Day 4 Versus Day 5 Fresh Embryo Transfer in In Vitro Fertilization: Is It All About Timing?

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dc.authorid0000-0003-2895-575X
dc.authorid0000-0001-7634-3008
dc.authorid0000-0002-4718-6020
dc.contributor.authorŞişmanoğlu, Alper
dc.contributor.authorOğlak, Süleyman Cemil
dc.contributor.authorÖzcan, Cenk
dc.contributor.authorUluğ, Ulun
dc.date.accessioned2025-08-14T15:13:42Z
dc.date.available2025-08-14T15:13:42Z
dc.date.issued2025
dc.departmentFakülteler, Tıp Fakültesi, Cerrahi Tıp Bilimleri Bölümü,Kadın Hastalıkları ve Doğum Ana Bilim Dalı
dc.description.abstractObjective: Most studies concentrate on comparisons between the cleavage stage and blastocyst stage of embryos during in vitro stimulation treatment. We aimed, in this study, to compare the pregnancy rates of day 4 or day 5 blastocyst transfers, all derived from fresh, antagonist-regulated in vitro fertilization (IVF) cycles, and to evaluate the factors affecting pregnancy success. Methods: This retrospective cohort study evaluated 3681 fresh embryo transfer cycles conducted at a private IVF center between 2019 and 2021. Patients were divided into two groups based on the day of embryo transfer: day 4 (Group 1) and day 5 (Group 2). Subgroup analyses were performed according to age (≤40 vs. >40 years) and the number of oocytes retrieved (≤4 vs. >4). All patients underwent ovarian stimulation with FSH alone or in combination with hMG, and GnRH antagonist protocols were used for pituitary suppression. Final oocyte maturation was triggered with recombinant hCG, and fertilization was achieved via intracytoplasmic sperm injection (ICSI) for all cases. Embryos were cultured in sequential media and assessed daily until transfer on day 4 or day 5, based on embryo morphology and clinic logistics. Results: Pregnancy was more likely among women under 40 than among women over 40. There were a total of 1217 women who underwent day 4 transfer and 2464 women who underwent day 5 transfer. A total of 660 (54.2%) of the women transferred on day 4 developed pregnancy. Among those transferred on day 5, 1610 (65.3%) developed pregnancy. When compared to the 4th day, a single embryo transfer on the 5th day enhances pregnancy success by 1.8 times, while two embryo transfers raise it by 1.6 times. Furthermore, when the number of oocytes is greater than four and the number of embryos transferred is two, the pregnancy success rate is 2.5 times higher when embryo transfer is performed on the fifth day versus the fourth day. Regardless of age, oocyte count, or number of embryos transferred, 5th-day fresh embryo transfers enhanced pregnancy success by 1.9 times compared to 4th-day transfer. Conclusions: Transfers of fresh embryos on day 5 are superior to those on day 4 and should be favored, especially for people over the age of 40, regardless of the number of embryos transferred, even if that individual has fewer than four oocytes.
dc.identifier.citationŞişmanoğlu, A., Oğlak, S. C., Özcan, C., & Uluğ, U. (2025). Day 4 Versus Day 5 Fresh Embryo Transfer in In Vitro Fertilization: Is It All About Timing?. Journal of Clinical Medicine, 14(13), 4596.
dc.identifier.doi10.3390/jcm14134596
dc.identifier.issn2077-0383
dc.identifier.issue13
dc.identifier.pmid40648969
dc.identifier.urihttps://hdl.handle.net/20.500.12939/5864
dc.identifier.volume14
dc.identifier.wosWOS:001527098100001
dc.identifier.wosqualityQ1
dc.indekslendigikaynakPubMed
dc.indekslendigikaynakWeb of Science
dc.institutionauthorŞişmanoğlu, Alper
dc.institutionauthorid0000-0003-2895-575X
dc.language.isoen
dc.publisherMDPI
dc.relation.ispartofJournal of Clinical Medicine
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectblastocyst stage embryo transfer
dc.subjectembryo quality
dc.subjectfresh embryo transfer
dc.subjectin vitro fertilization
dc.titleDay 4 Versus Day 5 Fresh Embryo Transfer in In Vitro Fertilization: Is It All About Timing?
dc.typeArticle

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