if you had 5-6 embies on day 3 (some good, some ok): would you wait until day 5?

(53 posts)(14 voices)
  1. hi ladies,

    my Q is: are the blasts that look best, automatically chromosomally \'normal\'?

    is it really worth it to push out to blast if you can see which are the best looking 3-4 embies on cd3? (cd3 embryo appearances can be deceiving also, of course- but are blasts more likely to be normal if they look normal than cd3 embryos?)

    i think my RE wants me to decide would i rather put in 3 or 4 on cd3 (and discard the worse 1 or 2) or do i want to wait until cd5 and hope at least 2 continue to grow in the lab - and look normal/healthy on cd5.

    do i have a higher chance of selecting my normal embryo out of 4 cd3 embies rather than 2 blasts?

    at my age (39 yrs old with egg quality issues), i don't expect to have more than 1 normal embryo. i know there are a couple of board members who believe in SET for 40 yr olds and who believe in pushing out to blast regardless of cd3 circumstances; i don't fall into the category of SET and i am very comfortable putting in 4 embryos on cd3.

    thanks in advance for responding!

  2. No matter what an embryo or a blast looks like, you NEVER know if it's chromosomally normal. Ugly looking embryos make healthy babies all the time, and beautiful embryos result in BFNs and miscarriages too. There are no guarantees in this game, unfortunately.

    Blasts have better implantation and pregnancy and live birth rates. The thinking being that if they made it to blast in the lab, they have been "self-selected" and are the strongest ones.

    I think putting back 3 or 4 embryos on your first IVF is a big mistake at age 39. If I were you, I'd push to blast and put 2 blasts in. If you put in day 3 embryos, put 3 in max.

  3. nyc-- is right there is no way to tell.

    the only way to see if the embryo has chromosone issues is to do PGD on them i have no experience with it but i have a few friends that did it n they still ended up with a miscarriage anyway so it is really hard to say which ones will stick n which ones will not..

    hmmm it is hard to say i prob would go with a 3 day transfer myself. i would say 3 max as well if u go for a 5 day n have 2 good looking ones then i would put back both..

    i know girls that put back perfect blasts n ended up with bfn's n then took fair embryos that were frozen n they stuck.. it's really the luck of the draw.

    gl when is transfer?

  4. Dr. D said 3 or 4 day-3 embies is to be my plan. i trust him. i was a bit surprised at first but after learning more and speaking to embryologists and labs, i understand why he said this.

    i don't think he initially expected me to have more than 3 or 4 day-3 embies but my AFC was a lot higher than we thought, so, i am wondering if i'll be in a position of deciding if i should go to day-5 or not.

    is it true that CRMI wants to see around 10 embies on day-3 in order to push to day-5? if that's true, it would make life easier for me as i probably wouldn't have to decide. thanks everyone for sharing!

  5. I would recommend that you don't put back more than three 3-day embryos your first time out.

    There are reasons for the ASRM guidelines, which say this:

    "For patients between 38 and 40 years of age who have a more favorable prognosis, no more than three cleavage-stage embryos or two blastocysts should be transferred. All others in this age group should have no more than four cleavage-stage embryos or three blastocysts transferred."

    This is your first cycle and you said your antral count is decent.

  6. my Q is: are the blasts that look best, automatically chromosomally \'normal\'?

    NO... I just pulled my embryology report from our proven 35 y/o donor's cycle. Out of 10 blasts, the embryologist decided to only biopsy 5 excellent quality blasts for PGD. Only 2 were normal. We transferred 1, and I'm currently 16w pg. Since the embryologist did not biopsy the lesser graded blasts and discarded them, we don't know if any of those were normal. Unfortunately, you can not tell whether the embie is chromosomally normal from just looking at them at any stage, even if they are excellent quality blasts.

  7. I think discarding embryos just because they don't look pretty is a huge mistake. At age 39, you are not going to make many normal embryos no matter what. And time is not on your side. If I were you, I would insist on freezing everything that has not arrested. There may come a day when you want to try FETs with those embryos because maybe it's all you'll have.

  8. I think discarding embryos just because they don't look pretty is a huge mistake. At age 39, you are not going to make many normal embryos no matter what. And time is not on your side. If I were you, I would insist on freezing everything that has not arrested. There may come a day when you want to try FETs with those embryos because maybe it's all you'll have.

    Tell me about it. It was painful considering I've only done day 2 transfers with 1-2 embies at most, but it's the lab's policy. Some labs will only freeze excellent looking embies anyways, so you should check with your RE or embryologist to see what their policy is.

  9. You should also insist on vitrification.

  10. I think its hard to determine the quality of day 3 embryos based on looks alone.

    I had 8 embryos on day 3 and transferred the two best looking ones on day 3. I am not sure why they did not take them to blast except that the embrologist thought only 2 of the 8 looked really good, so maybe they didnt want to take the chance and also said that it was easy to pick the best 2 to transfer. I didn't push for blast as I had success on a previous cycle with a day 2 transfer so was okay with a day 3 transfer.

    At transfer, the RE told me not to expect any to freeze. I was a little out of it and couldn't remember what else he said. The next day I called my RE (the RE who did the transfer was not my RE) and asked what happened to the other 6. He said that based on how they looked at day 3, none would meet their standards for freezing, but I could call the embryologist for more info. I called the embryologist who said that if she HAD to guess, none of the 6 remaining would meet freezing criteria, but she has been wrong lots of times and a day 3 that doesnt look so great sometimes turns out fine on day 5 and vice versa. My lab doesn't check them on day four, so she said to call back the next day. Well, on day five, 2 of the six did turn out to meet the freezing criteria, so we have 2 frozen.

    So based on my experience, a lot can change between day 3 and day 5--in my case for the better-but I am sure also for the worse in other cases.

    I am 25 weeks pregnant with one of the 2 transferred on day 3, so apparently they did pick at least one good embryo based on looks ( or just luck!).

    Also, as to your question: if I had 5 or 6 embryos on day 3, I would NOT push to blast as I would not want to risk losing them all (I know that some say if they didn't make it to day 5 they wouldnt result in a successful pregnancy---but I am not convinced that is true--neither is my RE). I would transfer 2 or at most 3 best looking at day 3 and then try to grow out the remaining to blast for frozens.

    Good luck! Me personally, I would not transfer more than 3 on day 3, and I think for my first cycle, even at 39, I would only transfer 2 especially if they looked good. But I def did not want twins.

  11. I was 36 during my first cycle. I transferred 2 on day 3. None of the other 3 made it to freeze. One of the two I transferred is now my baby girl. So, I would go w/ day3 again if I have to. I am now 39 and will be cycling in March. My new RE also recommends PGD, but we'll see how many embryos we have.

  12. Why PGD? Do you have a known single gene disorder?

  13. If this is your first cycle, I would be cautious about how many to transfer back...

    (I think 2-3 for a first cycle at 39, is reasonable...any more would have to be warranted based on poor looking embryos imho.)

    BUT, I would also take into serious consideration the embryologists opinion based on the quality too (and maybe transfer more (such as 4) if they felt that was best).

    As long as you are prepared for the very heartbreaking reality of HOM and what that might mean in terms of risks/options...then I say proceed with caution with what you (and partner?)/your medical team feel is best for you/your situation.

    ASRM guidelines are great guidlines, i.e. place to start, but I don't consider that to be the 'final word' since it is based on general situations.

    As to taking embryos to blast...personally with only 5-6, I would do day 3 transfer with 2-3 and freeze the remaining to try with an FET (because sometimes I think it is about the right lining/hormonal enviornment for some people/not just the embryos and some people have better uterine enviornments with fet's).

    good luck.

  14. my humble opinion-

    - if you have insurance coverage, or a 'larger' number of embryos, or if you are under 34 or so, i would go to blast.

    -i would not do pgd unless you have a family history of genetic disorder.

    i have done an unofficial boatload of research- there is very little actual predictive value of embryos on day 3- on 2 factors are indicative of blast formation on day 3- fragmentation and cell number. i am currently in a battle of wills with my re's embryologist, b/c she swears she can 'eyeball' a d2 embie and determine its ability to implant. bulllshit. if an embryo makes it to day five, it can do so in the dish, period. any lab, even a substandard one, is capable of culturing a competent embryo to blast.

    now, at 39 years young , i would transfer all of your d3 embies as early as possible, b/c there is no point in selecting out at that age, you are correct in that it would be very unlikely more than one or 2 are normal, so why weaken them in the dish.

    again, my humble, yet well researched vet-opinion.

    best of luck!!

  15. here is an excellent article on morphological predictive value of day 2 embryos-

    humrep.oxfordjournals.org

  16. Hi, I did read some of the peoples responses but not all. I do know there is some recomendations for not putting more then 3 for your first time but I am not sure about that. I am fairley young and was very young when we started our IVF journey. Here is my story My Dx is tubal I had cyst all over them so I had to have them removed before we proceded to do IVF
    Age 22-14 eggs retrived 9 fertilized at the time we didn't have option day 3 or day 5 because my clinic didn't really do day 5 as much . So we transfered 4 embryos 3-8 cells and 1- 6 cell that resulted in my DS which was a singleton

    2nd IVF- age 25 retrieved 14 eggs again 9 fertlized again transfered 5 embryos this time 3- 8 cell 1- 7 cell and 1 -6 cell resulted in twin pregnancy but ruptured at 18.5 wks with twin A delivered her at 22 wks (loss) held onto twin b until 24 weeks resulted in preemie who is doing faboulous and complete health (24 weeker)
    3rd ivf -age 29 retrived 11 eggs this time and only 6 fertlized the clinic I am at (same for all 3) now is a big fan of blast transfers and thinks they result in higher pregnancy rates and live births as well. We transfered 2 6 day blast and I am now 6 weeks pg with a singleton .
    So bottom line I guess is you never know thinking about it now being 22 and transfering 4 embryos and being first ivf was a great big risk for us and we had to be prepared to have multiples if happend and we no way no how are we people who would do selective reduction because of our religious beliefs and faith in God.
    but as you can see it only resluted in our ds. Its a hard decision because for us we din't have alot of money and at the time this was our only shot at having a baby at the time so we wanted to put more embryos so atleast 1 would take but at the same time you are running that huge risk of multiples.
    this last cycle I was so nervous because it was our first time doing a blast transfer and only putting in 2 embryos was a little scary to cause I would think omg what if we didn't put enough back in. We were tempted to put back 3 but because of what we had gone through with our second pregnancy we didn't want to risk having triplets and having a premature birth again. Now there are some people that can carry multiples just fine and almost make it to full term some are not so lucky you just never know. I think just really try to think about it if your religious pray about it and just go with your gut. Good luck for your cycle !! I know alot to think about
    Mel

  17. Why PGD? Do you have a known single gene disorder?

    No, I don't but he recommends testing for chromosomal abnormalities since I am older and didn't have embryos of great quality before. Still doing research on it though. His data showed an increased success rate in my age group, but I've also read it doesn't help.

  18. PGD does not increase live birth rates. And it only looks at a limited number of chromosomes. And there is a risk of damage to the embryo and of misdiagnosis. Don't do it unless you have a known disorder you are looking for. When you are older, the best chance you have is to transfer whatever you make.

  19. I know it's really tempting to try to game everything out in advance, but I think you could end up wasting a lot of mental energy. I spent a lot of time hypothesizing about whether I would push out to day 5 or how many to transfer and then the decisions were basically made for me. Even though I had a good AFC (around 18) and was 32 during my 3 IVF cycles, the best I ever did was have 3 embryos on day 3 (and that was just one of the cycles, for the other two cycles I only had one embryo left on day 3). I'm now cycling with Dr D at Cornell and we are doing co-culture do I'll be a day 3 transfer no matter what, but I'm not worrying about how many we'll transfer. I'll worry about that once we get the embryologist's report. For now I'm just trying to take care of myself, gets lots of sleep and enjoy myself before the IVF cycle starts. Sorry if my post is depressing...

  20. my humble opinion--now, at 39 years young , i would transfer all of your d3 embies as early as possible, b/c there is no point in selecting out at that age, you are correct in that it would be very unlikely more than one or 2 are normal, so why weaken them in the dish. again, my humble, yet well researched vet-opinion.best of luck!!
    5 embies then if i have them? i know the embryologist often wants to make these decisions for the patient, but i like to also have an informed input.

  21. jen, i'm not you, but i am also 39, and if i had 4-5 embies on d3 i would probably transfer them all. or, transfer 3, and freeze the other 2-3 at 2pn stage- it also depends on your history- whats your diagnosis? do you have previous failed cycles? if its male factor only and your antral follicle count and fsh is good, i might do 3, but honestly the chances of more than twins ( past 12 weeks ) with 5 transferred at 39 is very very small. let us know what happens, best of luck!

  22. i know the embryologist often wants to make these decisions for the patient, but i like to also have an informed input.

    While the embryologist/drs might make recommendations...I wouldn't let someone else 'make' the final decision for you (and your partner). Of course they (your medical team) can override your choice if you want to transfer more than they feel is medically sound/reasonable...but they should never pressure you do transfer more than you are comfortable.

  23. thank you everyone!

    even if i put back the max per SART, i still have to leave a few behind.

    it seems like the appearance of the embryos is not a reliable way to select which ones to leave out of the day 3 ET.

    this is especially hard because if i leave the lowest grade embryos out of the ET, they won't qualify for freezing standards.

    so the clinic will be throwing them away. and at 39 yrs old and paying out of pocket entirely and traveling out of state for cycles, that is really not ideal.

    (BTW, our nurse suggested using PGD to select the normal embryos, but only if the embryos appear strong on day 3.

    after reading that Cornell only wants to PGD or go to blast with 10 embryos looking strong on day 3, i am leaning towards day 3 transfer.)

    and- thank you, violet, for this article.

    i read the article a couple of times. is this article indicating that waiting until day 5 is a preferred way to select embryos for transfer or against?

  24. You should insist that even if you do a day 3 transfer, they should freeze whatever makes it to blast that you don't transfer. These "freezing criteria" are ridiculous. Plenty of lousy looking embryos make healthy babies.

  25. do i have to wait until day 5 to decide what to freeze and only freeze blasts?

    if i'm doing a day 3 transfer, can i ask to freeze the day 3 extra embryos?

    do you think that it's worth freezing if i only have grade C embryo(s) left? (i want to). thanks!

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