Advantage of day three over day two embryo transfer

  • Hind Abdulkadim Department of Urosurgery and infertility, College of Medicine, University of Kufa, Najaf, Iraq.


Objectives: This study was done to compare embryo quality and pregnancy rate between day two and day three embryo transfer, the effect of extended culture on embryo development potential also analysed.
Methods: In a 18 month period extending from January 2014 to june 2015 all couples undergoing infertility treatment in the form of intracytoplasmic sperm injection whatever the cause and in whom fresh embryo transfer were done (258 cycle) were included in this prospective study. The patients classified into two groups according to the day of embryo transfer. The policy of transfer was uniform in both groups and the transfer was done according to patient criteria or the number of embryos available.
Results: the main outcome measures were embryo quality, embryo development potential and pregnancy rate.  Our data suggest no significant statistical difference in pregnancy rate between day two and day three embryo transfer ( 42.9 versus 42.0% respectively P>0.05). The percentage of good quality embryos was slightly insignificantly higher in day two group than day three (86.03 vs. 84.7%, P>0.05). the percentage of slow growing embryos was significantly higher in those cultured for three days than those remain for just two days in vitro (15.9 vs. 23.3 , P<0.05) .
Conclusion: a similar pregnancy rate was obtained by doing embryo transfer on day two and day three after intracytoplasmic sperm injection in spite of slight regression in embryo quality and higher rate of developmental delay in cases of extended culture. So no advantage for day three over day two embryo transfer.
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1. Gardner D.K. and Lane M.(2018) Culture system for human embryo. In: Text book of assisted reproduction.Gardner D.K. ;Weissman A.; Howles C. M.; Shoham Z. (ed). Taylor & Francis Group.200-210.
2. Modares S. Z.; Zamaniyan N. ; Baheiraei N. ; Saharkhiz N. ; Abed F.; Malih4 N.; Sohrabi M. A Comparative Analysis Between Day 2 and Day 3 Embryo Transfer in IVF/ICSI: A Retrospective Cross-Sectional Study. International Journal of Women’s Health and Reproduction Sciences . 2016;3:119–124
3. Bastu E, Celik C, Keskin G, Buyru F. Evaluation of embryo transfer time (day 2 vs day 3) after imposed single embryo transfer legislation: when to transfer? J Obstet Gynaecol. 2013;33:387–390.
4. Bahceci M, Ulug U, Ciray HN, Akman MA, Erden HF. Efficiency of changing the embryo transfer time from day 3 to day 2 among women with poor ovarian response: a prospective randomized trial. Fertil Steril. 2006;86:81–85.
5. Oatway C, Gunby J, Daya S. Day three versus day two embryo transfer following in vitro fertilization or intracytoplasmic sperm injection. Cochrane Database Syst Rev. 2004;(2):CD004378.
6. Dawson KJ, Conaghan J, Ostera GR, Winston RM, Hardy K. Delaying transfer to the third day post-insemination, to select non-arrested embryos, increases development to the fetal heart stage. Hum Reprod. 1995;10:177–182.
7. Carrillo AJ, Lane B, Pridman DD, Risch PP, Pool TB, Silverman IH. Improved clinical outcomes for in vitro fertilization with delay of embryo transfer from 48 to 72 hours after oocyte retrieval: use of glucose- and phosphate-free media. Fertil Steril. 1998;69:329–334.
8. Shen S, Rosen MP, Dobson AT, Fujimoto VY, McCulloch CE, Cedars MI. Day 2 transfer improves pregnancy outcome in in vitro fertilization cycles with few available embryos. Fertil Steril. 2006;86:44–50.
9. Frankfurter D, Keefe DL, Trimarchi JB. Day 2 embryo transfer improves IVF-ET outcome in the poor responder. Fertil Steril. 2003;80(Suppl 3):61.
10. Ashrafi M, Kiani K, Mirzaagha E, Shabani F. The pregnancy outcomes of day 2 versus day 3 embryo transfer: a cross-sectional study. Int J Fertil Steril. 2007;1:47–54.
11. Dayal MB, Frankfurter D, Athanasiadis I, Peak D, Dubey A, Gindoff PR. Day 2 embryo transfer (ET) and day 3 ET afford similar reproductive outcomes in the poor responder. Fertil Steril. 2011;95:1130–1132.
12. Laverge H, De Sutter P, Van der Elst J, Dhont MA. A prospective, randomized study comparing day 2 and day 3 embryo transfer in human IVF. Hum Reprod. 2001;16(3):476-480.
13. Ertzeid G, Dale P, Tanbo T, Storeng R, Kjekshus E, Åbyholm T. Clinical outcome of day 2 versus day 3 embryo transfer using serum-free culture media: a prospective randomized study. J Assist Reprod Genet. 1999;16(10):529-534.
14. Racowsky, C., Jackson, K.V., Cekleniak, N.A., Fox, J.H., Hornstein, M.D., and Ginsburg, E.S. The number of eight-cell embryos is a key determinant for selecting day 3 or day 5 transfer. Fertil Steril. 2000; 73: 558–564
15. Scott LA, Smith S. The successful use of pronuclear embryo transfers the day following oocyte retrieval. Hum Reprod 1998;13(4):1003-1013.
16. Dale B, Fiorentino A, de Simone ML, et al. Zygote versus embryo transfer: a prospective randomized multicenter trial. J Assist Reprod Genet. 2002;19(10):456-461.
17. Quinn P, Stone B, Marrs R. Suboptimal laboratory conditions can affect pregnancy outcome after embryo transfer on day 1 or 2 after insemination in vitro. Fertil Steril. 1990;53(1):168-170.
18. Shahine LK, Milki AA, Westphal LM, Baker VL, Behr B, Lathi RB. Day 2 versus day 3 embryo transfer in poor responders: a prospective randomized trial. Fertil Steril. 2011;95(1):330-332.
19. Gunby JL, Daya S, Olive D, Brown J. Day three versus day two embryo transfer following in vitro fertilization or intracytoplasmic sperm injection. Cochrane Database Syst Rev. 2004;2.
20. De los Santos M, Mercader A, Galan A, Albert C, Romero J, Pellicer A. Implantation rates after two, three, or five days of embryo culture. Placenta. 2003;24:S13-S19.
21. Dobson AT, Raja R, Abeyta MJ, et al. The unique transcriptome through day 3 of human preimplantation development. Hum Mol Genet. 2004;13(14):1461-1470.
22. Kaur P, Swarankar M, Maheshwari M, Acharya V. A comparative study between cleavage stage embryo transfer at day 3 and blastocyst stage transfer at day 5 in in-vitro fertilization/intra-cytoplasmic sperm injection on clinical pregnancy rates. J Hum Reprod Sci. 2014;7(3):194.
23. Van der Auwera I, Debrock S, Spiessens C, et al. A prospective randomized study: day 2 versus day 5 embryo transfer. Hum Reprod. 2002;17(6):1507-1512.
24. Dar S, Librach C, Gunby J, Bissonnette F, Cowan L. Increased risk of preterm birth in singleton pregnancies after blastocyst versus Day 3 embryo transfer: Canadian ART Register (CARTR) analysis. Hum Reprod 2013;28(4):924-928.
How to Cite
ABDULKADIM, Hind. Advantage of day three over day two embryo transfer. Journal of Contemporary Medical Sciences, [S.l.], v. 5, n. 3, june 2019. ISSN 2413-0516. Available at: <>. Date accessed: 20 july 2019.