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    in vitro fertilisation (ivf)

    What are the steps in Embryo Transfer procedure in IVF treatment?

    • 12499 views
    • 4.7   (6 Votes)
    Medically Reviewed by Dr. Deepika Tiwari - MS, MBBS on 17 May 2019 - Written by Dr. Neha Gupta - MS, MBBS, DNB - Grammatically Approved by Dr. Kavita Jaggi Agrawal - MS, MBBS

    Embryo transfer procedure in IVF treatment includes steps such as ultrasound, fresh or frozen embryo transfer, followed by implantation of embryo, followed by blood test or pregnancy kit test. Embryo transfer procedure is the final step of the procedure which is must for successful IVF pregnancy.

    Embryo transfer is the major step followed in an IVF treatment. In this key process, a fertilized egg is carefully transferred into the uterus of an expectant mother or a surrogate. This step is performed professionally with an embryo transfer technique. In an embryo transfer process, a fresh or a frozen embryo is wisely used under the guidance of the infertility specialist. (2) While performing the IVF treatment, the patient is provided with an artificial hormone stimulating medication. This stimulation instigates the ovaries to release healthy eggs in the woman's body. During a regular process, only one egg ruptures from the ovaries and moves up to the fallopian tubes. While in artificial stimulation depending upon the condition of female internal reproductive organs, one or more eggs may rupture from the ovaries. The infertility specialist removes these eggs with removed with the help of a flexible catheter. The eggs are fertilized with the sperms in an IVF laboratory. The complete process of fertilization is monitored under a quality microscope by an embryologist. When an embryo is developed, it will be transferred inside the womb for implantation. Subsequently, it attaches itself to the endometrium lining of the uterus. The successful implantation of an embryo in a womb turns out to be a successful pregnancy. The embryo transfer practice will be followed after 5 days of an egg retrieval procedure. Patients are advised to make sure that they take an ample amount of rest after the completion of the embryo transfer procedure. Hormonal stimulation drugs are taken until the hormones reach a certain desired level. A pregnancy test will be performed after 2 weeks of an embryo transfer. In the meantime, the patient is suggested to take rest for a few days. In case of emergency, one should immediately visit the nearest IVF center. (1)
     
    Embryo transfer process includes many other elements, which will be discussed below:

    1. Embryo transfer process:

    Embryo transfer requires a number of preparations first, these preparations help in a successful IVF cycle:
     
    1. Ovarian reserve testing: Before beginning with the embryo transfer procedure, it is important to examine the structure and condition of ovaries.  (4) An IVF specialist has to check, whether the ovaries are fit to produce high quality and quantity of the eggs or not. 
    2. Hormone test: An IVF doctor may examine the levels of estrogen (estradiol), Follicle Stimulating Hormone (FSH) and Antimullerian Hormone (AMH) for the success of an IVF cycle. Hormone tests have to be performed for several days before the IVF Treatment, because imbalanced hormones may lead to a failure of an IVF cycle. Examining ultrasound with hormone test reports enables the IVF experts to predict the positive and negative effects of stimulators on the ovaries.
    3. Semen analysis: If eggs are appropriate to use in an IVF treatment, then a doctor will also recommend for semen analysis. In this analysis, the quality, quantity, and motility of the sperms are examined. The best quality sperms are separated during this process and then used for penetrating into the eggs while fertilization process.
    4. Infectious disease screening: The HIV test is performed on a couple to restrict the passage of the concerned disease into the newborn. The screening plays an important role in the success of the IVF procedure. 
    5. The mock practice of embryo transfer: An IVF expert prefers performing a mock test similar to the embryo transfer process before the real procedure takes place. This mock test is performed under the ultrasound machine. It helps in identifying the dimensions and internal environment of the uterus. In most cases, the positive performance of mock test results in a successful IVF cycle.
    6. Uterine cavity exam: The examination of the uterine cavity is one of the important stages in the IVF procedure. This involves Sonohysterography, Hysteroscopy, or Ultrasound machine to determine the dimensions of the uterus. The survival of a fetus will also depend upon the uterus size of the pregnant woman who carries the baby.

    embryos need to be transferred in IVF procedure

    • Sono-Hysterography: A liquid is injected into the cervix. Under Saline Infusion Sono-Hysterography (SIS), a catheter of liquid is inserted into the uterus to separate the walls of the endometrium for visualizing the endometrial cavity. (7)
    • Hysteroscopy: In this procedure, a thin, light and flexible telescope known as a Hysteroscope is inserted through the vagina and cervix to reach the uterus. Hysteroscopy is known as one of the best methods to visualize the uterine cavity without hurting the adjacent endometrium lining. (8)
    • Ultrasound: It helps in the success rate of pregnancy if performed on day 3 and 4. (9) An image is created on the computer screen to monitor the uterine cavity. During embryo transfer in IVF treatment, it becomes easy to detect the uterus parts individually through ultrasound. It aids in the successful implantation of an embryo. 

    Embryo transfer process:

    • Embryo transfer is usually performed on the 3rd day of fertilization or on the 5th day during the blastocyst stage. When an embryo formation is in 6-8 cells stage, it is known as the "Cleavage stage". (5)
    • Embryo transfer is a simple process and does not require anesthesia in most of the cases. The same process can be performed under a conscious state. If the patient is under too much stress than mild sedation is used to give the patient. A woman may experience some complications of sedation like infections, vaginal discharge, and bleeding. The whole process is a painless one. A woman may feel small cramps later, after the implantation step in the IVF procedure. (4)
    • A catheter filled with fluid and embryos is then inserted into the uterus going through the vagina and cervix. A catheter is a thin, long and flexible medical instrument, so that it can enter the vagina easily.
    • At the furthermost part of the catheter, a small syringe is attached which carries embryos which are then suspended into the uterus.
    • An IVF specialist places the embryo in the uterus by visualizing the same through an ultrasound machine. The embryos have to be placed on the lining of the uterus. Subsequently, a natural process will begin, where the embryo will attach itself to the uterine lining leading to a successful pregnancy. 

    2. How many embryos need to be transferred?

    Generally, most of the infertility centers follow the procedure of consultation with parents. They discuss the selection and number of embryos required to be transferred. Many countries have special guidelines to follow Single Embryo Transfer (SET) because transferring multiple embryos may cause a high-risk of multiple gestations or Small Gestation Age (SGA). There are a few aspects on which the transfer of embryos depends:

    embryo transfer needed

    a) A doctor and a patient perspective and attitude: Depending upon different country certain guidelines and recommendations are made. Doctors should discuss all the odds and complications related to transferring multiple embryos. The available medical technology is also considered while determining the chances of healthy births with performed IVF treatment. From the parent's perspective, they can face several challenges like:

    • A limitation to insurance coverage 
    • Medical complications to a mother's health 
    • Child raising concerns and multiplication of cost-raising multiple children.

    These problems may come in their way to have twins or multiple children.

    b) Parents agreement with a doctor belief: Identification of a good quality embryo with the latest IVF technology has improved. According to that, one best embryo can be identified and transferred to the uterus eliminating the chance of multiple gestations. However, there are still many doctors who do not believe in severe complications of multiple births. They say that multiple pregnancies are an over-rated and over-discussed topic. Many cases of multiple baby deliveries were successful in the past few years. In many countries, especially in the U.S., couples agree to have twins knowing the odds and facts about multiple gestations. It is also widely known that more than 50 % of the twin babies born are normal and healthy. Many couples believe that having a nutritious diet and regular exercise may provide normal and healthy babies. (2)

    In maximum cases, a single embryo is implanted into the uterus of the woman. Whilst, other doctors trust that transfer of two fertilized embryos enhance the chances of a successful gestation. Physicians usually debate on the topic that maximum 4 embryos are enough to obtain the desired results in the numerous complicated case. Otherwise, transferring only one embryo should priorities in good-prognosis patients. Even many countries follow the standard transfer of one embryo only. IVF doctors prefer using only one embryo in women beneath the age of 35 with an excellent chance of gestation.

    If we see overall discussions, below are the complications that may occur in a multiple embryo transfer:

    • In the case of multiple pregnancies, premature births are 12 times more than a single baby birth.
    • Low Baby Weight (LBW) births are 16 times more than a single baby birth.
    • Twins or multiple babies have 5 times more respiratory or jaundice problems.
    • Mothers of twin babies have two and a half more chances of causing pre-eclampsia than, the mother of a single baby.
    • Mothers of twin babies have more than 8 times of premature preterm rupture of their ova cell membranes.
    • Lastly, more than 4 times a mother of twins have higher chances for a cesarean section delivery.

    It has been observed that some couples want to have twins or multiple babies via an IVF process to reduce the cost of child expenses per birth. There has been a case of an Octomom in the USA who gave birth to 8 children with successful IVF treatment. Experts believe that a woman who has a desire to have multiple babies then it can be fulfilled through IVF. Under IVF technology using Double Embryo Transfer (DET), she may surely have twins or triplets without any complications.

    3. How are Frozen embryo transferred?

    After completion of an IVF cycle, the remaining good quality embryos are not abandoned. In fact, the couples are given with an option to freeze them or donate them later. These embryos are helpful when an IVF cycle fails. The couple can also use them in the future to have a sibling for their baby. They can also reserve them, through a freezing process to plan babies in their later age. (6) It is safe to have frozen embryo transfer as well as the fresh embryo transfer. One can freeze their embryos at an early age also. Advanced freezing technology or frozen embryo transfer, does not harm the quality of an embryo. These embryos, if not required in the future, can also be donated to couples who require it.
    Only the best quality of embryos is frozen in the cryopreservation banks. The embryos are frozen at different stages, during the single cell stage or blastocyst stage. In the blastocyst stage, the embryo can be in two to eight cells. It is frozen either by a slow cooling process or by 'vitrification' known as a fast freezing process. These embryos are stored in liquid nitrogen tanks until the requirement of a next IVF cycle. Couples or singles can store the embryos for at least 8 - 10 years. When a couple wants to use their frozen embryos, then these embryos are thawed in the laboratory for placing them into the uterus in the woman. The frozen embryo transfer is the same as a normal embryo transfer process. Results from both the procedures, fresh as well as frozen embryo transfer are the same. In the modern technique, freezing embryos are reliable and do not affect the quality of the embryos.
    Need for embryo transfer:

    frozen embryo transferred

    If a couple is unable to naturally achieve pregnancy through regular intercourse for one year, then they may seek to have an Assisted Reproductive Technology (ART) treatment to have a baby from the key IVF method. (2) There may be several other reasons involved in infertility of couples such as: 

    • Polycystic Ovary Disorder (PCOD):  When a woman goes through irregular periods then, chances to have PCOD occurs. Nowadays, it is a common disorder found in every, one out of ten girls. A woman's body accumulates small cysts in her ovaries. These cysts create a blockage and sometimes prevent successful conception. In most of the women, these cysts are found to be overweight. Therefore, controlling excessive weight may eliminate the risks to have infertility issues. (3)
    • Damaged fallopian tubes: The fallopian tubes are one of the important parts of the female reproductive system. Here egg and sperm meet for natural fertilization. Egg ruptures out of the ovaries traveling to the fallopian tube.  Whereas, sperms travel through the vagina and passing the cervix to fertilize the eggs in the fallopian tubes.  Any damage or blockage in these fallopian tubes restricts the sperms and eggs to meet. To avoid such a case, an artificial method of IVF is used to fertilize eggs and sperms outside the body and then implanted in the uterus.
    • Endometriosis: In a woman, if the tissues of her uterus grow outside the endometrium lining is known as "Endometriosis". It hinders the regular supply of oxygen via blood as well as blocks the reproduction process. These overgrown tissues hinder the embryo to implant itself in the uterine lining. Somehow, if an embryo is implanted in uterine during endometriosis, then it will not sustain there for a longer period. Therefore, an IVF treatment is suggested after treating the disorder called 'endometriosis'.
    • Premature ovarian failure: Premature ovarian failure may occur with respect to one or both ovaries in a woman. This disorder obstructs the production of good quality eggs on time. In rare cases, the ovaries also stop producing eggs. An IVF treatment is required to obtain the best quality eggs from a woman's ovaries. After fertilization of sperms and eggs, a healthy embryo is formed via IVF treatment. Ultimately, through embryo transfer technique, these embryos are implanted into the uterus of the woman for successful implantation.
    • Uterine fibroids: These are the small cysts or tumors grown on the wall of a uterus. These fibroids are also known as benign tumors. These tumors do not allow the embryo to implant itself in the endometrium lining of th uterus. After the IVF treatment, embryo transplant is performed to achieve pregnancy.
    • Genetic disorders: During pregnancy, there is a high risk of transfer of genetic disorders into the baby conceived during the pregnancy. IVF treatment is a useful way to restrict the transmission of any genetic disease. Chromosomal analysis and selection process before embryo transfer eliminates the chances of transfer of the affected fresh or frozen embryo. This may help in producing a healthy baby without any genetic disease.
    • Insufficient sperm production or low motility of sperms in men: Poor semen quality obstructs strength of a sperm to reach an egg in the fallopian tube. In IVF treatment with Intracytoplasmic Sperm Injection (ICSI) procedure, best sperms are separated from the semen. These sperms are then fertilized with the eggs outside the body in the IVF lab to form an embryo.

    4. Precautions after embryo transfer:

    • After the transfer of the embryo, one must take sufficient sleep and keep their body hydrated. Women should only work according to their body capacity to work. A nutritional diet and a brisk walk will help her in releasing tension and anxiety. After the stressful IVF procedure, bed rest for 2-3 days is suggested. She can change her mood by taking a small vacation.
    • To avoid uterine contractions, one must stay away from heavy exercises and have sexual intercourse after the ET procedure has taken place.
    • One must follow the nutritional diet of a pregnant woman right after the completion of the ET procedure. The diet of a pregnant woman is full of protein, vegetables, and fiber. Intake of high mercury fishes and soft cheese is not recommended.
    • One must not indulge in a hot sauna bath or hot yoga. In fact, any activity that raises one's body temperature to a great extent must be avoided because it may impact the success of implantation of an embryo. The woman should only follow the warm water bath regime.
    •  One must become meet people (family and friends) during this process since taking the stress all alone may increase the anxiety issues. This is the best time to have a stress-free life to gain positivity and peace of mind. In this way, the body will relax and adopt pregnancy fast.

    precautions taken after embryo transfer step in IVF treatment

    5. Positive signs after embryo transfer:

    • Once women become pregnant, their body will start changing in a certain manner. These changes occur due to an increase in pregnancy hormone called 'Human Chorionic Gonadotropin' (hCG).
    • Increased hormone levels lead to excessive vaginal discharge.
    • If the embryo implants itself in the woman's body, then her breasts will become swollen, softer and firmer than usual.
    • Missing periods are one of the significant symptoms of the occurrence of pregnancy.
    • Sometimes after taking hormonal shots, one may feel an urge to urinate. During pregnancy urge to urinate is more than in non-pregnant women.
    • In the initial stages of pregnancy, most of the women experience morning sickness or nausea.
    • Due to sudden changes in hormones, one may feel exhausted all the time. This is due to the elevation of progesterone hormone. This hormone causes the growth of a fetus and metabolism runs faster, decreasing the energy of a pregnant woman.

    positive signs after embryo transfer

    Embryo transfer represents a simple yet most substantial step in IVF treatment. Successful pregnancy depends upon the dynamic process of embryo transfer technology. The process is painless and less time-consuming. Many people have misconceptions over frozen embryo transfer and fresh embryo transfer. It is acknowledged by many IVF experts, that both methods of embryo transfer, are equally effective in gaining pregnancy. During fresh embryo transfer eggs and sperms are fertilization is performed right before IVF treatment. Whereas in frozen embryo transfers, the fertilization process, can be performed at any stage of life before turning 40. These developed embryos are later frozen with modern advanced technology, which reserves them as good as a fresh embryo. The frozen embryos stay healthy for a considerably long-time period of 10 to 15 years. There are different perceptions around the world about transferring a single embryo or multiple embryos. Adopting the finest advanced technology will help most of the cases to achieve multiple babies if someone strongly desires. There may be several complications, but many couples have succeeded brilliantly in getting multiple babies through IVF treatment. However, single embryo transfer is the safest and most recommended method to achieve pregnancy. It also limits the complications to a mother's health. Successful pregnancy possesses positive signs after embryo transfer. These signs may include increased pregnancy hormonal levels, tiredness, and swelling in the breasts. One may perceive these changes as a positive pregnancy, but nothing is confirmed until the pregnancy test is performed. One must take precautions after embryo transfer. These precautions may include a healthful diet, following a less stressful regime and involving positive, healthy and social elements in their environment.

    Dr. Neha Gupta

    Written by

    MS, MBBS, DNB, MRCOG
    Infertility Specialist, IVF Specialist
    Gurgaon
    Dr. Neha Gupta is an Obstetrician and Gynaecologist in Gurgaon. She has been practicing for many years now. Her rich experience in Normal Vaginal Delivery, Intrauterine Insemination (IUI), In-Vitro Fertilization (IVF), Hysterectomy and Tubectomy makes her the most preferred names in Gurgaon. She has acquired MBBS in 2004, DNB from National Board of Examinations in 2009 and MS - Obstetrics and Gynaecology from Maulana Azad Medical College in 2009. She is a member of the Royal College of Obstetricians and Gynaecologists, London. Dr. Neha Gupta has an expertise in Intrauterine Insemination and is practicing at Fortis Memorial Research Institute in Gurgaon. You can get the contact details of Dr. Neha Gupta at elawoman.com

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    6 Comments

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    Ram Bajpayi

    My wife is being treated with IVF. I know there are great chances of success but I am still scared. Just praying that I get the blessing of becoming a father.

    Sept. 1, 2018, 6:30 p.m. 5.0

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    Himanshi Kala

    To increase the chances of success of IVF, women should do regular exercise and sleep for at least eight hours. This will surely help them in a better delivery.

    July 12, 2018, 10:02 p.m. 4.5

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    Deepak Patel

    Women should have a healthy diet to nourish the embryo once it's inserted inside.

    Aug. 26, 2017, 4:29 p.m. 5.0

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    Swati Saini

    Choose your IVF center carefully while going through IVF treatment . Cost effectiveness and success rates should be checked at first.

    Aug. 26, 2017, 4:29 p.m. 4.5

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    Shrabani Saha

    IVf treatment is very effective when male semen analysis reports are normal.

    Aug. 26, 2017, 4:29 p.m. 4.5

    user_img

    Natasha Sahni

    I would recommend IVF to every childless couple as I myself have tasted success with the help of IVF.

    April 24, 2017, 9:26 a.m. 4.5

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