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An embryo transfer is the last stage in the IVF process, where the fertilized egg that has been left to grow for several days is placed in the woman’s uterus where it will hopefully implant, become a fetus, and result in the birth of a healthy child.
The embryo transfer procedure is done by loading the IVF embryo into a catheter, which is then passed through the woman’s vagina and cervix, and deposited in the uterus. Anesthesia is usually not necessary, but valium may be used.
There are many “types” of embryo transfers though the basic principle remains the same.
Just as the term implies, a fresh embryo transfer is the transfer of (an) embryo(s) that has not been frozen.
A Frozen Embryo Transfer is a cycle in which frozen embryos from a previous IVF or donor egg cycle are thawed and then transferred into a woman’s uterus.
A frozen embryo transfer may be done for a number of reasons:
Medically Advised Due to Uterine Receptivity: During an IVF cycle, a woman is in a state of controlled ovarian hyperstimulation, which adds a good deal of physiological stress to the woman’s body. In some cases, the woman’s body is unable to simultaneously prepare a beautiful “home” for the embryos to be transferred. If the woman has ovarian hyperstimulation syndrome or has elevated progesterone or estrogen levels or has a lining under 7mm at the time of trigger, it may be advised to do a “freeze all cycle,” followed by a FET. This allows the intended mother to wait until the uterus/endometrium is more receptive and implantation more likely.
A Second Embryo Transfer: In a conventional IVF cycle, it is common for 10-15 eggs to be produced through controlled hyperstimulation, which results in a number of high-quality embryos available for transfer. Today’s standard practice is to transfer one (sometimes two) embryo into the woman’s uterus and freeze all remaining embryos to increase the chance of future pregnancy (should the couple want to continue expanding their family after giving birth or if the first transfer fails).
Easier to plan: Because there are times when it is medically advised to convert a fresh cycle to a freeze-all cycle with an FET, many, particularly travel clients, find it much easier to plan in advance for a frozen transfer as they are rarely ever canceled, can be easily planned, and offer comparable success rates as a fresh transfer.
Cleavage stage embryos are called such because the cells in the embryo are dividing (or cleaving), but the embryo itself is not growing in size. This stage is usually reached around day three, but may happen on day two or four. They are often referred to simply as “day three embryos.”
Some fertility experts believe there’s no substitute for a woman’s uterus and that embryos should be put back into the uterine environment as quickly as possible. Since not all embryos survive until Day 5, transferring on Day 3 is a way to ensure an embryo gets to the optimal environment to thrive. At CNY, we generally recommend transferring a day three embryo if there are fewer than four embryos on day one.
A blastocyst is an embryo that has developed into a single-layered sphere of cells encircling a fluid-filled cavity with a dense mass of cells grouped together. Blastocysts contain anywhere from 60 to 120 cells. This usually occurs on day five but may happen on day 6, 7, or even 8. By this stage, the embryo has differentiated into two cell types: the trophectoderm, the cells on the periphery of the embryo that form the placenta, and the inner cell mass (ICM), the dense mass of cells on the inside that forms the fetus if the embryo implants.
A blastocyst embryo is considered to be more “special” than an earlier-stage embryo since it has a higher probability of being genetically normal, implanting, and leading to a live birth than a cleavage-stage embryo.
By delaying embryo transfer to the blastocyst stage, an embryologist is better able to select embryos with a higher probability for continued development.
An embryo that is grown to a blastocyst stage can also be genetically tested prior to transfer, which can help reduce the risk of miscarriage for some populations, avoid known genetic disorders, and select the sex of the child.
A(n) (Elective) Single Embryo Transfer is the practice of transferring only one embryo into a woman’s uterus. This offers a reduced chance of multiples while maintaining a very similar rate of pregnancy. Due to the reduced risk of an eSET along with having a very similar rate of pregnancy, eSET has quickly become the gold standard practice for transferring embryos with an IVF procedure.
A transfer of multiple embryos is quite simply the transfer of more than one embryo. While this can be done for some, there are strict guidelines that restrict the transfer of multiple embryos. Transferring a high number of embryos (or even more than one in some instances) can get a clinic shut down in today’s day and age.
Some of the above-mentioned embryo transfers are mutually exclusive, while others could be classified together:
That means a transfer could be a frozen single embryo blastocyst transfer, but it could not be a cleavage blastocyst transfer. That said, IVF often results in many embryos so you could do a Fresh Single Embryo Transfer followed by a Multiple Frozen Embryo Transfer months/years later from an embryo created in the same IVF cycle.
The timeline for an embryo transfer is highly variable as every individual’s cycle is unique and governed by a multitude of factors being monitored closely. These factors help time a number of key events in an IVF cycle, which in turn sets the trajectory for the next step of the IVF cycle. Because the embryo transfer is the final stage of an IVF cycle, the day on which this occurs is highly variable – so it’s important not to get attached to any specific calendar or timeline during your own IVF or FET cycle.
Day one of a fresh transfer cycle is noted as the first day of stimulation medications (usually on day 2-4 of a woman’s natural menstrual cycle if applicable). The day of transfer is ultimately determined by the day of the egg retrieval and the developmental stage of the embryo. However, both those things are indeed variable. For instance, the ultrasound and bloodwork monitoring could determine that an extra day of stimulation is required (or less) pushing the day of the egg retrieval forward or backward. Most cleavage-stage transfers happen three days after the retrieval, and blastocyst-stage transfers typically happen five days after, but embryos, too, develop at different rates. It is indeed quite common to do a blastocyst transfer seven days after the retrieval.
Below is a sample calendar for a fresh embryo transfer.
Similar to a fresh transfer, each and every FET is customized to the intended parent’s cycle depending on their lining development and response to medications (if being used). While the amount of time spent on estrogen before introducing progesterone varies by person and will be determined through the help of ultrasound and blood work monitoring, the day of the embryo transfer is ultimately dependent upon the day in which progesterone is started:
Below is a sample FET calendar.
Embryo transfers take place under sterile conditions, usually in a designated transfer room at the fertility clinic. Your doctor, a nurse, the embryologist, (and your partner) will be with you. Anesthesia is usually not necessary, but a muscle relaxer or Valium is often used to help calm nerves and relax the smooth muscles of the uterus. You should take any medications that have been prescribed for you exactly as instructed. You may be asked to refrain from taking anything that is inserted vaginally (like a suppository) the morning of the transfer.
Prior to the transfer, the doctor and embryologist will confirm your name and date of birth to make sure it matches identifying information on the embryos. Then, with the assistance of the embryologist, the embryo is loaded into the transfer catheter. Around that same time, a speculum is placed into the vagina to allow visualization of the cervix, which will then be cleaned. The catheter is placed through the cervix and into the uterus using ultrasound guidance. Once in place, the embryo is gently deposited into the uterus, where it will hopefully implant.
Embryo transfer is very similar to having a pap smear. It should not hurt, but you may feel some minor discomfort when the speculum is inserted or when the catheter is passed through your cervix.
The patient is allowed to rest for about 15 minutes afterward. Follow-up instructions are given, and bloodwork is scheduled for 4-7 days post transfer and a pregnancy test for ten days post transfer.
There’s a lot that can be done before an embryo transfer to improve the odds of a successful transfer. Most of these changes have an optimal effect if started at 30-90 days prior to the beginning of the stimulation phase of the IVF cycle as eggs start their final phase of development about 90 days before ovulation. This helps to enhance egg development and provide the best quality eggs (which make up half the growing embryos’ genetics) for your treatment cycle.
Various immunological medications can help improve transfer outcomes, particularly after a history of failed implantation. Some immunological medications include:
Most of the prep work for successful embryo transfer happens upfront. Once transfer occurs, there’s really not too much that can be done to alter the course. It is recommended women have a second round of acupuncture just after their transfer, as several studies show the benefit of acupuncture treatment pre and post-embryo transfer during an IVF cycle. Fourteen research studies published in Fertility and Sterility indicate that acupuncture performed before and after IVF embryo transfer has increased the rates of pregnancy by as much as 35-50% .
Implantation of the embryo can occur up to 72 hours after embryo transfer. Post-transfer instructions vary from clinic to clinic. While standard protocol used to be to recommend bed rest, this is no longer the case.
The experts at CNY suggests patients resume their normal routines, but are restricted from strenuous exercise, sex, or taking baths. We recommend going home, relaxing, and getting a good night’s sleep. Maintain a positive outlook, find ways to relax and connect with your partner during the dreaded “two-week wait” between transfer and pregnancy test. Try not to get too caught up in do/don’t lists. Focus on you and doing the things you like.
The cost of a fresh transfer is usually included in the base cost of IVF, around $12,000 on average, and $3,900 here at CNY Fertility. Because it is included in the price of IVF, it is difficult to extrapolate out from the other services required as part of the IVF package in order to obtain the cost of just a fresh embryo transfer.
The average cost of a Frozen Embryo Transfer is around $4,000 but ranges from $1,400 (including the procedure and monitoring) here at CNY Fertility to over $6,000 at other clinics around the country.
This may seem like a foolish question given what we just discussed, but it really depends on how you look at it. A frozen embryo transfer could be looked at as an additional expense, particularly if it is done as the first transfer (no fresh transfer). However, many IVF cycles result in more embryos than can be transferred at once. These embryos are frozen for future use (after a failed transfer or the successful birth). When used in this way, the cost of the frozen embryo transfer is significantly less than doing a fresh transfer, which would new IVF cycle from scratch.
