Author: Lora Shahine, MD
Every path to an embryo transfer is unique, but they all involve planning, injections, appointments, and usually some ups and downs on the infertility roller coaster. The embryo transfer is the final step in a long journey toward building your family. Preparing for this day and knowing what to expect can decrease your worries and maximize your chances of success.
Preparing for Your Embryo Transfer
The best way to prepare for your embryo transfer is to follow all directions from your clinic and learn more about what to expect on the day of the transfer.
1) Follow directions for your medications. Whether you are doing a fresh embryo transfer or a frozen embryo transfer, you’ll likely be on progesterone and other supportive medications, so make sure you have enough of them and that you follow directions from your clinic on how to take them. Traveling? Make sure to keep them with you (do not pack in checked bags due to unstable temperatures in the cargo area of the plane) and take a note from your clinic explaining why you need to take medications (including needles) on the plane. Some clinics give Valium for the procedure, so fill that prescription if provided.
2) Plan ahead for getting to the clinic on time – think of traffic, weather, and other issues that may cause a delay. If you have a long drive to the clinic, consider staying in a hotel near the clinic the night before the transfer to decrease your risk of being late.
3) Ask about logistics for the day of the procedure – what time you should arrive, who you can bring with you to the appointment (usually it’s one adult in the room at a time), and how long you should expect to be at the clinic. Try to ask questions beforehand – the day of the transfer is exciting and emotional, and you may forget to ask what you wanted to if you wait until the day of the transfer to ask.
4) Read directions from the clinic again – it’s easy to get overwhelmed and make assumptions, so be careful and ask your partner or a friend to read them too.
5) Prepare for a relaxing evening after the transfer – have your favorite meal ready (or plan for delivery), get a new book to enjoy, have a few movies picked out that you’ve wanted to see, and in general, just plan for pampering. (More on post-transfer instructions later).
The Day of the Embryo Transfer
1) Continue your supportive medications like estrogen and progesterone as instructed.
2) Come with a full bladder – follow instructions for drinking water beforehand; otherwise, you may be waiting while your bladder fills up. A full bladder helps change the angle of the uterus to make the transfer easier and helps your provider see the catheter clearly with trans-abdominal ultrasound to perfect placement of the embryo.
3) You may be prescribed Valium for the procedure – taking it makes a full bladder more comfortable and theoretically relaxes the uterus, but it has not been proven to increase success rates.
4) In the transfer room, expect to get undressed waist down, cover up with a sheet or warm blanket, and lie down on an exam table. The transfer is done in the position of a gynecological exam – feet in footrests and hips at the edge of the exam table. There may be music playing (ask ahead of time if you can bring your own), and the room may be low-lit to help you relax. Usually, a partner, friend, or family member is present and sitting next to you. Now you are ready to meet the team and get started!
5) Meet the embryologist who will discuss the embryo(s) and answer questions. Many clinics give a photo of the embryo taken the day of the transfer.
6) Meet the ultrasonographer, who will do a trans-abdominal ultrasound to confirm excellent visualization. The uterus lies beneath the bladder, and a full bladder provides a window through which the ultrasound waves can show a clear view of the uterine cavity.
7) The physician will review the procedure and answer any further questions you have before the procedure begins.
8) Every clinic is different, but at my clinic, Pacific NW Fertility, we do our transfers in a two-step process – first placing a prep catheter gently through the cervix under ultrasound guidance (the ultrasound is on the abdomen, and the patients can watch the catheter being placed on the ultrasound screen along with the team).
9) Once the prep catheter is ready, the embryologist will load the embryo(s) into a smaller catheter, and the patients can watch! We have a camera on the microscope in the embryology lab with a live feed into the transfer room so the patients can see the embryo before the transfer and watch it being loaded into the catheter – it’s incredible every time!
10) The embryologist brings the catheter with the embryo(s) into the room, and the physician passes that catheter through the prep catheter.
11) When the catheter is in the right spot, the embryo(s) is placed, and we all watch a flash on the ultrasound screen within the uterine lining. The embryo is too small to see on the screen – the flash we’re watching is a mix of a small air bubble and media that help push the embryo through the catheter and place it safely in the uterus. This is when I wish I could make a fireworks light up on the ultrasound screen for patients to see – it’s really just black and white, and the flash so subtle at times that patients can miss it, but it really is magical.
12) When the catheter is in the right spot, the embryo(s) is placed, and we all watch a flash on the ultrasound screen within the uterine lining. The embryo is too small to see on the screen – the flash we’re watching is a mix of a small air bubble and media that help push the embryo through the catheter and place it safely in the uterus. This is when I wish I could make a fireworks light up on the ultrasound screen for patients to see – it’s really just black and white, and the flash so subtle at times that patients can miss it, but it really is magical.
Immediately After the Transfer
1) The embryo cannot fall out! Patients often prefer to relax a few minutes after the embryo transfer, but studies do show that the length of time lying down after the procedure does not impact success.
2) At my clinic, we review medications and instructions, and then give the patient or couple a few minutes alone to reflect on the transfer – it’s such a special day. Then we recommend that the patient gets dressed, uses the bathroom (patients are thrilled to empty their bladders, and you cannot pee out the embryo – promise!), and goes home to relax.
Instructions for what to do after the transfer vary widely among clinics and certainly on Dr. Google, so it’s easy to get confused. Patients invest so much to get to the transfer, and it’s so high stakes that many are willing to do anything to improve their chances of a positive pregnancy test. My personal philosophy and personal recommendations are as follows:
1) We believe implantation occurs on the day of or day after the embryo transfer, so these are two days to relax and pamper yourself. Transfers are usually done in our clinic in the afternoon, so patients go home, relax, and get a good night’s sleep.
2) Some people take the day off after the transfer, but it’s not required. If it’s possible or you can work from home, consider it a self-care day. But if you can’t take the day off, don’t worry that you’re compromising your outcome.
3) Stay away from strict lists of how much you can lift, twist, etc. Providers may think they are helping with these strict guidelines, but I think it makes patients more anxious and worried.
4) Take it easy, take care of yourself, and use the days after a transfer to NOT do anything you don’t want to like housework, laundry, etc.
When those thoughts and worries creep in during the two-week wait, remind yourself that people get pregnant all the time without altering their activity.
During the Two-Week Wait
It’s agonizing to wait for a pregnancy test after all the effort it’s taken to get to the embryo transfer, but during this time:
1) Continue your supportive medications as instructed by your clinic.
2) Plan for relaxing or distracting yourself – you know what works best for you.
3) There are no signs and symptoms that are indicative of pregnancy or no pregnancy:
Some people who are pregnant have spotting and some don’t.
Some people who are pregnant have cramps and some don’t.
Some people have breast tenderness, mood swings, and more, and some people feel nothing – it’s best to continue the supportive medications and take the test when your clinic recommends.
4) Plan ahead for the outcome. Having a plan for pregnancy is the goal – usually, that means continuing the supportive medications and following up with the clinic. But also ask about what will happen if the test is negative – when you should stop medications and what the next step will be.
If you’re planning for an embryo transfer, I wish you all the best. It’s the culmination of a lot of hard work and a huge accomplishment to get to that point. The anticipation and waiting for the outcome can be tough, but remind yourself that you’re doing everything you can, and no matter what the outcome, you’ll be okay – just take it all one day at a time.
Learn more about infertility and miscarriage with more blog posts at drlorashahine.com.