Three or five days following the Egg Retrieval, the patient will have the Embryo Transfer (ET). During this time, the fertilized eggs (embryos) have been allowed to grow and divide in the incubator. The patient will have started Progesterone suppositories or Crinone to prepare the uterine lining for implantation.

The day before ET, the patient will be contacted and given a specific time to come to the clinic the next day.

On the day of the embryo transfer, if you like, bring some relaxing music and a Walkman with headphones. Try to think about things that relax you. Bring a picture from your last vacation, a small pillow from home, or a special pair of socks to keep your feet warm. Don't drink coffee or soft drinks before the transfer. If you have a cold, cough, or allergies, let us know; you may need a cough or allergy suppressant. We request that you arrive at the center with your bladder at least half full as this will enable us to better visualize your uterus with the abdominal ultrasound.

About 15 minutes before the transfer, the physician will meet with the couple and discuss the number and quality of the embryos available for transfer. A decision will be made by the couple and their physician as to the number of embryos that will be transferred and the number to be frozen or discarded depending on the quality of embryos. The embryos will be separated into a separate dish. Meanwhile the physician will prepare the patient for the ET. This procedure is very similar to an artificial insemination procedure except that embryos are transferred to the uterus instead of sperm. A speculum is inserted in the vagina; the cervix is washed and cleansed. The embryologist will then load the embryos into a transfer catheter and deliver the catheter to the physician who gently introduces the small flexible tube through the cervical canal into the uterine cavity where the embryos are released.

This is done without anesthesia, and feels about like a Pap smear. A sensation or twinge as the catheter passes through the cervix is common, but the actual embryo transfer normally cannot be felt. Most transfers are performed with the female on her back, the normal position for a pelvic exam. Ultrasound via a transducer placed on the lower abdomen is often used to guide the transfer catheter.

Once the embryos have been released, the catheter is taken back to the laboratory, where the embryologist inspects it for any retained embryos and gives an "all-clear" signal. The transfer itself takes about 30 seconds; the whole procedure takes fifteen minutes. If there are any retained embryos, they are reloaded and a second transfer occurs immediately to insure that all embryos reach the uterine cavity. A second transfer does not decrease your chance for a successful pregnancy.

Click here to view laboratory footage of an embryo transfer.

Multiple pregnancy is a risk when several embryos are transferred. Since several eggs will be retrieved from the ovaries and inseminated, multiple embryos are likely to develop. If multiple embryos are transferred into the uterus, twins, triplets, or even quadruplets or more could occur, perhaps requiring a selective reduction. Higher multiples are rare. In IVF, the risk of multiple pregnancy depends on the number and quality of embryos replaced; your doctor will estimate the risk of multiples for you. Some patients are not willing to accept any risk of multiple pregnancies and therefore elect to transfer fewer embryos, freezing the remainder for use in a later frozen transfer cycle. Your doctor will discuss this with you before the transfer.

Blastocyst embryo transfer

One of the most common complications of fertility treatment is a multiple gestation pregnancy greater than twins. When fertility drugs are administered without IVF, there is an increased risk for multiple gestation pregnancies that in extreme cases can result in septuplets or octuplets as recently occurred in Iowa, Texas and California.

However, when IVF is performed, the number of embryos that are transferred can be controlled. In an effort to have the best success rate for each couple, multiple embryos need to be transferred because not all embryos that look healthy on the third day are capable of making babies. In a women under 40 years of age, only 50 percent of embryos that look healthy on Day 3, have normal chromosomes. In order to balance the risk of failure against the risk of a multiple pregnancy, we have traditionally transferred between two and five embryos for patients under 40 years of age. Approximately 50% of these patients went on to have a pregnancy, leaving 50% with a negative pregnancy test. Unfortunately, some of the pregnant patients were found to have triplets or more, adding significantly to the risk of health problems for the mother and pre-term birth for the infants. In some cases, selective reduction was the only safe option.

Recent breakthroughs in the embryo laboratory allow us to grow embryos more efficiently and also allow us to keep them in culture for a longer period of time. For the last six or eight years, embryos have been transferred on the third day after egg retrieval, at which time most embryos have divided to the 4 – 8 cell stage. We are now able to grow embryos to the fifth day, by which time the embryos that have the potential to make a baby look different. These embryos are known as blastocysts. We transfer only two blastocysts during any embryo transfer.

The biggest single advantage of the blastocyst transfer is a significant reduction in the rates of multiple pregnancy greater than twins. In addition, we can obtain valuable diagnostic information when we look at the percentage of embryos that do develop to the blastocyst stage (usually this should be approximately 30% of fertilized eggs).

This brings us to the down side of the blastocyst transfer. Approximately one in ten patients may not make blastocysts by the fifth day. When the problem lies with the embryos progressing to the blastocyst stage, it is more likely to happen to patients who have had previous failed cycles or who have had recurrent pregnancy loss. While the chances are not zero for a pregnancy where no blastocysts are available on day 5, they are significantly lower than when two good, quality blastocysts are transferred. When no blastocysts are available, this may give us information about why a pregnancy has not happened before and may help us decide together with the patient what treatment is best in the future.

In summary, growing the embryos to the blastocyst stage gives us very valuable information about the potential of the embryos and also allows us to control the risk of a multiple pregnancy greater than twins. This eliminates the risks associated with three or more babies implanting simultaneously. This also allows us to bypass the emotionally and ethically difficult procedure of selective reduction.

Cryoperservation & Frozen Embryo Transfer (FET)

Freezing extra embryos increases the opportunity to achieve a pregnancy as a result of a single egg retrieval procedure. If a pregnancy does not occur in "fresh" IVF cycle, the patient can return at a later time for transfer of the remaining embryos. An ultrasound assessment of the uterine lining is performed before the embryos are thawed, to make sure an adequate uterine environment is present. Usually about 75% of the frozen embryos survive the thawing process, but it can vary depending on the stage at which the embryos are frozen.

After the transfer

After completing the transfer you will be repositioned very gently so your legs are together and slightly elevated. This position is recommended for a short period of time following transfer. It is important during this time that you remain relatively relaxed and comfortable. Usually you will remain at rest for 15 to 30 minutes after the transfer.

The lining of the uterus is uniquely designed to enhance the process of embryo implantation. Special secretions of nutrients and cell adhesion molecules assist the embryo in the process of continuing development, attaching to the uterine wall and burrowing the placental cells into the uterus. The embryos are now safely housed within the walls of the uterus. For better or worse, there is very little you can do at this point to affect the chances of successful implantation. Whether or not the embryo or embryos implant in the uterus is primarily dependent on the health of the embryo.

When you go home, be a couch potato for 6-8 hours after the transfer. Have a good book ready to read and move between bed, the bathroom, and the couch. If you have small children you should avoid lifting them. After 8 hours, you may increase your activity, but don't do vigorous aerobics or running. Your ovaries will still be full of fluid from the effects of the stimulation and you may feel some bloating or pelvic discomfort at this time. It is okay to take stairs slowly, and walk short distances, less than a half mile. Avoid any vaginal creams, lubricants, or spermicides. Take showers instead of tub baths, and don't go swimming. Avoid vaginal intercourse or orgasm for about a week after your transfer. If you have to travel, give yourself twice as much time as usual and minimize stress.