day 3 vs day 5 transfer

[AndreaD]

I am currently undergoing an IVF cycle which has had numerous set backs. I was a poor responder with only 2 follicles >1.7cm, but 6 eggs were retrieved - clearly some from smaller follicles. My husband had difficulty on the day of oocyte retrieval and his sample had to be obtained via PESA. 5/6 eggs were injectable. 3 fertilized.

When the lab called me today they stated that my Dr has decided already that I will have a day 5 transfer. I am concerned about this for many reasons. First of all, I think our chances of success are already low based on my poor response, using PESA sperm and my history of recurrent pregnancy loss (4 miscarriages in the last 2 years).

Is there any benefit of Day 3 vs Day 5 transfer in my situation? I realize that the Day 5 transfer will give more information about the quality of the embryos, however we are most interested in having a baby in the end.
I have seen many conflicting opinions on this. Your thoughts would be much appreciated.

Andrea

[Dr Jeffrey Fisch]

Our most recent data shows that delivery rates are similar if two embryos are transferred on day 3 or day 5. Going out to day 5 does help eliminate some of the abnormal ones, but doesn't guarrantee a normal embryo. Since the embryos are the same genetically on day 3 as on day 5, I really see no reason to wait, if the embryos appear good. It really only tales one normal embryo to make a baby, so the numbher of embryos is not the main issue. The PESA will have no adverse effect. The majority of early miscarriages are caused by an abnormal embryo, not your ability to carry. If you would like to discuss your case in more detail, contact me directly. In many cases we find that a careful reevaluation of the specific stimulation protocol can result in better egg production.

Jeffrey Fisch
jfisch@sherinstitute.com