Undergoing IVF to build the family of your dreams can be overwhelming, but our team is here to help every step of the way. Here are some things you should know in order to plan and prepare for your embryo transfer.

What is the difference between a fresh and frozen embryo transfer?

A fresh embryo transfer occurs in the same cycle as the IVF cycle. Eggs are retrieved, fertilized in the lab, embryos are allowed to develop and are then transferred into the uterus 3-5 days after egg retrieval.

A frozen embryo transfer (or FET) occurs when eggs are retrieved, fertilized in the lab, and embryos are frozen instead of transferred.

Why is a frozen embryo transfer preferred?

1.       An FET gives patients time to recover after egg retrieval and before implantation. Hormones are at their highest after retrieval. A pregnancy could cause these hormone levels to go even higher which can make symptoms worse and put you at risk of ovarian hyperstimulation syndrome—also known as OHSS. An FET is recommended for patients with a high follicle count or PCOS.

2.       An FET gives us time to sync up the timing between the embryo and the uterus to increase chances of successful implantation. Endometrial receptivity is a stage in which the endometrium is receptive to accept an embryo. The embryo may not implant successfully if not transferred at the optimal time. The endometrium is only receptive for a short period of time which varies from person to person. This period of time is called the window of implantation. An Endometrial Receptivity Analysis may be recommended for some patients. Speak to your provider to see if an ERA is right for you.

3.       An FET gives us time to perform preimplantation genetic testing. Embryologists can test embryos for chromosomal abnormalities increasing the chance of success and decreasing the chance of miscarriage as we would transfer a genetically normal embryo that could lead to a healthy, viable pregnancy. The embryo transfer can occur as soon as results come back or whenever the patient is ready for pregnancy which can be years later.

Are there circumstances in which a fresh transfer is recommended?

The main advantage of doing a fresh embryo transfer is quicker time. There is also a benefit to patients who are older or may have more fragile eggs/embryos that could do better with a fresh transfer.

What does the frozen embryo transfer preparation process look like?

Uterine preparation for FET lasts 3 – 4 weeks. The first two weeks prepare the uterine lining for implantation. Once the lining is ready, you will begin progesterone injections—this happens at some point in week 3. Transfer is scheduled on the 6th day of progesterone exposure.

On cycle day 1, you will have a transvaginal ultrasound and bloodwork done.  We call this the baseline appointment.

If your ultrasound and hormone levels are normal, you will begin preparing the uterine lining though a controlled cycle, natural cycle, or modified natural cycle. A controlled cycle is the most common.

Your provider will control the growth of your uterine lining by having you take estrogen (pills, patches, injections, or combination of these). It takes approximately two weeks for your uterine lining to grow and develop. You will have two ultrasounds to check your lining. If your lining has grown as expected, you will be given a start date for progesterone injections. In a controlled cycle, your body is not ovulating, so your progesterone is being replaced with daily progesterone in oil injections. Progesterone start day is day 0 and your embryo transfer will be on day 6.

There is a narrow window of implantation, so the duration and amount of progesterone is highly important. We provide a frozen embryo transfer calendar that lists all your medications to make this easier. Your medications may include:

·       Oral birth control to “override” your cycle and control when you get your period.

·       Lupron—taken up until you start progesterone—to help prevent breakthrough ovulation. We will also monitor this by looking at the ovaries during ultrasounds to make sure there are no signs of pre-ovulation.

·       Baby aspirin to help improve blood flow to the uterus

·       Medrol to suppress any inflammatory reaction between the embryo and endometrial lining

How are embryos frozen?

We currently freeze embryos through vitrification (also known as flash freezing). This process has a very good survival rate of 95-98% or better.

How long does an embryo have to be frozen before transfer?

There is no ideal length of time. Once it’s frozen you can thaw it out the next day or years later.

When will my embryo be thawed?

Your embryo will be thawed the day of the transfer.

What is embryo glue? Is it recommended for everyone?

Embryo glue is hyaluronic acid. It mimics the sticky secretions in the uterus. It might be useful in particular situations. It adds cost to the treatment process, so it’s a very individual decision you have to make with your doctor. While it may help, it doesn’t guarantee that the embryo will implant.

How do I prepare for my embryo transfer in the weeks leading up to it?

 ·     Maintain a healthy diet (avoid highly processed foods and eat organic produce, if possible, especially the produce on the dirty dozen list which has the highest pesticide residue)

·      Avoid artificial sweeteners 

·      Eliminate alcohol or limit consumption to less than 3 servings a week

·      Abstain from recreational drug use

·      Take at least 400 mcg of folic acid daily 

·      Exercise regularly—modify your workout if you’re a strenuous exerciser (this is good for those undergoing a frozen embryo transfer since ovaries will be back to their regular size)

·       Get enough sleep

·       Decrease your stress levels (yoga and meditation are great ways to reduce stress)

How do I prepare for my embryo transfer the day of?

·       Come into the clinic with a full bladder–this helps us see the uterus better during the abdominal ultrasound used to guide our catheter during the transfer

·       Do not use any perfumes, fragrance lotions, or make up–these contain chemicals that are endocrine disrupting that may be harmful to eggs and embryos

·       Bring someone with you–it’s nice to have someone there for support and if you’re given Valium, someone will need to take you home

What will happen during the embryo transfer procedure?

We will use a thin flexible catheter to transfer your embryo to the upper portion of your uterus. This is a 10–15-minute procedure using ultrasound guidance. There is no anesthesia involved. We may give you Valium to help relax the uterus and prevent uterine contractions during the embryo transfer if you are anxious.

What should I do after the embryo transfer?

On the day of transfer and the following day, take it easy. We don’t recommend bed rest, but don’t do any major exercises. Wait two weeks to see if implantation has occurred. After 10 days, we will check your HCG (pregnancy hormone) levels. In a normal pregnancy, HCG levels double every 48 hours. We will check this 3-4 times. After that, you will have your first pregnancy ultrasound. You will continue all meds until 10 weeks gestation.

What can I do to ease anxiety during the two week wait?

The two week wait is hard, but there are a few things you can do to ease the anxiety during this time of uncertainty:

·  Lean on your support system

·  Keep yourself busy

·  Spend time with friends and family

·  Be kind to yourself

How soon after transfer will I be considered pregnant?

Behave as if you are pregnant from the moment the embryo is placed in your uterus. We will check your HCG (pregnancy hormone) levels 9-10 days after transfer.

What signs/symptoms should I watch out for after transfer?

Mild cramping and spotting can be normal. If there is any severe pelvic pain, more than spotting, fever, nausea, or any other concerning symptoms, please call the clinic.

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