Understanding Embryo Transfer: A Step-by-Step Guide

Embryo transfer is the last stage of your IVF treatment and takes place following the fertilisation of your eggs by IVF or ICSI. Once the eggs are removed from your ovaries following stimulation with fertility medication, they are fertilised in the lab to form an embryo. The embryo is then transferred to your uterus.

What happens during embryo transfer?

Embryo transfer is a simple procedure which typically takes 5 to 15 minutes and is similar to a cervical screening test. The procedure is usually painless; however, you may experience some discomfort.

To begin with, you will be asked to change into a gown and taken to the procedure room.

In the procedure room, your IVF consultant will place a small speculum into your vagina to expose the vaginal walls.

A narrow tube, known as a catheter, containing the embryo/s will be gently inserted through the cervix and to the uterus. Once in place, the embryo/s is carefully guided from the catheter into the uterus, along with a small amount of the fluid that the embryo was growing in.

In some cases, the procedure will be carried out using an ultrasound probe which is placed on the lower abdomen to guide the catheter.

You may experience mild cramping, bloating, constipation and/or some vaginal discharge following the procedure.

What is a speculum?

A speculum is an instrument shaped like a duck’s bill. It is used to gently open the walls of the vagina so that the vagina and cervix can be seen or examined more easily.

What is an ultrasound probe?

An ultrasound probe is a small device which uses high frequency sound waves to create “echo” images of parts of your body. Ultrasound is the method used to create “baby scans”.

What is a mock embryo transfer?

A mock embryo transfer is a trial run of the procedure which takes place either before or during your IVF cycle.

A trial run allows the doctor to measure the length from your cervix to your uterus, which varies from woman-to-woman. Knowing this length means the doctor can determine the correct catheter size to use and how it should be placed, as well as the best route and ideal location for embryo transfer.

The trial run also allows the doctor to check for anything that may prevent the procedure from taking place, such as, fibroids or scar tissue or any other problems that may need to be taken into consideration.

Gynii Me’s Tip: During your first consultation, ask your doctor if it is necessary for you to have a mock embryo transfer. If so, then check whether the mock embryo transfer will take place before your IVF treatment, or before your embryo transfer procedure.  

What are fibroids?

Fibroids are non-cancerous growths made up of muscular and fibrous tissue which develop in the uterus.

What is the difference between fresh vs frozen embryo transfer?

Embryo transfer can either take place in a fresh transfer cycle or a frozen embryo transfer cycle. In a fresh embryo transfer cycle, your fertility nurse will get in touch with you to let you know the ideal day for your embryo transfer to take place. The ideal day for embryo transfer will depend on the progress and quality of your embryos.

The process for a frozen embryo transfer is similar to a fresh embryo transfer cycle; however, hormone stimulation with medication and collection of eggs is not required. This is because any remaining good quality embryos frozen from previous treatment will be used in a frozen embryo transfer cycle. The frozen embryos will be thawed and only an embryo which has survived the thawing process will be transferred.

Research has shown that frozen embryo transfer success rates are now the same if not higher than fresh embryo transfer success rates. According to the HFEA’s national figures published in May 2019, the overall birth rates per embryo transferred were higher for frozen embryo transfer cycles (23%) compared to fresh embryo transfer cycles (22%).

Read more here:

Gynii Me’s Tip: Most people choose fresh embryo transfer following a fresh treatment cycle. However, sometimes the frozen embryo approach is needed, for example, if OHSS has occurred during IVF treatment.

How does OHSS occur?

To make the eggs grow, fertility drugs, are used to stimulate the ovaries during IVF treatment. Sometimes, this medication causes a reaction, leading to OHSS.

How many embryos should be transferred?

Although the UK law allows for up to two embryos to be transferred in women under the age of 40, it is now common practice to transfer only one embryo and freeze any remaining good quality embryos. This is because single embryo transfer reduces the risk of multiple pregnancies (twins, triplets or more), which can be associated with health risks to both the mother and the babies. This includes an increased chance of early or late miscarriage, premature birth and low birth weight. Research suggests that single embryo transfers are safer and as effective as multiple embryo transfers.

For older women above the age of 40, the law states that up to a maximum of 3 embryos can be transferred. This is because success rates decrease with increasing age, so older women have a reduced chance of successful embryo implantation.

Gynii Me’s Tip: Before the procedure, you and your partner should think about the number of embryos you would like to transfer and discuss this with your doctor to understand the risks and chances of success. The doctor will advise you on the number of embryos to be transferred. However, it is you and your partner who will need to make the decision. You will be asked to sign the consent forms just before the embryo transfer to ensure you accept and have understood the treatment plan.

Day 3 versus day 5 embryo transfer?

The embryo is usually transferred when it is either at day 3 (cleavage stage) or day 5 (blastocyst stage) of embryo growth.

Day 5 embryos usually have a greater chance of implantation success as they develop for longer in the lab. This means there are more good quality embryos to pick from. However, not all embryos will be able to survive until day 5, so there is a risk of being left with no embryos to transfer.

The decision to perform an embryo transfer on day 3 or on day 5 will depend on a number of factors, including ; your age, fertility history, the number of embryos available, and crucially the quality of the embryos. If there are a low number of embryos available to transfer, day 3 embryo transfer will be recommended. This is more common for older women, women with a lower number of healthy eggs and couples with one or two embryos. Younger women with a good number of embryos usually have a day 5 embryo transfer.

HOW DO I PREPARE FOR EMBRYO TRANSFER?

You can make sure your embryo transfer goes as smooth as possible by planning ahead so that the experience is as stress-free as possible. Below are a few tips for your embryo transfer:

  • Time how long it will take to travel to the clinic and plan your journey.
  • Arrange to have someone accompany you to the clinic and back on the day.
  • Make sure you are clear about what fertility medication you need to take (for example, progesterone supplementation) and set a reminder for yourself to take it.
  • If you take regular medication (for example, for asthma or diabetes), check whether you should take it on or before the embryo transfer day.
  • Ask whether you should eat or drink on the day.
  • Avoid products containing endocrine-disrupting chemicals (for example, nail polish, cosmetics, perfumes, soaps and lotions with fragrance, non-stick cooking utensils).
  • Eat healthily – specialists recommend a low carb, high-fat diet in preparation for and during treatment.
  • One month prior to starting IVF treatment, it is recommended that you take 400mcg of folic acid daily. Folic acid is important in embryo development during early pregnancy and protects against certain birth defects.

ON YOUR EMBRYO TRANSFER DAY

Do’s and Don’ts

  • Arrive with a comfortably full bladder as this will help ensure a clear ultrasound scan of your uterus.
  • Wear comfortable clothing.
  • Remove all nail varnish.
  • Don’t wear jewellery.
  • Don’t wear perfume, body lotion, hairspray and makeup, as strong odours can damage the embryo/s.

WHAT CAN I DO AFTER EMBRYO TRANSFER TO INCREASE SUCCESS?

  • You will be told what medication to take by the clinic nurse.
  • You will need a supply of panty liners or sanitary pads ;in case of spotting or bleeding.

Relax for the rest of the day and evening. Full bed rest is not required following your embryo transfer as this has not shown to increase the chances of embryo implantation. If you feel up to it, you can return to work the following day and carry on with regular daily activities.

What should I avoid after embryo transfer?

Following embryo transfer, it is best to avoid:

  • Smoking, vaping, nicotine patches and other nicotine products.
  • Alcohol, caffeine, cola drinks and other unhealthy stimulants.
  • High impact or rigorous activities (for example, jogging, running and swimming).
  • Lifting heavy objects.
  • Sexual intercourse.
  • Extreme hot and cold temperatures (for example, hot baths, using heating/ice pads).

Gynii Me’s Tip: Some women prefer to go back to work after embryo transfer as they feel they are less anxious when they are focused on other tasks. Other women prefer to take two weeks’ off to avoid any stress at work. If your work involves physical activities, it is worth speaking to your manager to see if you are able to rearrange your work to avoid strenuous activity, for the next couple of weeks. If you are not sure how to have this conversation with your employer, please get in touch, and we can provide advice.

WHAT NEXT? - THE TWO-WEEKS WAIT AND PREGNANCY TEST

Once the embryo/s have been transferred, you will be advised to wait two weeks until taking a pregnancy test. Two weeks after your embryo transfer, you’ll be able to find out if the embryo has been implanted successfully with a pregnancy or a blood test.

If you are pregnant, the fertility clinic will offer an ultrasound scan at around 7 weeks to confirm the fetal heartbeat. If a fetal heartbeat is detected, the clinic will refer you to your GP, who will connect you with a midwife and gynaecologist.

If you are not pregnant, you will need to stop taking progesterone medication and will likely get your period within a week.

Gynii Me’s Tip: Most clinics offer a free follow up consultation after a failed cycle. We recommend you take this opportunity to review your last treatment cycle (e.g. how your body responded to the medication, potential causes of a failed cycle) and to discuss the next steps with your fertility doctor.  You should also ask if it is necessary to have a new treatment plan for your next cycle.  

HOW DOES COVID-19 CHANGE THINGS?

You will be asked to have a COVID-19 test before the embryo transfer procedure. If you test positive, your embryo transfer will be cancelled, and the embryo/s will be frozen until you have fully recovered and a test shows that you are clear of the virus. According to the HFEA, you should wait 28 days after you have recovered from COVID-19 before beginning or continuing with treatment.

You should stay at home during your treatment as much as possible in order to reduce the risk of transmission. Unnecessary exposure to risks of COVID-19 infection should be prevented by limiting interactions with individuals of different households.  

EMBRYO TRANSFER Q&A

What is the difference between a natural and medicated frozen embryo transfer (FET) cycle?

Two types of approaches are used in embryo transfer for monitoring and preparing the lining of the uterus for transfer. These include a natural frozen embryo transfer (FET) cycle and a medicated frozen embryo transfer cycle.  

FET treatment involves transferring the embryo at the ideal time in the ovulation cycle and when the lining of the uterus is at the right thickness. The lining of the uterus can be prepared using medication. The length of a FET cycle approximately lasts 6 to 8 weeks; however this may vary depending on an individual’s treatment plan.

What is Natural FET?

A natural FET cycle is performed when a woman has regular menstrual cycles and ovulation. Your menstrual cycle is monitored, and the timing of the transfer is carried out in time with natural ovulation. Sometimes, a natural FET cycle may be supplemented with a hormone injection (specifically, a human chorionic gonadotrophin, or hCG, injection).  This helps control precisely when ovulation will happen to help with embryo transfer. Natural FET cycles require more monitoring and ultrasound scans (approximately 3-4 scans) as they are more difficult to predict.

What is medicated FET?

During a medicated FET cycle, oestrogen and progesterone medication is administered to the woman; to aid the thickening of the uterine lining and make it receptive to the embryo. Medication is also given to suppress your natural cycle and prevent ovulation. Oestrogen and progesterone medication are continued from the point of a positive pregnancy test all the way through the vital first 12 weeks of pregnancy.

How soon after failed FET can I try again?

If your failed FET was a natural cycle, you can try again immediately after the failed FET cycle. However, it is recommended to wait for at least one full menstrual cycle following a failed FET (approximately 4 to 6 weeks), especially if it was a medicated FET cycle. This is recommended in order to give your body a chance to fully recover  and your cycle to return to normal.

What are the symptoms you may have during the two-weeks' wait?

The “two-week wait” refers to the time you have to wait until you can take a pregnancy test following an embryo transfer. During this time, the symptoms you may experience include; cramping, bloating, spotting or light bleeding, fatigue and breast tenderness. These symptoms are normal and do not confirm that you are, or are not, pregnant. Pregnancy can only be confirmed with a pregnancy or blood test following the two-week wait.

About Gynii Me

Gynii Me is a UK based company dedicated to supporting individuals and couples throughout their fertility journey.

We are committed to helping you, no matter what your situation or background, to understand your options and make the right decisions at each stage of your journey in starting a family. 

Our ultimate goal is to make fertility treatments accessible, affordable and transparent.

 

Our services

Gynii Me provides the following services:

  • Helping you choose the right fertility clinic and specialist doctor based on your age, health information and location
  • Access to our experience and specialist knowledge to help guide your fertility journey
  • Support to ensure a stress-free experience throughout your fertility treatment
  • Health management, including emotional support and wellness management, before and during fertility treatment
  • Providing flexible treatment funding options.

Gynii Me’s services can be accessed via our easy-to-use website, or please get in touch with us at hello@gyniime.co.uk.