Embryo Transfer As soon as the embryos are ready to transfer back into the uterus, Dr. Douglas will consult with both you and your partner concerning how many to transfer and what to do with any embryos that may remain after the transfer. Transfers routinely occur on either day 3 or day 5 of the cycle. Dr. Douglas and the embryologists at Presbyterian ARTs will carefully monitor the growth and health of the embryos as they progress from retrieval to transfer and decide the best possible time to return them to your uterus.

IVF Treatment Information IVF Plano Success Rates Growth of the Egg Retrieval of the Egg Sperm and Fertilization Growth of the Embryo Embryo Transfer and Support Preimplantation Genetic Screening (PGD/PGS) Embryo Storage

Day 3 Transfers

(Day 3, 8 cell embryos)

• Usually recommended when there are not many embryos and it is already obvious on day 3 which are the only ones that have a chance to implant. If the quality of the embryos is lower than expected for the woman’s age then we may also transfer the embryos on day three.

Day 5 Transfer

(Day 5 embryos)

• For couples with a large number of nicely developing embryos, Dr. Douglas usually prefers to let the eggs grow to day 5. The extra days of growth will allow the embryologist to determine which are the best embryos to transfer back.
  
• For those patients doing PGS

Deciding How Many Embryos to Transfer
We determine the recommended number of embryos to transfer based on the female’s age, the cause of infertility, previous pregnancy history, number of attempts, and other factors. Although you and your partner, with Dr. Douglas’ input, will decide on the number of embryos to transfer, we usually defer to the embryo transfer guideline (see table below) established by the Society of Assisted Reproductive Technology (SART). These guidelines were developed to maximize a couple’s chance for pregnancy while minimizing their risk of a multiple’s pregnancy. The risk of a multiple’s pregnancy must be considered carefully in this decision.

What Happens During the IVF Transfer?
Once the embryos are ready for transfer, Dr. Douglas will use a thin, flexible catheter to transport the embryos from the laboratory into the procedure room. He then insets this catheter through the cervix and into the uterine cavity in a process similar to intrauterine insemination. Ultrasound guidance can be used to help Dr Douglas thread the catheter through the cervix, and up to the top of the uterine cavity where he will slowly push the embryos out onto the endometrial lining. We encourage patients to include their partners during this stage of the process for additional support. The entire procedure takes approximately 15 minutes, and you will experience minimal discomfort during the transfer. Once Dr. Douglas finishes the procedure, the embryologist will return the catheter to the lab to make sure that all embryos have been placed into the uterus.

After an embryo transfer, you will remain lying on your back for approximately one hour. Once you return home, he will have you rest for 24 hours and avoid strenuous activity until the pregnancy test. However you may return to work the next day as long as it is not a “physically demanding” job.

Progesterone Supplementation and Waiting…
After your retrieval, you will begin daily progesterone supplementation, either by vaginal application or injections. The addition of progesterone following the egg collection increases the likelihood of a successful embryo implantation and maintains a pregnancy after transfer. Progesterone helps support the lining of the uterus and encourages implantation of the embryo. Although your body will produce progesterone on its own, IVF patients need supplementation.

In a normal cycle, the cells lining the follicle produce progesterone. During the IVF retrieval process, the progesterone-producing cells that line the inside of the follicle will come out with the egg, this is why supplementation is needed. Adding back progesterone with vaginal or injectable supplementation provides a critical component in maintaining an IVF pregnancy. We usually recommend progesterone supplementation starting two days after egg retrieval until the pregnancy test, which is 2 weeks from the egg collection. If a pregnancy occurs, then patients will continue progesterone supplementation until the placenta and ovary are making enough so that supplementation is no longer needed.

Pregnancy Tests and OB Ultrasounds
Exactly two weeks after the oocyte retrieval, Dr. Douglas will schedule a serum pregnancy test to determine the success of the IVF procedure. We discourage patients from using home urine kits to test for pregnancy before the scheduled appointment. These tests can be inaccurate because of the HCG present in the blood stream from the “trigger shot.” Home pregnancy tests look for HCG in the urine as an indicator of pregnancy.
At seven weeks you will have an OB sonogram. If the sonogram is normal you will be released to your Ob-Gyn for continuing obstetrical care.