Is Day 4 a Viable Option for Embryo Transfer (ET)? A Comparison of Live Birth Rates (LBR) between Days 2,3,4 and 5 of ET
2Department of Obstetrics and Gynecology, Laniado Medical Center, Affiliated with The Rappaport Faculty of Medicine, Technion, Haifa
3Department of Clinical Utility, Laniado Medical Center, Affiliated with The Rappaport Faculty of Medicine, Technion, Haifa
4School of Public Health, Sackler School of Medicine, Tel Aviv University
Introduction
Day 4 ETs are rarely done. Our positive experience with day 4 ET and the few publications, that found variable results, led to this study.
Aim
To assess weather day 4 is equal to days 2,3 and 5 for ET.
Methods & Materials
A retrospective analysis of all ETs we have done between 2015-2016 including IVF and ICSI patients of all ages, diagnoses and stimulation protocols. Double ET cycles were excluded. The analysis included 429 fresh ET on days 2-5. All embryos were cultured in the Miri TL time-lapse using a single step culture media and reduced oxygen. Embryo selection was made based on evaluation of time-lapse videos and the decision of the day for ET was based upon the discretion of the treating physicians and working days and not on the belief that one day is better than the other.
Results
LBRs were 17.6% (19/108), 22.9% (38/166), 20.0% (28/140) and 20.0% (3/15) for days 2 to 5 respectively (p= 0.761). The only significant difference between the groups was embryo quality, which was higher on later days (p = 0.047). Analysis of patients aged<35, with good embryo quality showed a LBR of 44.0% (11/25), 50.0% (19/38), 51.6% (16/31) and 12.5% (1/8) for days 2 to 5 respectively.
Conclusions
Days 2-5 ET results in similar LBR, after adjustment for the major predictor variables. Day 4 is as good as any other day for ET. Laboratories are urged to gain experience with this option as it allows for better clinical flexibility.
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