The effect of day 2 versus day 3 embryo transfer on early pregnancy outcomes in women with a low yield of fertilized oocytes

  • C. R. Sacha
  • I. Dimitriadis
  • G. Christou
  • I. Souter
  • C. L. BormannEmail author
Assisted Reproduction Technologies



To evaluate the differences in implantation and pregnancy rates when embryo transfer occurs on D2 versus D3 in women with a low yield of fertilized oocytes.


A total of 156 IVF/ICSI cycles from 141 women at an academic fertility center were analyzed in a retrospective fashion. Women with a low number of fertilized oocytes (≤ 2 two pronuclei (2PN) stage zygotes) who had their fresh embryo transfer on D2 or D3 were included in the study. Positive pregnancy test per IVF cycle (PPT), clinical pregnancy rate (CPR), spontaneous abortion rate (SABR), and implantation rate (IMPR) were the main outcome measures assessed. Mann-Whitney U test and χ2 test were used as appropriate. A generalized linear mixed effect model adjusted for relevant covariates was conducted. P < 0.05 was considered significant.


Patients having their embryo transfer on D2, when compared to those who had a D3 embryo transfer, experienced similar PPT [30.8 vs. 28.2%, respectively; adjusted OR (95%CI): 0.49 (0.16, 1.52)], CPR [26.9 vs. 25.6%, respectively; adjusted OR (95%CI): 0.44 (0.12, 1.67)], and IMPR [17.3 vs. 16.7%, respectively; adjusted β (95%CI) − 5.6% (− 15.0, 3.9)].


Our findings suggest that transferring embryos on D2 versus D3 in women with a limited number of 2PN stage zygotes does not affect early pregnancy outcomes. These results indicate that there can be some flexibility in scheduling the day of transfer at the convenience of both the patient and the center.


IVF Embryo transfer 2PN Implantation rate Pregnancy outcomes 



The authors acknowledge the embryology laboratory staff at Massachusetts General Hospital for their role in preparing embryos for transfer, as well as Kaitlyn James for her assistance with the statistical analyses.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Laverge H, De Sutter P, Van der Elst J, Dhont M. A prospective, randomized study comparing day 2 and day 3 embryo transfer in human IVF. Hum Reprod. 2001;16(3):476–80.CrossRefPubMedGoogle Scholar
  2. 2.
    Carillo AJ, Lane B, Pridham DD, Risch PP, Pool TB, Silverman IH, et al. 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(2):329–34.CrossRefGoogle Scholar
  3. 3.
    Dawson KJ, Conaghan J, Ostera GR, Winston RM, Hardy K. Delaying transfer to the third post-insemination to select non-arrested embryos, increases development to the fetal heart stage. Hum Reprod. 1995;10(1):177–82.CrossRefPubMedGoogle Scholar
  4. 4.
    Ertzeid G, Dale P, Tanbo T, Storeng R, EKjekshus E, Abyholm 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):529–34.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Pantos K, Makrakis E, Stavrou D, Karantzis P, Vaxevanoglou T, Tzigounis V. Comparison of embryo transfer on day 2, day 3, and day 6: a prospective randomized study. Fertil Steril. 2004;81(2):454–5. Scholar
  6. 6.
    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(4):387–90. CrossRefPubMedGoogle Scholar
  7. 7.
    Baruffi R, Mauri A, Petersen C, Felipe V, Franco Junior J. Day 2 vs. day 3 embryo transfer after intracytoplasmic sperm injection. A prospective, randomized study. J Reprod Med. 2003;48(8):631–4.PubMedGoogle Scholar
  8. 8.
    Brown J, Daya S, Matson P. Day three versus day two embryo transfer following in vitro fertilization or intracytoplasmic sperm injection. Cochrane Database Syst Rev. 2016;12
  9. 9.
    Bahceci M, Ulug U, Ciray H, Akman M, Erden H. In vitro fertilization: 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(1):81–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Xin ZM, Xu B, Jin HX, Song WY, Sun YP. Day 3 embryo transfer may have better pregnancy outcomes in younger than 35-year-old patients with poor ovarian response. J Assist Reprod Genet. 2012;29(10):1077–81. Scholar
  11. 11.
    Georgadak K, Khoury N, Spandidos D, Zoumpourlis V. The molecular basis of fertilization (Review). Int J Mol Med. 2016;38(4):979–86. Scholar
  12. 12.
    Souter I, Baltagi LM, Kuleta D, Meeker JD, Petrozza JC. Women, weight, and fertility: the effect of body mass index on the outcome of superovulation/intrauterine insemination cycles. Fertil Steril. 2011;95(3):1042–7. Scholar
  13. 13.
    Jones GM, Trounson AO, Gardner DK, Kausche A, Lolatgis N, Wood C. Evolution of a culture protocol for successful blastocyst development and pregnancy. Hum Reprod. 1998;13(1):169–77.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • C. R. Sacha
    • 1
  • I. Dimitriadis
    • 1
    • 2
  • G. Christou
    • 2
    • 3
  • I. Souter
    • 1
    • 2
  • C. L. Bormann
    • 1
    • 2
    Email author
  1. 1.Department of Obstetrics, Gynecology, and Reproductive Endocrinology and InfertilityMassachusetts General Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Massachusetts General Hospital Fertility CenterBostonUSA
  3. 3.Department of Environmental HealthHarvard T. H. Chan School of Public HealthBostonUSA

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