IVF – Natural Cycle D3 Embryo Transfer

This case is a 38-year-old woman who previously underwent one IVF attempt. She had transferred four high-quality day-3 embryos but did not become pregnant. When she came to me, she had four remaining average-grade embryos cultured to day 3 (D3). Due to her advanced age and the urgency of time, in order to improve her chances of conception and reduce the emotional toll of repeated failures, we chose a natural cycle and transferred all four embryos (they were frozen together and had high fragmentation). I honestly didn’t expect all four to implant successfully (the odds were low), but while we were happy, we were also concerned about the risks of multiple pregnancies. Fortunately, one was naturally absorbed, and she ended up with triplets, which was more manageable. The couple was overjoyed!

In general, I don’t encourage “intentional” multiple pregnancies, as they carry risks such as premature birth, congenital anomalies, umbilical cord entanglement, postpartum hemorrhage, and more.

However, it’s hard to avoid this in IVF, because each embryo transfer brings hope. For older patients, transferring only one or two embryos has low success rates;
transferring more increases the chance of multiples. That’s why thorough communication between doctor and patient before the treatment is so important. Both parties need to understand and accept the pros and cons of different approaches.

In this case, the patient may have a harder pregnancy, face the dilemma of fetal reduction, require a cesarean section, and need to prepare for a potential preterm delivery.

Still, I sincerely congratulate this couple who waited so long for their baby, and wish them a smooth pregnancy and delivery!