Why do IVF clinics continue doing Day 3 embryo transfers when they know the pregnancy rate is much better with transferring blastocysts ?
The commonest excuse IVF clinics trot out for doing Day 3 transfers for patients who have only a few eggs is that a bird in the hand is two in the bush !
They tell the patient that it’s much safer to put back the embryos on Day 3 because there is a risk that they won’t grow to Day 5 in the incubator. They scare them by saying that if they arrest in the lab, there won’t be any embryos left to transfer on Day 5, and that it’s better to be safe rather than sorry. They are willing to accept a lower pregnancy rate, just to give patients the satisfaction that at least they reached the stage of embryo transfer. This is quite meaningless, because the joy is short-lived when the embryo fails to implant. After all, patients don’t want an embryo – they want a baby !
Unfortunately , patients are clueless and accept this reasoning , but this is completely flawed , because we know that the implantation rate of a blastocyst is far better than the implantation rate of a day 3 embryo , because if has so many more cells, and has grown and developed further.
No Day 3 embryo can become a baby until it becomes a blastocyst first . It’s best to allow the embryos to become blastocysts in the lab, where we can monitor their quality and identify which ones to transfer, rather than dump them all back in.
Of course, if the lab is bad, then it is true there is a high risk the embryo will arrest and not become a blastocyst, but then the chances of getting pregnant with Day 3 embryos made in a bad lab is poor anyways ! Bad clinics try to compensate for this by transferring many embryos at a time, because they want to pass the buck for IVF failure onto the patient.
Bad clinics are very worried that if the embryo arrests then the patient will blame them, and they don’t want to take this risk, because they refuse to be honest with their patients. If the clinic does do a transfer and the cycle fails, then can pass the buck on the patient and blame “bad luck” for the failure of the embryo to implant ! After all, implantation is a black box, and doctors can’t control what happens to embryos after they are transferred, but it’s clear that the chances of a Day 3 embryo implanting is much less than that of a Day 5 blastocyst implanting.
Good IVF clinics continue monitoring embryos in the lab, and sharing photos of their daily progress with their patients, so they know exactly what’s going on. Even if the embryo arrests, this gives us valuable information as to what we can do differently in the next cycle . The problem is that if we transfer on Day 3 and then it fails to implant, we don't know whether the problem was because the embryo wasn't good enough to become a blastocyst, or whether some other factor was responsible for the failure.
While not having a blastocyst to transfer causes major heart-break, at least we have learnt important information from the cycle, and can tweak the protocol in the next cycle.
Also, the patient doesn't have to go through the unnecessary suspense of the 2ww. False hope can be cruel, and causes far more heartache !
Some bad IVF clinics justify doing a Day 3 transfer by saying that the best place for a day 3 embryo is the uterus , rather than the test tube . This is a lie.
The best place for a Day 3 embryo is the fallopian tube , and not the uterus . An embryos does not reach the uterus until it becomes a blastocyst, which is why you should not allow your doctor to do an embryo transfer until your embryos become blastocysts in the lab.
Otherwise, you will end up reducing your chances of getting pregnant . Please be proactive and don't allow your doctor to take you for a ride to suit his convenience
Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !
