Embryo Transfer | What is your best option ?

Embryo Transfer

The end point of an IVF treatment cycle is an embryo; and an IVF lab will successfully create many embryos in the lab for most of their patients. Good IVF labs routinely show patients their embryos; but unfortunately many labs don’t, which means most patients are clueless about how good the quality of their embryos is. However, this is vitally important information, so you can assess your chances of conceiving, and modify the next treatment cycle accordingly.

Ideal option for Embryo Transfer

Patients are often confused as to how many embryos to transfer, especially when they have three or four top quality blastocysts. Many of them want the doctor to put back more embryos, in order to maximize their chance of getting pregnant in the first cycle itself.

This may be tempting, and while it is true that putting two embryos back will increase the chances as compared to transferring just one in that single cycle, this comparison can be very misleading.

Thus , putting back more than two embryos, especially when these are top-quality blastocysts, is a bad idea because of the risk of high-order multiples or triplets, which can cause a lot of problems for the babies, and is not advisable.

Even when compare one vs two, you should be measuring a “cumulative pregnancy rate,” and not just the rate for one cycle. If you put two embryos back in one cycle, and you don’t get pregnant, then you’ve lost both, and will have to start a new fresh cycle, which is expensive. On the other hand, if you put one at a time, even if the first cycle fails, you still have the second frozen embryos as a backup, and transferring frozen embryos is much less expensive !

This is why patients should think about cumulative pregnancy rates over multiple cycles, as compared to the pregnancy rate in only a single cycle !

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What happens during an embryo transfer

An embryo transfer is short and simple. It usually takes a few minutes and needs no anaesthesia.

• The doctor loads the embryo or embryos into a thin, soft catheter.
• A speculum holds the vagina open, exactly as for a smear test.
• The catheter passes through the cervix into the uterus, guided by an ultrasound scan.
• The embryo is placed in the cavity of the uterus. You can usually watch it happen on the screen.
• You rest for a short while and then go home.

There is no pain beyond mild cramping, and many couples are surprised by how ordinary it feels next to the scans and injections that came before.

What affects whether the embryo implants

Implantation depends on two things: the embryo, and the lining of the uterus.

• Embryo quality. A chromosomally normal, well-graded blastocyst has the best chance. This is why many clinics grow embryos to day five before transfer.
• The lining. The endometrium needs to be thick and receptive, usually 7 to 10 mm with a good pattern. In a frozen cycle we control this with hormones.
• The transfer itself. A gentle transfer that does not traumatise the lining matters. A difficult transfer can lower the chance.
• Your age and history. These set the baseline odds, but the transfer technique is the part the clinic controls.

If you want to understand the embryos themselves, see how embryo quality and grading work.

The two-week wait

After the transfer you wait about two weeks for a pregnancy test. There is nothing you can usefully do in that time to change the outcome. No food, no position and no amount of rest has been shown to help. Avoid heavy lifting, and take the medicines exactly as prescribed, including progesterone. If the test is positive, a scan follows about two weeks later. If it is negative, your clinic should review why rather than simply repeat the cycle. For the full sequence, see the frozen embryo transfer timeline.

Embryo transfer questions, answered briefly

Does bed rest after transfer help?

No. Studies show no benefit from bed rest after an embryo transfer, and some suggest it may be slightly worse. Carry on with normal, gentle activity, and avoid only heavy lifting.

How many embryos should we transfer?

The safest number for a healthy mother and baby is usually one, especially in a younger woman with good embryos. Transferring two raises the chance of twins, which carries real risks for both mother and babies. Your clinic should discuss this with you rather than decide it for you.

Day 3 or day 5 transfer?

Growing to day 5, as a blastocyst, lets the laboratory choose embryos that have proved they can keep developing, and it matches the embryo to the uterus at the right time. Not every cycle produces a day-five embryo, and some clinics transfer on day 3 when embryo numbers are low.

Can a frozen embryo transfer work as well as a fresh one?

Yes. In many clinics frozen transfers now do as well as fresh ones, and they let the body recover between the stimulation and the transfer. If you have embryos already stored, see what happens to your frozen embryos after IVF.

If a transfer has already failed, answer six questions in our free Next-Step tool or ask Dr Malpani for a free second opinion.