Embryo Transfer in IVF Cycle - When is the Right Day?
Embryos are generally transferred back to the woman's uterus at the 2 - 8 cell stage, which occurs 48 - 72 hours after the retrieval.
When she arrives for the embryo transfer, the patient (and her partner) will return to the Procedure Room. The patient is required to have a mildly full bladder so that her uterus can be visualized by abdominal sonogram during the procedure. She will undress, don an examining smock, assume the usual examining position, and be placed under abdominal sonographic guidance. The physician will then insert a speculum into the vagina and clean the cervix. The patient may feel one cramp as an outer catheter is placed through the cervix into the lower segment of the uterus. A fine plastic catheter, into which the Embryologist has transferred the embryos, is then placed through the outer transfer catheter and advanced near the top of the uterus. The sonographer will visualize the lining of the uterus and guide the physician in the placement of the catheter. Once the placement is correct, the embryos will be expelled from the catheter and inserted into the uterus.
The Rest Period
After the transfer, the patient will be wheeled to the recovery area where she will rest on her back for two hours. Her husband is welcome to remain with her for the entire rest period. The recovery room is equipped with a television and cable channels.
The patient may receive an injection of HCG after the embryo transfer to help the ovaries produce more progesterone during the embryonic implantation phase. In some cases, she will also be instructed to self-administer two additional HCG injections on specific days following the transfer. She may also be asked to use progesterone suppositories for a specified number of days following the transfer.
Post Transfer Instructions
The patient will be advised to be restful during the first 24 hours after the embryo transfer and to engage in only limited activity during the second 24 hours. She may then carry out her normal level of exercise and activity. It should be noted that physical activity or diet has no impact upon embryo implantation or conception. Once the embryos are transferred, there is really nothing a patient can do to influence the outcome of her cycle. Conception is a natural phenomenon which depends mostly upon the genetic quality of the eggs. Almost without exception "nature" will only allow genetically perfect embryos to survive in order to maximize the chances of the birth of a normal baby.
The outcome of any particular IVF cycle is determined by the quality of the embryos and the post-transfer hormonal support. Good embryos cannot be lost as a result of moving about, and there is no scientific evidence to suggest that any particular activity will cause a woman to lose a pregnancy during the implantation stage. Therefore, we believe that, after the initial 48-hour post-transfer period, the patient should go about her regular daily activities without worrying that she will harm her chances for a successful pregnancy.
During the two weeks after the embryo transfer while a couple is anxiously awaiting the outcome of their IVF cycle, the time will pass more slowly and stressfully if a woman confines herself to bed. Stress can actually be reduced by staying active and being productive. Moderate exercise may also be a useful aid in reducing stress during the two week post-transfer period.
Number of Embryos Transferred
The number of embryos that should be transferred during any single IVF cycle is open to debate. It has been said in the medical literature that transferring no more than four embryos per IVF cycle will yield optimal results. Transferring more than four is believed to result in excess numbers of multiple pregnancies. Experience shows, however, that the chance of a successful IVF outcome may be increased if more embryos are transferred, especially in older patients with unexplained infertility. It is now believed that the risk associated with multiple pregnancies can be safely reduced by eliminating excess embryos via an embryo reduction during the first trimester. This procedure is successful 90% of the time and results in a total miscarriage in only 10% of cases.
We Care's partner clinics we believe in individualizing the number of embryos transferred. We base our decision on the quality of the embryos as seen under the microscope prior to transfer and on specific patient requests. Embryos that are not transferred may be frozen for use in subsequent cycles.
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