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Embryo transfer procedure for in vitro fertilization
Advanced Fertility Center of Chicago
IVF Specialist Clinic
Gurnee & Crystal Lake, Illinois
The embryo transfer procedure is the last one of the in vitro fertilization process. It is a critically important procedure. No matter how good the IVF laboratory culture environment is, the physician can ruin everything with a carelessly performed embryo transfer. The entire IVF cycle depends on delicate placement of the embryos at the proper location near the middle of the endometrial cavity. The basic principle of embryo transfer is placement of the embryos to the ideal location in the uterine cavity with as little trauma and manipulation as possible. When it comes to successful IVF outcome, the importance of embryo transfer technique can not be overstated.
In order to get sufficient eggs for IVF, the woman is first stimulated with injectable medications to develop multiple egg development. The eggs develop in structures in the ovaries called follicles. Each follicle contains one egg and can be seen on ultrasound. When the follicles are mature, the egg aspiration procedure is performed to remove the eggs from the ovary. Sperm is mixed with the eggs about 4 hours after the egg aspiration, and the following morning we check the eggs for evidence of fertilization. The fertilized eggs (now called embryos) are cultured in the laboratory for 1-5 more days and then an appropriate number are selected for transfer to the woman's uterus. We usually transfer 1 or 2 embryos - see below for more details.
Ultrasound guided embryo transfer technique
The embryo transfer procedure seems very similar to a Pap smear for the woman. There should be no pain involved and no sedation or other drugs are required. We use a moderately full bladder for embryo transfer. This helps in 2 important ways. It allows good ultrasound visualization of the catheter which helps with smooth and proper transfer of the embryos to the best location, and it also unfolds the (anteverted, "tipped up") uterus to a more accommodating angle which makes the process easier and less traumatic for both the endometrial lining and the embryos.
The embryo transfer catheter is loaded with the embryos and the physician passes it through the cervical opening up to the middle of the uterine cavity. Abdominal ultrasound is used simultaneously to watch the catheter tip advance to the proper location. It is sometimes difficult to keep the tip of the catheter in the exact plane of the ultrasound beam at all times - but it is very important to control the proper placement of the embryos. When the catheter tip reaches the ideal location, the embryos are then "transferred" (squirted out of the catheter) to the lining of the uterine cavity (endometrial lining) by the infertility specialist physician. After the embryos are transferred, the catheter is slowly withdrawn and checked under a microscope for any retained embryos. If any embryo is retained in the catheter (uncommon) the transfer procedure is repeated immediately and the catheter is checked again for a retained embryo.
Proper location for placement of the embryos
Research has been done to determine the optimal location to place the embryos in the uterine cavity. Basically, the middle of the endometrial cavity - half way from the internal os of the cervix to the uterine fundus (top of cavity) - is the best place. Care should be taken to keep the catheter between the top and bottom layers of the endometrium and not to allow it to dissect under the endometrial surface. This is called subendometrial embryo transfer. Pregnancies will occur with subendometrial placement of the embryos, but success rates are lower.
Smooth, efficient and effective embryo transfer |
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| Notice that the uterus and lining have a very fuzzy appearance. There is also a severe angle between the cervix and uterus (angle indicated by green lines). She drank water to fill her bladder before we proceeded with the transfer. With the fuller bladder, the angle in the cervix was reduced and the uterus and lining were clearly visualized. | During the embryo transfer procedure the Wallace catheter is seen in the cervix and uterine lining (below the yellow lines). It is seen coming from the vagina into the cervix at the right. The catheter is also seen inside the uterine lining (at left side). The embryos are released from the catheter tip - seen just right of the "L". The angle between the cervix and uterus (green lines) is not severe. |
| Cervix = C, Bladder = B, Lining = L, Vagina = V | |
Difficult embryo transfer
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| The uterus is sometimes a little "tricky". Here it is distorted by myomas (fibroids), making the embryo transfer itself - and visualization with ultrasound difficult. | Same image: Uterus outlined in red, myoma in blue, endometrial lining outlined in green. Catheter needs to place embryos between green lines - in the orange area. |
Activity restrictions after IVF transfer
At our IVF clinic, we have the woman lie on her back for 1 hour after embryo transfer before going home. We request that she also limit physical activity for the remainder of that day. This means hang out on the couch or in the Lazy-boy recliner - watch videos, read, boss hubby around, etc. We allow "normal activity" beginning the morning after embryo transfer - but heavy bouncing of the uterus is restricted until after the pregnancy test. Therefore, water skiing, jogging, "uterus bouncing sex", etc. are probably not a good idea until after the pregnancy test. Once pregnant, we should be OK do start all that stuff again.
IVF embryo transfer and travel
For our couples that travel here from out of town for IVF and embryo transfer, we recommend that they do not fly out on the day of the transfer, but wait until the next day. For patients that are diving back home - it is acceptable to drive home (regardless of the length of the drive) after one hour of rest in our office following the transfer procedure.
Come here from out of town to do IVF
When does the embryo implant following IVF transfer?
A healthy human embryo will hatch from its shell on day 5-7 and implant very soon after hatching out. So actual invasion of the embryo and attachment to the uterine wall occurs about 2-5 days after a day 3 transfer and within 1-3 days after a day 5 transfer.
How soon to do a pregnancy test after IVF?
About 9-11 days after the transfer (9 days for day 5 transfer and 11 days for day 3 transfer), we do a blood test to find out if she is pregnant. If embryo implantation has occurred, HCG hormone will be detectable in the mother's blood at that time.
How soon can I do a pregnancy test after IVF? We don't recommend doing a urine pregnancy test after IVF. The reason is that there are a lot of falsely negative results. We have seen many beautiful babies born after the wife called us to say that she took a home urine pregnancy test that was negative. A blood test is needed because it is much more sensitive and reliable.
At our IVF clinic, the number of embryos to be transferred is decided by the couple after a discussion with Dr. Sherbahn regarding their embryo quality and how it impacts on the risks for multiple pregnancy versus the risk of failing to conceive at all. Most couples at our center decide to replace 1 or 2 embryos when the female partner is under 35, 2 or 3 embryos when she is 39-41, and 2 to 4 (if they have that many) if she is over 41 years old. Transferring this number of embryos seems to result in a "reasonable" balance of high overall pregnancy rates, and low high-order (triplets or more) multiple pregnancy rates.
Our IVF pregnancy rates
Learn about blastocyst transfer
an IVF technique that can have high pregnancy rates with very low risk for triplets
Advanced Fertility Center of Chicago
Gurnee, IL
(847) 662-1818
Crystal Lake, IL
(815) 356-1818
