NNEKA THE FERTILE CHICK:EMBRYO TRANSFER, DAY 3 OR DAY 5

Our IVF sisters will immediately know what this question refers to. It is the dilemma of many-an-IVF process – what day, exactly, to transfer the fertilized embryos. But let me backtrack a little…to educate those of us for whom this phrase might sound alien.

Some weeks ago, we talked about the “joys” of injections and meds of an IVF process. Those were essentially to stimulate the production of eggs. When these eggs are nice and ripe, they are harvested (during what is called the egg retrieval process, or “ER”), after which they are mixed with the partner’s semen in a petri dish for natural fertilization, or directly injected with sperm (in a process called Intra-Cytoplasmic Sperm Injection, “ICSI”). Whichever the case, you should hopefully now have a few fertilized eggs, i.e. embryos. This brings us to the question at hand: when is the perfect day to transfer these embryos to the uterus?

The common theory is that, it is best to groom these embryos till day 5, when they are now blastocysts. The theory for this makes a lot of sense. By day 5, it is more possible to identify the stronger embryos to transfer. Weaker embryos, or those with chromosomal abnormalities, are expected to have arrested before they reach the day 5 mark. In effect, since only “strong” embryos will be transferred at day 5, the chances of pregnancy are expected to be higher. And in truth, generally, success rates with day 5 transfers are actually higher…but there is still a BUT…and I’ll get to that shortly.

The other school of thought is that fertilized embryos should be transferred to the uterus as soon as possible. This is based on the theory that these embryos are better off in their natural environment, i.e. the uterus. Today, I see the logic with this theory…but a few years ago, it would have been unheard of for me.
I have talked about the online community I was a member of, at the time I started my own IVF cycle. There, having day 5 transfers was the order of the day. Sure, there were the few people who opted for earlier transfers, but almost everyone opted to get to blastocyst stage. And their success rates seemed quite impressive, so I was all the more determined to also have a day 5 transfer.

So, from the very beginning of my sojourn at the first clinic where I cycled, I told everyone who cared to listen…the doctors, the nurses, the accountants…everyone whom I had cause to interface with…that I was definitely having a day 5 transfer. When the time for my egg retrieval came by, I paid the extra fee required to take the embryos to blastocyst, and prayed I would have enough embryos for this to happen, as the clinic’s policy was that there had to be at least 5 embryos to attempt a day 5 transfer. Luckily, I had 9 embryos, so I felt good to go! Everyday, I called their Embryologists to check on my embryos, and was excited with the progress reports I got…at first. They were dividing excellently, and were in perfect condition….but that was until they got to day 4, after which they appeared to stall. By day 5, only 2 of the embryos had gotten to blastocyst stage…the rest were still morulas (what they are supposed to be at day 4). Needless to say, that cycle failed.

So, I returned to my longtime Gynaecologist, and decided to have my second cycle with him. As usual, I came armed with my request for a day 5 transfer, and was shocked when he vehemently refused. He apparently belongs to the school of thought that favours earlier embryo transfers. I then started arguing about why I HAD to have a day 5 embryo transfers, citing all the statistics I had gotten off the Internet. He listened patiently as I reeled all these off, before pulling out my case notes to discuss my prior cycle. He explained that, apart from the fact that he believed embryos fare better in their natural environment, a lot of Nigerian hospitals were not equipped enough to take embryos to blastocyst stage. Apparently, after day 3, the medium required to store these embryos to blastocyst stage is a different one, and this is where a lot of local hospitals falter. And then like a typical Oprah light bulb moment, it hit me. At the other clinic, my perfect embryos suffered a sharp decline after day 3, i.e. when their storage medium was changed. It was apparent to me that they had probably been ill-equipped to offer day 5 transfers. With this realization, I surrendered and decided to go along with his plan for an earlier transfer, which in my mind was a day 3 transfer… except, it wasn’t. The day after my egg retrieval, my doctor told me he would rather transfer the embryos at day 2, and asked me to return to the clinic the next day. To say I wasn’t devastated would be putting it mildly! Day 2 ke? When I was only just going to manage day 3! As disappointing as it was, I knew I just had to trust my doctor…and, most of all, trust God. So, I proceeded to have a day 2 transfer…and I have my babies today.

Of course, 4 years down the line, I am sure the faulty storage medium issue is no longer the case for most local hospitals. Over the years, a lot of these clinics would (or should) have been able to refine their processes and systems, so I’m sure taking embryos to blastocyst stage won’t be a problem for them. But I’ll bet there are still a few hospitals not well equipped for this service, but which will keep offering it anyways…so beware! If you are cycling in Nigeria, and wish to have a day 5 embryo transfer, just be sure you do enough due diligence on the clinic you are using, and make sure you ask A LOT OF QUESTIONS. Whilst I don’t generally believe in clinic success rates, in this case, they are extremely important. You want to know how successful they have been with their day-5 transfers. If this number is low, my advice will be for you not to waste your money and opt for an earlier transfer jeje!

The bottom line is, yes there are a lot of benefits of having a day 5 transfer, but day 3 (or even day 2, like I had) transfers have theirs as well. It is important to weigh all your variables, with respect to the number of embryos you have, the clinic you are using, and your general circumstances, to be able to decide which is a better option for you!

Good luck!

Photo Credit: Dreamstime | Michael Zhang