Why Transferring More Embryos Can Be Risky in IVF
Patient: Dr Malpani, I noticed that some doctors recommend transferring two or three embryos during IVF. Is that normal?
Dr. Malpani: Yes, unfortunately, many IVF clinics in India still follow that practice. But it’s actually outdated and potentially risky. The best clinics globally prefer single embryo transfer — specifically, transferring one top-quality blastocyst.
Patient: But doesn’t transferring more embryos increase the chance of pregnancy?
Dr. Malpani: It sounds logical — more embryos, higher chance, right? But in reality, that’s not how it works. What it does increase is the risk, the cost, and the emotional toll if it doesn’t work. You may end up wasting embryos unnecessarily and needing a fresh cycle, which benefits the doctor, not you.
Patient: That’s worrying. How does transferring multiple embryos affect the risks?
Dr. Malpani: It increases the risk of multiple pregnancies — twins or triplets. While some people think that’s a bonus, it actually raises the chance of complications like preterm birth and NICU admissions. Your IVF doctor might be happy with just achieving pregnancy, but it’s the obstetrician — and you — who’ll bear the consequences.
Patient: So why are so many clinics still doing this if it’s so risky?
Dr. Malpani: The hard truth? Lack of confidence in their embryology lab. Many clinics don’t have the capability to grow embryos to day 5 — the blastocyst stage — so they transfer them earlier, like on day 3, and in greater numbers to compensate for low embryo quality.
Patient: Day 3 vs Day 5 transfer — what’s the difference?
Dr. Malpani: A day 3 embryo still belongs in the fallopian tube, not the uterus. It’s not ready for implantation yet. A day 5 blastocyst, on the other hand, is naturally prepared for the uterus. Transferring too early shows the lab isn’t confident their embryos will survive till day 5.
Patient: So when clinics transfer multiple embryos early, they’re cutting corners?
Dr. Malpani: Exactly. It’s a shortcut. Instead of improving their lab to create better-quality embryos, they just transfer more of them. It’s a way of transferring the risk to you instead of owning responsibility for poor lab performance.
Patient: That feels unfair. What happens to the leftover embryos?
Dr. Malpani: Sadly, many good embryos get wasted. If one implants and the rest don’t, those embryos are lost forever — embryos that could have given you another chance in a frozen cycle.
Patient: What should a good IVF clinic offer instead?
Dr. Malpani: They should recommend transferring a single top-quality blastocyst, give you photos of the embryo, and document everything clearly. That shows they’re confident in their work and value transparency.
Patient: Is there a right time to ask these questions?
Dr. Malpani: Yes — before you pay any money or start your cycle. This is the time to ask about their lab protocols, embryo grading system, and whether they routinely give embryo photos to all patients.
Patient: Thank you, Dr Malpani. This has been incredibly eye-opening. I feel much more equipped to ask the right questions now.