What to Expect at Your IVF Embryo Transfer | A Nurse’s Perspective
IVF can be a long, challenging process with unexpected roadblocks.
It begins with fertility testing (bloodwork and vaginal exams), moves onto the diagnosis and planning (studying injection videos, ordering medication, and scheduling your life around injections), and then it’s game time. Injections begin and you hope you’re doing everything correctly so that you give your family the best shot to grow. Night after night, morning after morning, it’s something else to remember, to alter, to stress about. It’s a lot of weight to carry. (Read a patient's experience with an IVF embryo transfer here.)
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But then you turn a corner. You go in for your egg retrieval and you can let out a sigh of relief... your follicle stimulation is complete, and you’ve done all you can. It’s the fertility specialist’s turn to take over.
After your oocyte count is complete, your fertility team is keeping a careful watch over your embryo growth. How many are looking viable? Growing? Multiplying? Hatching? All the while, you’re waiting by the phone to hear updates and final numbers. The pressure during the embryo growth phase is stressful for you, and we understand that.
Sometimes, in the midst of all that, cycles can hit roadblocks. Whether it’s a lower production than expected or a cancelled cycle (because of, say, a low basal antral follicle count before the cycle begins or low production mid-cycle), the pressure of making it through to “the end” can feel mountainous. Rest assured, though, that your fertility team and Reproductive Endocrinologist will work with you incredibly closely, doing everything they can to make sure these things don’t happen.
The Embryo Transfer is the final step; it’s what you worked so hard for. It will be the last stop in the journey towards building your family.
The Embryo Transfer Process – From A Fertility Nurse
Below, I explain the process from the RMA of Connecticut perspective. While this will look similar across the board, we take great pride in our diligence, security, and carefulness when it comes to any point in the IVF process, especially the embryo transfer.
Frozen Versus Fresh Embryos: What’s the difference?
Before you begin IVF, you’re given the option to do a fresh embryo transfer or frozen embryo transfer. Often times, your doctor will make a suggestion which is best for your protocol.
A “fresh” transfer is just as it sounds – the embryo will not be frozen before transfer. Instead, it will be monitored and grown in the lab for approximately 5 days. If all levels appear optimal, the fresh transfer will happen at that point.
A “frozen” transfer is also an intuitive nomenclature – an embryo is removed from cryopreservation the morning of your transfer to thaw, then is transferred the same way a fresh embryo would be. The frozen embryo was also monitored and grown in the lab for 5-7 days to make sure of its viability, then it was carefully stowed away for cryopreservation until your eventual embryo transfer.
Why Do You Freeze Embryos?
There are many reasons why embryos are frozen.
- You may be screening embryos for chromosomal or genetic abnormalities, a procedure known as PGT-A or PGT-M.
- It could also be that clinically, the timing of your transfer is “off” based on premature elevation of your progesterone levels.
- The more likely reason is that you had left over embryos from your previous IVF cycle, and you are now ready to move forward.
How Long Does an Embryo Transfer (ET) Take?
The timing of the ET can differ and will depend on if you are proceeding with a fresh or frozen embryo transfer.
Fresh Embryo Transfer:
The ET process usually takes place five days after egg retrieval. During that waiting period, the eggs are mixed with sperm so fertilization can take place. The embryology team is “babysitting” your embryos and working hard to ensure they have the best chance for survival.
By day five, the embryo(s) are now considered a blastocyte, consistency of 200-300 cells, and are ready for transfer. Your pregnancy test is approximately 9 long days after Transfer.
Frozen Embryo Transfer:
If you are having an FET (frozen embryo transfer), that means you have embryos frozen from a previous IVF cycle. Your embryos were most likely frozen five, six, or in some cases, seven days after egg retrieval. In cases like this, the process can take 3-4 weeks from the time you get your menses.
It’s not as simple as just “thawing the embryos and ‘popping’ them back into the uterus.” It takes a bit more work…
Once cleared to start a cycle, you will take an oral medication called Estrace for approximately 2-3 weeks. This helps to thicken and optimize the lining of your uterus for implantation. You will be seen for a mid-cycle ultrasound to assess your lining and your doctor will give you the “green light” to proceed.
You will then be instructed to begin intramuscular progesterone injections (ouch!) along with progesterone vaginal inserts (double whammy).
Your Transfer will take place 6 days after starting progesterone. The timing is critical to the success of your Transfer. Similar to a fresh embryo transfer, your pregnancy test will take place about 9 days after transfer.
What to Expect at Your Embryo Transfer:
Finally, the day has arrived! Thawing your embryo takes very little time, just about an hour or so.
Transfers at RMA can take place every day of the week, including weekends. This can help alleviate the stress of having to take another day off of work. They are normally scheduled between 1-2pm during the week and late morning during the weekend.
Unlike your egg retrieval, the ET will not require any anesthesia, which means you can eat a healthy, light breakfast, and even lunch, pending your specific time.
Most transfers require a full bladder, we advise you to drink 20-30oz of fluid, starting an hour before Transfer.
We advise you not to wear any perfume and your partner should not wear any fancy cologne. The embryos are super sensitive to certain odors.
After a series of verifications to ensure you will receive the correct embryo, your embryo(s) will be carefully loaded into a catheter, and the catheter is inserted through your vagina and cervix, and into your uterus, with the guidance of ultrasound imaging.
The ET is virtually painless, with some cramping possible. You will be advised to rest for a few minutes after the transfer, and then you can get up, empty your bladder, and go home. You also have the option of incorporating Laser Acupuncture into your transfer – a quick session before and after your ET is shown to raise implantation rates by up to 15%!
There are minor restrictions after transfer. The best news is that you don’t have to be on bedrest. In fact, limiting activity has been linked to increase stress which can affect treatment results. Of course, we don’t want you going out and running a marathon, but keeping to your daily routine is key with a few restrictions to keep in mind: No hot baths or jacuzzies, no douching, no heating pads.
Oh, I almost forgot, no sex. (Sorry!...or not?! :) )
You can also go to work the following day.
Tips for Your Embryo Transfer:
- Follow directions for your medications and review medication videos in advance to ensure you understand how to administer all your medications correctly.
- Make sure you have enough medications, especially if you are traveling during your cycle
- Stress Reduction is key! Take a walk, stroll through your favorite park, listen to music, mediation, yoga, the list is endless so pick one or two things that you enjoy doing and do them!
- Acupuncture is being utilized more routinely. If you are needle phobic, RMA uses laser acupuncture and the best news is that it can improve pregnancy rates by 15% (when administered before and after the ET).
- Eat healthy and take a Pre-Natal Vitamin with Folic Acid
- And if you pray, pray! We are all thinking about you during this special time.
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A Note from Your Fertility Nurse
Take a deep breath and recognize all your achievements up until now – you’ve made it to the embryo transfer!
The clinical side of the embryo transfer is a fascinating orchestration of science, technology, and your specific journey. It’s a day filled with hope and positivity that we want to resonate with you over the next nine days. Next up, your pregnancy test in 9 days. We wish you nothing but good news and are always on your team, no matter what happens.
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