Now that you’re a pro in knowing what you can expect in an egg retrieval, it’s time to embark on the embryo transfer journey. This is the fun part. It’s less invasive, less medications, less costly, and this is when you are actually PUPO (pregnant until proven otherwise) and you know it.
Don’t get me wrong, none of this is easy, and if anything, you may find yourself stressing more as you get to the end of the two-week wait. You just have to try to remind yourself of your goal and that you’re one step closer at every phase of the IVF cycle.
In this guide we’ll go through what medications and the types of monitoring you can expect, what you will experience during the transfer process, and what outcomes you can expect.
Medications & Monitoring – Embryo Transfer
A fresh transfer is typically done between 3 to 6 days after egg retrieval. This is dependent on how the embryos progress and how your body is recovering after retrieval. Fresh transfers can be cancelled because of OHSS. It is a dangerous condition that sometimes requires hospitalization, so a transfer is not ideal at that time.
Fresh and frozen transfers can also be cancelled if the uterine lining isn’t ideal. Prior to a transfer, your doctor will want your lining to be around 8mm or greater. Frozen transfers, because they are done at a later cycle, are medicated cycles.
Your doctor may decide to put you on birth control again for a period of about a month (this may be more, may be less – if at all). Before your protocol begins, you doctor may ask you to come in for an endometrial scratch. It is a relatively painless outpatient procedure that is believed to aid in the receptivity of the embryo in utero.
Now, you are ready to begin medication for your frozen embryo transfer (FET). Again, the protocol that I’ll describe here is a common one, but not everyone has the same one. You’ll be asked to come into the office for a baseline transvaginal ultrasound and blood draw again. Based on those results, the clinic will inform you of when you can begin with your first day of medications.
Lupron (the brand name, generic is leuprolide acetate) is a subcutaneous injection that is often paired with estrogen tablets, patches or intramuscular injections. The injectable type is typically only used if the tablets and/or patches are not as effective. Around the start of these, you and your partner may be asked to begin an antibiotic for preventative measures.
These medications are intended to ultimately increase the uterine lining to a measurement that is 8 mm or more. When that is achieved, you will be asked to begin progesterone. Often these are prescribed as suppositories or intramuscular injections, both of which have equally unpleasant qualities.
The suppositories are messy and can be very irritable. The injectables come with a very long needle that is extremely intimidating. After a few days of use, the muscle may feel like you’ve done about 1,000 squats. There are some methods to help alleviate the discomfort (warming the area and oil, numbing pads, etc.).
After the start of progesterone, your transfer will be scheduled within 4 to 6 days after (depending on the date the embryo was frozen). If the transfer is successful, progesterone treatment will continue throughout the first trimester of pregnancy or as needed.
If conditions are right and you are approved for a transfer, you will be asked to come in at a specific time with a full bladder. Not gonna lie, this is not fun at all. To give you a clear picture of what to expect, you are likely going to sit in the waiting room for some time in agony waiting to use the bathroom, but all the while knowing that you are going to have to wait to at least get through the process of an embryo transfer.
Next, once you’re called back, you will be shown a picture of your embryo or embryos and you may be asked to take a prescribed pain reliever. You will be brought back to the room where the transfer will happen shortly after that.
I’m back tracking a bit, but fragrance-free everything is again very important here. Embryos are just as sensitive to smell during the transfer process, so make sure you’re not putting any strong fragrances on and if you can, try to use shampoos, soaps and lotions that are fragrance-free prior to transfer.
Ok, so back to the transfer, by this point, you are in a room dressed in a gown, legs in the air. An ultrasound tech will begin by looking at the fullness of your bladder by pressing pretty firmly on it (again, more discomfort). They will next locate the uterus and the exact area that they will be placing your embryo(s). The doctor will next do the same, but in my experience with more force.
The process of the actual transfer from here is very quick and gives you the feeling of, “that was it?” A catheter with the embryo is walked into the room by the embryologist. The doctor then inserts it, which you can see on a screen if you have a keen eye. It’s just a little blurb that goes across the screen and if you’re lucky, you’ll see the point where the embryo is transferred in…and that’s it, you’re done. You sit up, get dressed, go to the bathroom and leave.
You are asked to relax for the rest of the day. By this, I mean you can get up and walk around, you’re not bed ridden, however you’re asked to limit activities. During the rest of the two-week wait, you can resume most normal activities. Working out should be limited to walking and low-impact exercises. Now all places may not do this, but I was asked not to carry grocery bags (or anything of heavy equivalence), and not to push or drag heavy things (like luggage or grocery carts).
Then comes the dreaded wait and symptom spotting. I can do my best to warn you not to google, but it’s inevitable. Everyone is different, every transfer is different, every pregnancy is different. Most of what you might feel during this time is a side effect of the progesterone and other medications you might be on. If you try to remember that, you may drive yourself a little less crazy.
Some women find it easier to test at home rather than waiting for the beta HCG test at their doctor’s office. The test usually happens anywhere from 9 days post transfer to 12 days post transfer (depending on your doctor’s choice). The lead up to that phone call is extraordinarily nerve racking. You’ve spent so much time, so much money, so much effort and it all comes down to that one phone call. Again, I can say to try to relax as much as possible, but of all people I know that’s nearly impossible during this time.
What Outcomes You Can Expect
Statistically speaking, most women will have to go through 3 cycles of IVF before they have a successful pregnancy. The first cycle is often-times a best guess by your doctor, of course considering your medical history and what works for most patients with a similar history. But being that haven’t yet been exposed to many of these medications, if at all, there’s no way that your doctor can know how your body will react.
If you can look at your first cycle this way, going into subsequent rounds may be a bit easier. Your doctor knows more about your reaction to medications and can tweak whatever they need to in order to make your next round more successful and typically that is what happens.
Also note that even with PGS and PGD testing, the technology is not perfect. A “normal” embryo may still fail to implant or miscarry. It is best to prepare yourself for multiple retrievals and multiple transfers, as that is what happens, statistically speaking.
Now, negative Nancy is going to be put away (I did mention the pessimist thing earlier – sorry). This process is successful so often, it just sometimes comes down to the right timing, protocol, and lifestyle that you are living. It takes a lot of determination to get through this process, but what it can give back to you is all worth it. If this is a part of your story, you’re in good company and I wish you all the best of luck.
So now that you’ve read this article, you can put what you’ve learned here into practice immediately and increase your chances of getting pregnant.
Resource 1: Take our Fertility Quiz
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Resource 3: Egg Quality Vitamin Guide
Are you having trouble getting pregnant or staying pregnant? Egg quality may be an issue for you. This is the #1 most common factor in women who suffer from infertility and miscarriages. Egg quality can be impacted by a number of factors, most commonly advanced maternal age, as well as conditions like PCOS and endometriosis.
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The information in this document has not been evaluated by the FDA and is not intended to diagnose, treat, prevent, or cure any disease.