Tangeroo asks Dr. Timothy Smith:

I have read with great interest the dialogue with Lauren on this issue. I am presently trying to decide what to do for my second ivf attempt (more about that later). I have been scouring the 'net for as much info as I can get on the pros and cons. One article I was able to get through my RE was called "To Blast or Not to Blast?" recently published, one of authors is from Boston IVF.

That article suggested that it was not that clear cut that 3 day embies that don't make it to blast would not have continued to grow and implant if transferred earlier. Other articles I have read state that the real benefit to blast is just avoiding high order multiples, not any difference in PG rates.

I also read an article suggesting that sequential transfer (both 3 day and 5 day on the same patient) could have some benefits with the 3 dayers somehow paving the way for the blasts -- something about cytokines (sounded suspect to me though). 
Back to me now, my first ivf we got 25 eggs, 21 fertilized, 12 looked really good on day 3, so we decided to blast. On day 5, we transferred 2 great looking blasts and ended up with 5 to freeze (4 on day 5, 1 on day 6). Still, no success. My RE was surprised that it didn't work because everything looked indicative of a high chance of success. I just turned 37, have PCO, normal range FSH (5.5).

For this next cycle (assuming similar fertility results), my RE is giving me the choice to go 3 day or 5. She suggested we could try 3 with or without AH just for the sake of trying something different. That for some patients day 3 seems to work after day 5 did not. (She admits this is not scientific).

At this point, I am leaning toward another day 5 try, but if this doesn't work, on the 3rd cycle go try day 3.

In addition to any comments you may have on the articles I have read, my questions to you are, in your experience doing almost all day 5 transfers, have you had any patients who had good looking but ultimately failed day 5 transfers then switch to day 3 and have success?

Also, if I can slip in a question about AH, is there any benefit to be gained from doing it if it is not obviously necessary? i.e. if the zona doesn't visually appear to be too thick.

Stay tuned for Tangeroos's answer on the next page...

Table of Contents
1. Benefits to blast?
2. Blastocyst transfers routine?
3. Hatching blastocysts
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