Another question about 3 day vs 5 day
3 Replies
oct01 - July 13

Hi Dr. Smith,

I'm in the middle of my first ICSI cycle after 6 failed IUIs.

I'm 31 yrs old (DH is 32) with no known fertility issues except 25% ASA. I'm on a standard BCP/Lupron/Follistim protocol. My antral follicle count ranges from 11-14 in previous cycles.

My DH had a bilateral varicolectomy 1 year ago due to very poor SCSA results. Currently, his SA is good except 22% morphology and HDS 24%. His DFI is down to 11%.

We were given a 50% chance of success with ICSI. While our RE does 3 and 5 day transfers, we were told we would most likely get a 3 day transfer.

I've read all of your postings on this issue and I'm wondering if I should be pushing for a 5 day transfer in my case?

Thanks for your thoughts on this issue.


Dr Smith - July 13

Yes, you should ask for a Day 5 transfer because the HDS is still high. Genetic abnormalites contributed by the sperm do not show up until after Day 3. Usually on Day 4-5 when the embryo fails to undergo compaction or arrests development at the compacted morula stage (the stage immediately preceding to the blastocyst stage). By waiting until Day 5, embryos that are going to arrest due to male genetic problems can be identified and not transferred.


oct01 - July 13

Thanks for your response.

However, I'm still a little confused. I was sent a 2004 study from SCSA Diagnostics published in Fertility and Sterility with the following findings. I was under the impression that it was DFI that affects blastocyst development and not HDS. Did I read this wrong?

Thanks again for providing clarification.

Title: Sperm chromatin structure assay (SCSA) parameters are related to fertilization,
blastocyst development, and ongoing
pregnancy in in vitro fertilization and
intracytoplasmic sperm injection cycles

Objective: To determine the relationship between sperm chromatin structure assay (SCSA) parameters (DNA fragmentation index [DFI] and high DNA stainability [HDS]), and conventional IVF and IVF/intracytoplasmic
sperm injection (ICSI) outcomes.

Design: Retrospective review and prospective study.

Setting: Private IVF clinic.

Patient(s): Two hundred forty-nine couples undergoing first IVF and/or ICSI cycle.

Intervention(s): IVF, ICSI, blastocyst culture.

Main Outcome Measure(s): DFI, HDS, conventional semen parameters, IVF, ICSI.

Result(s): IVF and ICSI fertilization rates were not statistically different between high- and low-DFI groups.
More men with >15% HDS had lower (<25% and <50%) IVF fertilization rates. High DNA stainability was
not related to ICSI fertilization rates. High DNA stainability did not affect blastocyst rates or pregnancy
outcomes. Men with >30% DFI were at risk for low blastocyst rates (<30%) and no ongoing pregnancies.
Men with >30% DFI had more male factors. World Health Organization thresholds were not predictive of
ongoing pregnancy.

Conclusion(s): The relationship between HDS and poor IVF fertilization rates provides preliminary evidence
that ICSI may be indicated in men with >15% HDS. Men with high levels of DNA fragmentation (>30%
DFI) were at greater risk for low blastocyst rates and failure to initiate an ongoing pregnancy. The SCSA
provides valuable prognostic information to physicians counseling couples before IVF and/or ICSI cycles.


Dr Smith - July 14

I stand corrected. You are right. I was aware of the paper you cited and I incorrectly remembered that both DFI and HDS affected blastocyst development. However, after re-reading the paper, I realize I had remembered it wrong. Sorry for the confusion. The old gray matter just ain't what it used to be...

Regardless, I'm still a big supporter of blastocyst transfer because it provides much more information about the developmental potential of the embryos prior to transfer. So, even though the elevated HDS does not appear to affect blastocyst development, I still think its a good idea in general. In your specific case, because of your relatively young age, it would be prudent to transfer only two embryos (to reduce the chances of twins and avoid triplets all together), Therefore, it is important to choose the "right" two embryos for transfer. Waiting until the embryos reach the blastocyst stage will indentify those embryos that are truely capable of implantation.

Frankly, I'm surprised that they are considering a Day 3 transfer, since you are in the best prognosis group. You would be slated for blastocyst transfer in most programs that offer both Day 3 and blastocyst transfer.



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