Moments in assisted reproduction: the embryo transfer
In Vitro Fertilisation (IVF) treatment includes several very important moments and one of the most important is the embryo transfer. Everything starts with the first visit to the fertility specialist so that the female and/or her partner can undergo a complete assessment.
Once the doctor has made a diagnosis, your IVF treatment starts with a controlled ovarian stimulation (monitored with ultrasounds and blood tests). Next will be the egg retrieval, fertilisation of the eggs (generally using ICSI), embryo culture and, finally, the intrauterine embryo transfer. This last step involves placing a maximum of three embryos, selected by the embryologists, inside the uterine cavity (the endometrium). If possible we will freeze any additional, viable embryos. After transfer we can say that IVF treatment has come to an end.
Today we’re going to focus on the embryo transfer given that it’s a critical stage in the IVF cycle. Following the period of embryo culture, during which the embryos stay in conventional incubators or in the Embryoscope incubator for 3 to 5 days, the doctor or embryologist will tell you what day you need to return for your embryo transfer.
The embryo transfer is a very important moment. If we want this procedure to go smoothly there are several variables we must be aware of which we will explain here.
What should be kept in mind on the day of the embryo transfer?
First and foremost, and even though it may seem very obvious, this procedure must be performed by a trained and experienced professional. At our fertility clinic in Spain the embryo transfer is carried out in the operating theatre, under abdominal ultrasound guidance, but unlike the egg collection it does not require anaesthesia. A doctor, embryologist and nurse will accompany you throughout this procedure.
For the embryo transfer it is important that your bladder is full when you arrive to the operating theatre. This is for two different reasons, the first being that having a full bladder will help the uterus to be better positioned and thus facilitate the embryo transfer. Secondly, having a full bladder will make it easier to visualise the uterus using the abdominal ultrasound.
Additionally, you need to keep in mind that you shouldn’t wear any perfume or makeup on the day of the transfer as the embryos are very sensitive to environmental factors such as changes in temperature, aromas, light, etc.
How is the embryo transfer performed?
Once inside the operating theatre the female will get as comfortable as possible for the vaginal ultrasound. The doctor will insert a vaginal speculum to visualise the cervix before proceeding to very carefully clean it with sterile gauze and embryo culture medium to remove any remains of medication, cervical mucous, etc.
The doctor will perform canalization of the cervical canal once the cervix has been cleaned. This involves placing a guiding catheter into position and which must be, based on our experience at URE Centro Gutenberg, as “flexible” as possible to avoid causing discomfort to the patient.
The embryologist will load the selected embryo(s) into a thinner catheter that is even more flexible than the guiding catheter; the doctor will then insert this second catheter through the guiding catheter that was used to canalise the cervical canal. The tip of the inner catheter will be placed about 10-15 mm from the back of the uterus which is where the selected embryo(s) will be deposited.
Although it’s a delicate procedure, the embryo transfer doesn’t usually take more than ten minutes. Following transfer the patient will stay in the operating theatre for another ten minutes, after which she can go home.
In what scenarios is it not possible to carry out the embryo transfer?
Unfortunately there are some situations in which, for different reasons, it is not possible to perform the embryo transfer. These are the main reasons:
- Poor embryo quality.
- Inadequate endometrial preparation.
- Risk of ovarian hyper-stimulation syndrome.
Except in cases of poor embryo quality in which we would need to start a new cycle of IVF, all other scenarios simply require us to postpone the embryo transfer by a few weeks and perform it in a deferred cycle. To do so, we will freeze the embryos and prepare the female’s endometrium to be ready to receive them after they’ve been thawed.
This situation obviously means that the treatment process is drawn out, but it improves pregnancy success rates when compared to if we had done a fresh embryo transfer.
What happens after the embryo transfer?
Once the embryo transfer has been performed the patient is generally advised to take it easy and avoid intercourse, although the truth is that these recommendations haven’t been shown to increase the likelihood of getting pregnant.
And after? The last thing to do is to wait for the results of your pregnancy test. And for the result to be positive!
Do you have additional questions about this or other assisted reproduction procedures? Don’t hesitate to contact us! Our fertility specialists will be happy to help you.