In Vitro Fertilization: Embryo Transfer

What is Embryo Transfer?

One of the final steps in in-vitro fertilization is the transfer of the embryo(s) into the uterine cavity. Embryo transfer can be performed on the second, third, fourth, or fifth day of culture. The optimal transfer time is determined by the quantity and quality of the embryos obtained following ICSI or the classic IVF procedure. Embryo transfer is performed using a special catheter under ultrasound guidance.

Before Embryo Transfer

Before making the decision to undergo embryo transfer, we recommend considering a few factors:

• Are you mentally and physically prepared to welcome new, small, defenseless members into your family who await your love, dedication, and time?
• Are you capable of educating and providing living conditions and development for not one, but potentially two children?
• Are you prepared to face potential complications related to pregnancy or children's illnesses? Even with naturally conceived children and single pregnancies, there is always a risk of malformations, miscarriages, problems maintaining the pregnancy, etc.;
• If you are undecided, talk to your doctor. Their knowledge and experience will help dispel your doubts;

When to Undergo Embryo Transfer?

Most centers transfer embryos when they are at the 4- to 8-cell stage, i.e., the second or third day after retrieval. In natural conception, embryos at this stage would be in the tubes, not the uterus. Therefore, in this medically assisted fertilization technique, the embryos remain in the uterus awaiting the developmental stage that allows implantation. Some believe it would be preferable to transfer embryos at a more advanced developmental stage, the blastocyst stage (5 days after retrieval). This is the stage at which the embryo would physiologically begin to implant.

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What does Embryo Transfer Involve?

Advantages of Embryo Transfer

The procedure allows the transfer of only those embryos that have proven capable of surviving to a relatively advanced stage of development. This procedure also avoids transferring embryos that cease development in the first few days following oocyte fertilization. However, this technique does not increase the probability of achieving pregnancy and requires significant technological resources. The choice of the time of embryo transfer therefore depends on the particular clinical case. Most centers tend to perform the transfer on the third day after oocyte retrieval.

How Many Embryos Are Transferred?

The choice of embryos to transfer depends on many factors. First, the quality of the embryos and the woman's age. Another criterion is the number of previous failed implantation attempts. In general, transferring a larger number of embryos means an increased probability of pregnancy, but also an increased risk of multiple pregnancies. An event considered negative for the prognosis of the pregnancy on the mother and the health of the fetuses. Good clinical practice involves transferring the fewest possible embryos. A high percentage of twin pregnancies is a negative indicator in the evaluation of the quality of an ART center. Multiple pregnancies, including twin pregnancies, carry an increased risk of obstetric and neonatal complications. The greater the number of fetuses, the greater the risk of such complications.

These include, but are not limited to, the following complications:

• Miscarriages;
• Premature birth;
• Death of one of the fetuses;
• Low birth weight;
• Divergent intrauterine growth;
• Fetal transfusion syndrome;
• Increased risk of congenital malformations;
• Increased risk of maternal diabetes, hypertension, and heart failure;
• Increased risk of preeclampsia;

The Embryo Transfer Procedure

Embryo transfer is a simple and almost always totally painless procedure, similar to in vivo intrauterine insemination. The embryos are aspirated with a small amount of culture medium into a thin catheter, which is inserted into the cervical canal until it reaches the uterus, where the embryos are deposited on the endometrium. The best technique involves transabdominal ultrasound-guided transfer. It is important that the embryo transfer into the uterus is done as quickly and gently as possible. The embryos must not suffer from temperature changes and must not remain in the lumen for too long. Furthermore, the transfer must be performed without trauma to the endometrium and without bleeding.

What to Do After Embryo Transfer?

There is much discussion about how to behave and what therapy to follow in the days following the transfer. Is it necessary to follow particular rules, or can one lead a normal life? Is it necessary to take medication to promote embryo implantation? Opinions differ greatly on the subject. However, the majority of scientific evidence suggests that rest, or even absolute immobility, does not increase the probability of pregnancy and that these precautions are totally unnecessary. It is therefore advisable to lead a normal life, without excessive exertion or stress in the days following the embryo transfer.

Things to Avoid in the First Few Days Following Embryo Transfer

Here are some things that gynecologists generally advise avoiding in the first few days:

• Activities involving jumping and jolting (such as gymnastics or running);
• Exposure to excessive heat (saunas, hot baths, sun);
• Smoking, caffeine, alcohol, and drugs;

Any medication that may be prescribed should be continued until the pregnancy test and possibly beyond if the test is positive.

Other Phases of In Vitro Fertilization

Female analysis, Male analysis, Suppression, Stimulation, Retrieval, Sperm collection, Testicular sperm extraction, Fertilization, Embryo transfer.

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