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Embryo transfer
Embryo transfer is a key step in IVF, where embryos are transferred to the uterus to achieve pregnancy.
In cooperation with embryologists from the partner hospital, we apply proven techniques to achieve a successful pregnancy.
Embryo transfer by days
Embryo transfer is done on the second, third or fifth day after aspiration.
Depending on how many embryos there are, how they are developing, previous procedures and discussions with the couple, it is decided on which day the embryo will return to the uterus.
An embryologist talks to a patient.
Most often, one embryo is transferred, while in certain situations two embryos are returned.
- The patient arrives for the embryo transfer with a full bladder about 30 minutes before the scheduled time for the transfer;
- After that, the patient goes to the operating room where the transfer is done. The transfer is done on the gynecological table;
- No anesthesia is required for embryo transfer;
- A speculum is inserted into the vagina to visualize the cervix;
- The assistant holds the ultrasound probe on the stomach;
- The gynecologist places a thin external catheter into the cervix;
- When the tip of the catheter is visible on the screen of the ultrasound device, the embryologist brings in the internal catheter with the embryo;
- An internal catheter is then placed into the uterine cavity;
- When the tip of the catheter is identified in the middle of the uterine cavity, the embryo/embryos are "inserted" into the uterine cavity;
- After the embryo transfer is completed, a "white dot" about 1-2 mm is visible on the screen, which is actually the liquid and air surrounding the embryo. The embryo is 0.1-0.2 mm in size and cannot be seen on the screen.
- After the transfer, the patient gets up alone and returns to the room and after receiving the discharge list, leaves the hospital.
- She can return to normal activities. Heavy physical activities, smoking and alcohol use are not recommended.
- A pregnancy test is done 12-14 days after the transfer. Beta hCG blood test or urine beta hCG test can be done.
- Progesterone therapy started before the transfer is continued until the pregnancy test. If the test is positive, the patient continues progesterone therapy until the first ultrasound check. When the test is negative, the therapy is stopped and a few days after stopping the therapy, the patient will have her period. Progesterone therapy is not required when all embryos are frozen and no transfer is performed. In that case, the patient will have her period 5-10 days after the egg aspiration.
Cryo-embryo transfer (FET)
For the transfer of a pre-frozen embryo, the term FET is usually used instead of frozen embryo transfer or cryo embryo transfer.
The essence of cryo embryo transfer is to prepare the endometrium, that is, to perform the transfer when the chances of embryo implantation are the highest.
It can be done:
It is done in women who have regular periods.
- The patient comes to the Clinic when she gets her period and an ultrasound examination is scheduled.
- Depending on the size of the dominant follicle, the day when blood collection for LH analysis begins is determined.
- Most often, LH is analyzed on day 3-4 to determine the day of ovulation, and then on the second, third or fifth day after ovulation, embryo transfer is done, depending on which day the embryo was frozen. Progesterone is often used after the transfer.
Pills are used for ovulation stimulation from the third to the seventh day of the cycle. These medications are used in women with irregular cycles.
- The patient comes to the Clinic when she gets her period and an ultrasound examination is scheduled.
- Depending on the size of the dominant follicle, the day when blood sampling for LH analysis begins is determined.
- Most often, LH is analyzed on day 3-4 in the morning hours to determine the day of ovulation.
- On the second, third or fifth day after the ovulation, depending on which day the embryo was frozen.
- Progesterone is most often used after the transfer.
In the cycle when medications based on estrogen and progesterone mimic the natural cycle.
For this method the abbreviation of hormone replacement therapy is used.
- The patient begins therapy with medications containing estradiol.
- After about 10 days of estrogen therapy, an ultrasound is performed.
- If the endometrium has a satisfactory appearance and dimensions, progesterone therapy is started, while the estrogen therapy is continued.
- The day a patient starts progesterone therapy is day 0, and then from that day, the second, third or fifth day, the embryo transfer is done, depending on which day the embryo was frozen.
- The therapy continues until the 12th week of pregnancy, while it is gradually reduced).
The procedure of arrival and departure from the hospital, the transfer itself, is the same as when a fresh embryo is transferred, that is, immediately after the stimulation and aspiration of the egg cells.
A pregnancy test, beta hCG is done 12-14 days after the transfer.
Expert advice: frequently asked questions
Answered by Dr. Milan Milneković
How many embryos are recommended for transfer?
Single-embryo transfer (SET) is recommended. In certain situations, depending on the age of the woman, the number of attempts, the quality of the embryos and possible risk factors, two embryos are transferred.
When two embryos are transferred, the chance of pregnancy increases by 25%, but 25% of the pregnancies achieved is twin pregnancies. Twin pregnancies have an increased risk for pregnancy complications, primarily premature birth.
Twins occur in 1% of pregnancies after the transfer of one embryo.
Does embryo transfer hurt?
Embryo transfer is not painful. Since embryo transfer is done with a full bladder, embryo transfer can sometimes be uncomfortable when the ultrasound probe is placed on the anterior abdominal wall over the bladder.
How long does the embryo transfer procedure take?
The embryo transfer procedure takes about 5 minutes.
How long does it take after embryo transfer to determine pregnancy?
A pregnancy test is recommended 12 days after blastocyst stage embryo transfer and 14 days after embryo transfer on the second or third day after egg aspiration. The hormone human beta chorionic gonadotropin (beta hCG) can be detected in the blood serum 5-7 days after the transfer, but premature testing is not recommended.
A urine beta hCG test can also be done.
Is it necessary to rest after embryo transfer?
No special resting regime is required after embryo transfer. IVF has been done for over 40 years and no studies have shown that resting increases the chance of success.
What are the chances of success?
The chance of pregnancy after embryo transfer in women under the age of 35 with their own eggs is over 50% and gradually decreases with age so that after 43 years, so that it is less than 4-5%.
What is the difference between fresh and frozen embryo transfer?
"Fresh" embryo transfer is a procedure when the embryo is returned to the uterus immediately after stimulation, that is, on the second, third or fifth day after egg aspiration.
Embryos that are of good quality are frozen to be used later when the couple wants another child or pregnancy did not occur after a "fresh" embryo transfer.
If there is a risk of ovarian hyperstimulation syndrome or some other medical or social reason not to do a "fresh" transfer, all the obtained embryos that meet the quality are frozen. With today's fast freezing (vitrification) technique, 95% of embryos survive thawing.
The result is the same after the transfer of a "fresh" and previously frozen embryo.
When can the transfer be repeated after an unsuccessful embryo transfer?
If pregnancy did not occur after a "fresh" embryo transfer, the procedure can be repeated after one-two months, while after the embryo transfer of a previously frozen embryo, a new transfer can be done after the next month.
What factors influence success?
The success of the embryo transfer is influenced by the quality of the embryo, the condition of the endometrium and the technique of performing the embryo transfer.
How to behave after embryo transfer?
After the embryo transfer, it is recommended to return to normal activities. Smoking and alcohol use, as well as extremely heavy physical work and training, are not recommended.
