Embryo Transfer

Assisted reproductive technology (ART), such as in-vitro fertilization (IVF), can help couples and individuals battling infertility bring a child into the world. Between 1986 and 2015, 1 million babies were born in the United States using assisted reproductive technology (ART), such as IVF.

Understanding and deciding which fertility treatment to pursue can be a daunting and emotional experience for intending parents who are just starting their IVF experience.

The last treatment before your blood pregnancy test for intended parents having IVF is an embryo transfer. But what does an embryo transfer entail for you, and what are your options once the big day arrives?

What is an Embryo Transfer?

An embryo transfer is simply the process of taking a fertilized egg and sperm and inserting the newly created embryo into a woman's uterus. Because the location of the embryos inside the uterus must be accurate, your fertility specialist will use an ultrasound to direct the transfer.

Because the ultrasound allows your reproductive specialist to see exactly where the catheter should go, they can limit the chance of the catheter hitting the cervix. If this happens, don't worry; you'll simply feel a little cramping feeling.

Embryo transfers, which are a part of the in vitro fertilization process, can greatly boost the chances of intended parents becoming pregnant. IVF is frequently used by intended parents who are suffering from male factor infertility, female factor infertility, or both to produce a successful pregnancy and delivery.

Why Intended Parents Turn to Embryo Transfer?

While the causes of fertility problems may be unidentified, your fertility clinic and reproductive endocrinologist will work with you to figure out what's causing your infertility and how to get pregnant.

Embryo transfers are a great choice for parents who have the following:

• Fallopian tube damage or obstruction. The egg will fail to become fertilized and migrate to the uterus if your fallopian tubes are damaged or obstructed.
• Ovulation problems. Menstrual periods that are irregular or missing mean fewer eggs are present for fertilization, making it more difficult to conceive naturally.
• Endometriosis. This affects the function of the ovaries, uterus, and fallopian tubes when uterine tissue implants and thrives outside of a woman's uterus.
• Fibroids in the uterus. These are benign tumors on the uterine wall that might obstruct embryo implantation, which is required for a successful pregnancy.
• Tubal ligation.  If your fallopian tubes have been permanently cut or removed, IVF and embryo transfer may be able to help you conceive.
• Poor motility or morphology of sperm. Male factor infertility is prevalent, accounting for 35% of all infertility cases. ICSI (intracytoplasmic sperm injection) fertilization of the egg can result in a viable embryo for implantation.

Embryo Transfer Types

You'll be able to choose from a few different alternatives for collecting and fertilizing the expectant mother's eggs and sperm via IVF.

Frozen Embryo Transfer (FET)

Embryos from previous IVF cycles can be kept and frozen indefinitely. When this happens, many intending parents with remaining embryos from earlier egg retrievals prefer to thaw then transfer their extra embryos.

The most popular type of transfer is frozen embryo transfers, which allow for genetic analysis of embryos before implantation, resulting in higher success rates and a lower risk of genetic abnormality or miscarriage.

During a frozen embryo transfer, the doctor uses a fine transfer catheter to guide the thawed embryos through the cervix and into the uterus. A frozen embryo transfer is a straightforward operation that rarely necessitates pain medication, while medicated and semi-medicated options are available for your convenience.

Fresh Embryo Transfer (ET)

Your fertility specialist will evaluate which embryos have the best probability of implantation after the expectant mother's eggs have been collected and fertilized. Your fertility specialist will place the freshly generated embryos back into the target mother's uterus three to five days following the first retrieval.

Embryo Transfer Day 3

These embryos are also known as Cleavage embryos and are called after the cells of the embryo that are cleaving or dividing. The embryo, on the other hand, is not growing in size. Because not all embryos survive until day 5, some fertility specialists deliver embryos to a woman's uterus on day 3 to ensure that the embryo can grow.

Embryo Transfer Day 5

The day five embryo, also known as a Blastocyst, has formed into a sphere of 60 to 120 cells around a fluid-filled cavity. Blastocysts usually form on day five, but they can form later.

Blastocysts are frequently seen to be a better choice than an earlier stage embryo since they have a higher likelihood of being genetically intact, implanting, and resulting in a live birth than a Day 3 embryo. Your fertility specialist can better select the embryo with the best possibility of implantation and pregnancy by extending the period before you transfer the embryo.

Single Embryo Transfer

The procedure of transferring only one embryo into a woman's uterus is known as single embryo transfer. This reduces the chances of multiples while keeping a similar pregnancy rate. Because of the lower risk and equivalent pregnancy rate of single embryo transfer, it has rapidly become the gold standard approach for transferring embryos during an IVF treatment.

Multiple Embryo Transfer

A multiple embryo transfer is just a transfer of more than one embryo. While this is possible for some, the transfer of several embryos is subject to tight rules. In today's world, transferring a large number of embryos (or even more than one in some cases) can result in a clinic being closed down.

Embryo Transfer Preparation

Don't worry if this is your first embryo transfer; you'll be in the most educated and skilled hands. Embryo transfer will take place three to five days following fresh egg retrievals, or longer if frozen embryos are used.

Make sure to do the subsequent as you prepare yourself for your embryo transfer:

• Schedule your medications and take them regularly. Inquire together with your doctor about over-the-counter drugs and supplements, like vitamin D. Make sure you are taking your fertility drugs and hormones too.
• Invest in self-care and entertainment (but stay away from chemicals).
• Take into account holistic treatments. In women receiving IVF procedures, acupuncture, meditation, and massages can increase pregnancy rates by up to 67 percent.
• Before and after, get plenty of rest. Allow your body to relax and avoid strenuous exercise.
• Avoid exposing your abdomen and uterus to high temperatures. This can cause your reproductive system to deregulate, affecting the success of your embryo transfers.
• Decrease inflammation in your body, GI tract, and reproductive organs by eating a high-fat, low-carb diet.
• Avoid chemicals that can be present in nail polish, some shampoos, cleaning supplies, and other goods.
• Prepare for your transfer procedure the day before by packing a bag, deciding on a leaving time, and more.
• Keep a full bladder for your process. For the ultrasound-guided transfer, drink plenty of water!
• Consult your reproductive endocrinologist for more details on how to better prepare for your embryo transfer.

While performing the steps above will not guarantee a successful conception and pregnancy, have confidence in your fertility specialists. You're in skilled hands, and it's a good thing to have trust in the procedure.

Embryo Transfer Process

The embryo transfer process is similar to a pap smear in that it is a quick procedure that usually lasts between 20 and 30 minutes. During this process, your reproductive specialist will use ultrasonography to introduce a speculum into the woman's vagina. The specialist will next insert a catheter into the uterus through the cervix. The embryos are then transported down the tube and into the uterus.

Following the transfer, you will be allowed approximately an hour to fall down on your back and relax. However, because it is not a particularly invasive process, you may not require all of this time. The complete treatment, including relaxation time, takes only 2.5 to 4 hours in total.

How Many Embryos Should you Transfer?

Intended parents frequently question if transferring numerous embryos improves the chances of healthy pregnancy after an IVF treatment. The truth is that there is no one-size-fits-all solution to this question, as each fertility clinic has its own policy on how many embryos are placed into a woman's uterus.

The fertility expert may only transfer one embryo into the uterus in many circumstances. For women 35 and older, delivering two embryos might sometimes improve the chances of successful implantation. The age of the embryo recipient and her reproductive history are two factors that influence what percentage of embryos are transferred.

According to a 2019 CDC report, 50% of all IVF procedures in the United States involved transferring two embryos, 24% three embryos, and 12% four or five embryos. What were the outcomes? Multiple embryo transfers can lead to more live births, but they also raise the risk of medical issues for both the intended mother and the baby/babies. As medical technology and practices advance, multiple embryo transfers are becoming less common.

Rather than raising the number of embryos delivered during IVF, preimplantation genetic testing and diagnosis (PGS/PGT-A/PGD) had the greatest influence on success rates for intended parents.

These tests allow your fertility specialist to determine which embryo has the best probability of implantation and a healthy pregnancy, increasing your chances of a successful cycle. Consult your fertility specialist to see if you're a suitable candidate for multiple embryo transfer and if PGS/PGT-A/PGD is appropriate for you.

What Happens after Embryo Transfer?

After each session, your fertility doctor will provide you with thorough instructions to help you feel at ease and confident that you are taking care of yourself in the days immediately prior to the post-embryo transfer pregnancy test.

Some doctors advise 24-hour bed rest after the procedure, while others advise using low-impact exercise to increase blood flow to the womb and increase the chances of conception.

Strenuous exercise, intercourse, and bathing, on the other hand, must be avoided. Maintain a good attitude about your embryo transfer operation and act as though you're pregnant, along with meals.

Fresh Embryo Transfer vs Frozen

There are numerous factors to consider when determining whether to use fresh or frozen embryos. Both have advantages and disadvantages.

Although cramping and vaginal bleeding are prevalent, more serious side effects such as uterine perforation and infection are extremely rare. Make certain that the fertility clinic you choose has no history of these dangers related to IVF or embryo transfers.

Fresh Embryo Transfer Benefits and Risks

Women's endometrium (uterine lining) will be assessed for thickness and quality with both frozen and fresh embryo transfers. Fresh embryo transfers, on the other hand, use ovarian stimulation medications to raise estrogen levels throughout the IVF cycle, whereas frozen embryo transfers use a variety of medications (or none at all) to support the uterine lining.

The biggest advantage of a fresh embryo transfer is that it takes less time to conceive. After the egg collection and embryo implant into the uterus, there is a maximum of five days of waiting. Furthermore, because insurance companies are less likely to pay the expense of embryo cryopreservation or embryo freezing, patients prefer to have their embryos transferred fresh.

There are, however, limitations for those looking at fresh transfers. A fresh embryo transfer would be unlikely to succeed if a woman's progesterone level is high due to the conditions accompanying embryo implantation. Fresh transfers should also be avoided by patients at risk for ovarian hyperstimulation syndrome (OHSS), as the drugs used to stimulate egg maturation can be hazardous.

Frozen Embryo Transfer Benefits and Risks

For a variety of reasons, women choose frozen embryo transfers. Let's look at some of the primary advantages and disadvantages of frozen embryo transfers (FET). Perhaps you want to allow your body to break following an egg retrieval process, or perhaps you were originally focused on fertility preservation but now feel ready to get conceived using a prior cycle's egg or embryo.

The most significant advantage of frozen embryo transfers is that, unlike fresh transfers, they allow embryos to be genetically screened prior to implantation, raising success rates and reducing the risk of genetic abnormalities.

Many IVF centers advise patients to go frozen with their embryo transfers. A patient does not require a second egg retrieval to produce embryos if they have leftover embryos from a previous cycle. Intended parents can choose to undertake a frozen transfer cycle after a failed IVF cycle at any time in the future because frozen embryos remain viable for almost ten years after they are frozen.

Frozen transfers also give a woman's hormones and physiology a chance to recover from the effects of the fertility drugs used during the retrieval. Ovarian hyperstimulation syndrome (OHSS), or increased progesterone levels during ovarian stimulation, can signify that the embryo and uterus are out of synchronization, and frozen transfers can help.

How Long Should I Wait Before Doing Post-transfer Pregnancy Test?

Although it may be enticing to take a pregnancy test a few days following your embryo transfer, fertility clinics highly advise waiting until the standard two-week timeframe to ensure reliable results and to handle the emotions that are anticipated during this process.

A two-week waiting is recommended by doctors since conducting a pregnancy test too soon after the embryo transfer can lead to false results. This occurs because the hormone human chorionic gonadotropin (hCG), which is used to determine pregnancy in pregnancy tests, can vary in concentrations depending on where you are in your fertility journey. For example, very early pregnancy typically results in little natural hCG production, resulting in distressing false-negative results.

You can get your first pregnancy test following the embryo transfer after two weeks have elapsed. Your fertility doctor will schedule a blood test two weeks after the transfer to identify the pregnancy result in order to receive a more precise reading.

Embryo Transfer Success Rate

Frozen embryos are just as successful as fresh embryos, with studies showing that frozen embryo transfers have higher success rates than fresh transfers, owing to preimplantation genetic testing and fewer residual retrieval hormones in the recipient's body. The recipient's embryo quality, uterine receptivity, and doctor technique and understanding are all factors that determine embryo transfer success rates.

The age of the egg donor or target mother, egg quality, sperm qualification, and uterine receptivity during the transfer are all aspects to consider when it comes to the success rates of frozen and fresh transfers.

However, one of the most important studies to answer this subject evaluated patients' egg retrievals and pregnancy rates after the transfer using the SART database. With a frozen cycle, a woman would have a greater likelihood of conception and live birth if she retrieved six or more eggs. Fresh embryo transfers, on the other hand, are more likely to result in a pregnancy and a live birth if a woman has fewer than five eggs collected.

Embryo Transfer Cost

We're frequently asked how much an embryo transfer costs and the answer is that it depends. Fresh embryo transfer costs are normally included within the IVF package, though this differs from treatment center to treatment center.

A frozen embryo transfer might cost anywhere from $3,500 to $6,000 and is sometimes not included in the IVF package. Even if you make a fresh transfer, the majority of patients will store their unused embryos in the hopes of using them later.

Is Embryo Transfer the only Choice?

It's quite typical for fertility journeys to have a lot of ups and downs, and a negative pregnancy test doesn't mean your journey needs to end. The medical professional will be able to give you an honest evaluation of whether or not you are a candidate for additional fertility treatments. If you want to seek other reproductive treatments or another IVF cycle, you can work together to identify your next actions.

Every patient's route to pregnancy will look different, whether you're considering parenthood, exploring your fertility choices, or just looking into Assisted Reproductive Technology. Individuals or couples thinking about ART techniques can realize their goals of having a happy, healthy baby.

Conclusion

The embryo transfer is the final step in the IVF procedure. It is the procedure for successfully implanting an IVF Embryo into the uterus of the intending parent. While there are various kinds of embryo transfer and the exact timeline can vary greatly, your choices will be led by a fertility specialist, embryologist, and other reproductive specialists to achieve the best possible outcome for your specific case.