microarray genetic testing on the eggs. Of the seven, only two came back as normal and were transfered as day 3. Nothing stuck.

  12. Just for another view - even at 43, I would still be cautious about transfering the whole lot unless you are willing to do selective reduction. On one of the threads that I post on, there was a 41.5 yo who transferred 10 three day embies (including 3 which were not good quality), 5 took and 4 had heartbeats. She chose to do selective reduction.

    On my last cycle in Jan, I had 6 blastocysts. I am transferring them 2 at a time, rather than risk multiples as I am not prepared to do selective reduction. My doctor gave me the choice of transfering them 2 at a time or 3 at a time, but he was more comfortable with transfering them 2 at a time. Unfortunately no luck with the fresh cycle, but hopefully with the frozen ones!

  13. I am a rarity, but at 41 after transferring four three-day embryos I became pregnant with multiples. I did a reduction and miscarried soon after, losing them all. This is not a typical story--it happens rarely after selective reduction--but believe me, you do not want to be in my shoes.

  14. I have done 8 IVF, two at 41.5yo and 6 at 43-43.5yo. My first 2 IVFs I transferred 4 and froze 4 (blighted ovum 1 sac); my second transferred 5 (had singleton). These were day 5 transfers. My other 6 IVFs I had between 3-9 embys and transferred them all...got 4 BFP all blighted. Honestly if you have more than 5, wait until day 5, some will die off so you can transfer the best ones; if you have 5 or less, put them all back on day 3. Yes, multiples can occur, but 43 is much different than 41. Trust me I know. I had 16 eggs retrieved with 13 fert on my first 2 IVFs; my last IVFs I had 11 eggs and had 3 fertilize on average. Your quality changes dramatically in that short year.

  15. I would either transfer all or run straight to CCRM and do a CGH study. Most of your DP's eggs are going to be abnormal a the age of 43. I am ALMOST 41 and the decline in my fertility and rate of normals is stunning in just four months. Four months ago I was in OK shape - now I think I am almost too late. Going to CCRM next month.

    CCRM is getting 70 pregnancy rates in women 38-43 right now with CGH (tests all the chromosomes).

    Good luck to you!!!!

    HOM are not the norm for women over 40 - not in the least.

  16. I agree with the others under 5 transfer all at day 3, over 5 wait and see what you have at day 5. Even if all implant it's likely that she will loose 1 or more early on.

    My first IVF we had 8 follicles in the range they are looking for, only 5 eggs at ER, we were told at my age that 50% fert and making it to day 3 was the norm. 4 Made it and we transfered all. BFN.

    Our 2nd IVF we did at SIRM; Early on things looked good, but by the time we got close to ER the RE only found 3 follicles with a possible 4th and 5th one. We considered canceling, but decided that we would go ahead, on a prayer. The RE (DR Fisch) kept talking about how they go for quality not quanity. They got 3 eggs but one was not mature and I figured it was over. When both fertilized and made it to day 3, I was surprised. The entire time I knew it wasn't going to work and was prepared when they called with our BFN. Only it wasn't, it was my first ever BFP. I just keep thinking about how close I came to backing out. At 44 I was given a 60% chance of M/C until after we saw a hb. Once we saw the hb that chance only dropped to 40% until 12 weeks. I wasn't ready for that one either. I ended up both a loss and a baby. Our pg started as twins and one stopped developing sometime before 10 weeks.

    Twins can be more common in woman over 40, but HOM are not. Esp with your own eggs. Many that I know of who were over 42, and started a pg with more than 2 self reduced, because of abnormal eggs.

    I don't know if PGD is an option, but I think that can lower your chance of m/c and point you in the right direction.

    Good luck. Patti

  17. Hey everyone - I'm 43 and did a mini IVF protocol with Dr. Silber in St. Louis. His goal was to transfer four blasts at once because he said the chances of even getting one to take would be amazing at my \"advanced\" age.

    I ended up having to do two retrievals because of a low egg count each time, which ended up giving me three 3-day blasts. I did my transfer on 11/25/08, and on that day, they showed me a picture where two of the three blasts didn't survive the freezing/thawing cycle. I was told this is very rare and they don't know why it happened. But in the end, all it took was the one good blast, because I'm now 14w3d prego.

    But I would have definitely done all four at once just for the reason that they really don't even chart success rates after age 42.

    I'll keep my fingers crossed for you!!

  18. How long after egg retrieval does embryo transfer occur?

    Once an ART cycle has progressed from egg retrieval to fertilization, the embryo(s) can be transferred into the woman’s uterus in the subsequent 1 to 6 days. Figure 35 shows that in 2006 approximately 64% of embryo transfers occurred on day 3. Day 5 embryo transfers were the next most common, accounting for about 27% of ART procedures that progressed to the embryo transfer stage.

    Figure 35: Day of Embryo Transfer Among ART Cycles Using Fresh Nondonor Eggs or Embryos, 2006.

    In general, is an ART cycle more likely to be successful if embryos are transferred on day 5?

    As shown in Figure 35, in the vast majority of ART procedures, embryos were transferred on day 3 (64%) or day 5 (27%). Figure 36 compares success rates for day 3 embryo transfers with those for day 5 embryo transfers. In all age groups, the success rates were higher for day 5 embryo transfers than for day 3 transfers. However, some cycles do not progress to the embryo transfer stage because of embryo arrest (interruption in embryo development) between day 3 and day 5. These cycles are not accounted for in the success rates for day 5 transfers. Therefore, differences in success rates for day 3 and day 5 transfers should be interpreted with caution.

    Figure 36 is a bar graph representing percentages of day 3 and day 5 embryo transfers using fresh nondonor eggs or embryos that resulted in live births, by woman’s age, 2006. Note: Cycles using GIFT or ZIFT are excluded. This comparison is limited to transfers on day 3 and day 5. Embryo transfers performed on days 1, 2, 4, and 6 are not included because each of these accounted for a small proportion of procedures.

    • Age <35, Day 3, 42.0%, Day 5, 51.8%
    • Age 35–37, Day 3, 35.2%, Day 5, 43.8%
    • Age 38–40, Day 3, 25.0%, Day 5, 35.3%
    • Age 41–42, Day 3, 14.3%, Day 5, 21.7%
    • Age >42, Day 3, 6.6%, Day 5, 9.1%
    <HR align=left width=\"80%\" color=#cacaff SIZE=1>ref: cdc.gov

  19. Thanks for all the feedback.
    The cycle looks good so far.
    We got 18 mature eggs, 16 fertilized. Transferred 6 embies on day 3 - 2 eight cells, 1 seven sell and 3 six cells. The rest were fives and fours and one three. We'll find out tomorrow if there will be any to freeze. I'm at SIRM NY with Dr. T and he just came in and told us his plan to transfer 6. Made sense to me.

    Now the dreaded 2ww. Fingers crossed.

  20. 18 eggs, thats awesome . Goodluck.

  21. what is HOM?

  22. HOM = High order multiples

  23. Hi-What protocol did you use? I am at SIRM also in New Jersey but the protocol I used I did terrible on. I am 41.5 years old and a poor responder with diminished ovarian reserve.

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