The Embryo Transfer during IVF

The embryo transfer is the part of the in vitro fertilization (IVF) process that may be the most nerve-wracking for the patient. Many women worry that if they do something wrong, the embryo won’t attach or will fall out. Try to relax.

Embryos don’t “fall” out, and laughing, coughing, sneezing, peeing, pooping and walking can't knock them out!

In the practice of Laurence A. Jacobs, M.D., before we start your embryo transfer, we'll give you some information about the procedure, as well as information about your after-procedure activities, which include taking it easy, but not "bed rest" per se.

WHAT IS AN EMBRYO TRANSFER?

The embryo transfer is a fairly simple procedure in which the embryo or embryos that have been developing in the Petri dish for three to five days are placed (not implanted, they have to do that part themselves) in a woman’s uterus.

During the procedure, a thin, soft catheter is threaded through the woman’s cervix and the embryo or embryos are placed inside the uterus with the goal of implantation and a successful pregnancy. The process only takes a few minutes and has very little discomfort.

Girloncouch.jpgWHAT IS THE PROCESS OF THE EMBRYO TRANSFER?

In my practice, the embryologist (the scientist who is involved in collecting eggs and sperm, and fertilizing the egg) removes the embryos from the incubator and shows them to you magnified up to 1,000 times on the video screen.

Next, we use the vaginal speculum in order to wash off the cervix with some sterile fluid. You will feel pressure, but typically there is no pain. For women who have undergone intrauterine inseminations (IUIs), the sensation should be very similar.

The embryo transfer is performed under ultrasound guidance, so that we can be very exact in the embryo placement location — generally 1 to 2 cm from the top of the uterine cavity. After cleansing the cervix with solution, an empty transfer catheter will be placed through the cervix into position inside the uterine cavity. Then we wait a few moments for the embryologist to bring the catheter containing the embryo(s) from the lab a few feet away, so we can minimize the time that the embryos are exposed.

Once we have the embryo(s), we feed the catheter with the embryo(s) through the empty catheter that is already in place. On the ultrasound screen you will be able to watch thebubble of air and fluid the embryo is contained in get placed gently into the uterine cavity. After placement of the embryo(s), we wait until the embryologist checks the catheter under the microscope to make sure that the embryo(s) transferred properly. Then you can get up and go straight to the bathroom if you desire.

DO I GO ON BED REST AFTER THE EMBRYO TRANSFER?

Several recent studies have confirmed that immediate bed rest after the ET is completely unnecessary. It may seem counterintuitive, but, in fact, a study published in a well-respected peer-review journal, Fertility and Sterility (Fertil Steril 2013; 100: 729-35), demonstratedbetter pregnancy rates with immediate resumption of normal activities (including bathroom)compared to bed rest right after the embryo transfer.

Here’s an interesting historical note. Back in the 80s, after an embryo transfer we prescribed that patients stay on complete bed rest for three hours and even rely on bedpans instead of going to the bathroom! This is not what we prescribe today, and we know that any fluid you may see coming out is from the sterile cleaning solution.

You may even see some spotting, and that is nothing to worry about. Why? It’s because embryos do not fall out.

During the embryo transfer procedure, Robert, my long-time ultrasonographer, has been telling patients for years:

"Laughing, coughing, sneezing, peeing, pooping and walking do not knock the embryos out. Embryos don't fall out. You can't knock them out, but you also can't make them stick."

The embryos have to implant into the uterine lining on their own over the next few days.

WHAT CAN I DO AFTER THE EMBRYO TRANSFER?

When you get home you do not need bed rest —just be a “couch potato.” You can sit up and watch TV, or work on your laptop or your iPad. Your position does not matter.

The first 24 hours after an embryo is transferred are most likely the most critical. It is within this timeframe that an embryo has to “attach” to the uterine wall before it can fully implant, which may take several days. Therefore, for the first one to two days, stay home and chill out.

Do not do normal vigorous activities,such as heavy lifting, bending or exercise. You want embryos to remain in the uterine cavity and not get pushed into a Fallopian tube, which would result in an ectopic or tubal pregnancy. Common sense goes a long way. You can go to the bathroom as needed, and you can use stairs but don't run up and down them. If you feel you don't have to do something, then don't do it.

In addition, it is important to avoid excessive heat. No hot baths or hot tubs, and no whirlpools. Showers are OK because they will not elevate your body temperature. We don't want you running around or doing vigorous exercise because it may elevate your body temperature. Embryos do not like heat.

Good mental health is very important during the “two-week wait,” the 10 to 12 days waiting for the pregnancy test. You don't want to second-guess yourself regarding doing certain activities. It's not your fault if an embryo does not implant, but you don't want to give yourself any possible reasons for feeling guilty or second-guessing your activity level if the IVF procedure does not work this time.

If you have questions about the embryo transfer or the process of in vitro fertilization, you may contact me at laurence.jacobs@integramed.com.