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Embryo transfer is the most important stage of IVF. This is the final in vitro fertilization procedure. It is recommended to implant no more than two embryos, in many clinics one is transferred.
Numerous studies have shown that with a single embryo transfer, the pregnancy rate is 50-60%. The transfer of two embryos increases the chance of pregnancy by 15%, but the rate of full-term birth drops by 40%.
However, it is important to take into account other factors, such as the woman’s health status, heredity, the number of IVF attempts.
In this article, we will explain in detail how embryo transfer works.
IVF procedure schedule by day
IVF is a long process that begins with examining a couple, passing tests, and going to doctors. How long it will last depends on which protocol your doctor decides to use. (one)
Two protocols are most often used – short and long.
The IVF cycle consists of several stages:
- Stage 1 – stimulation of superovulation;
- Stage 2 – follicle puncture;
- stage 3 – fertilization of eggs and cultivation of embryos;
- Stage 4 – transfer of embryos into the uterine cavity.
The long protocol lasts at least 40 days. On the 20-21st day of the cycle, drugs are prescribed – agonists of gonadotropic hormones. They suppress the production of hormones by the ovaries. On the 2-4th day of the next cycle, ovulation stimulation begins.
The puncture procedure consists in extracting mature eggs from the follicles for further fertilization outside the woman’s body. This is a painful manipulation, so it is performed under general anesthesia. It lasts 10-20 minutes, is performed by inserting a special hollow needle through the vagina under the control of an ultrasonic sensor.
With a short protocol, ovulation stimulation begins from day 2-3 of the cycle. (2) Gonadotropin preparations are administered for 10-14 days.
The puncture in the short protocol is also carried out on the 12th-15th day of the menstrual cycle. This protocol usually lasts 25-30 days.
The resulting cells are transferred to the laboratory, where the embryologist examines and selects full-fledged, healthy and viable oocytes and sperm. The eggs are fertilized on the day of collection. Embryos are cultured up to 5-6 days. On the 5th (rarely 3rd) day of development, the embryos are transferred to the uterus using a long, thin, elastic catheter. Without anesthesia, under ultrasound control.
After replanting the embryos, hormonal preparations are prescribed to maintain the pregnancy.
Two weeks later, an analysis is carried out to determine hCG and ultrasound. If the pregnancy is successful, hormonal support continues throughout the first trimester, and possibly longer.
Stages of embryo development
Those who decide to resort to IVF are interested not only in the procedure itself, but also in various subtleties. In particular, how the embryo develops before the transfer. We will tell you what happens to the embryo after fertilization.
The first day
The embryologist assesses whether the fertilization was successful. It is considered successful if the presence of male and female nuclei is noted in the egg. A fertilized egg is called a zygote.
Second day
The zygote begins to split, the female and male nuclei merge. Now the zygote is called an embryo, and its cells are called blastomeres. On the second day, their number can be from 2 to 4.
The third day
The number of blastomeres reaches 6-8. It is on this day that most of the poor-quality embryos die. Further development depends on which genome was formed and how timely it began to function.
Fourth day
The embryo becomes more “compact”, its surface is slightly smoothed. It starts to work its own embryonic genome, which is formed from the maternal and paternal. At this stage, the embryo is called a morula.
Fifth and sixth day
A cavity forms in the morula, now called the blastocyst. It has a complex cellular structure, which consists of approximately 200 cells. At this stage, genetic testing is performed, conservation is carried out or, in most cases, transfer is carried out.
How does a woman feel during IVF?
With in vitro fertilization, everything is very individual. A woman may not feel anything, or vice versa, there is a whole range of different sensations.
At the stage of ovulation stimulation, a woman usually begins to notice a deterioration in her health, severe headaches, nausea, dizziness, and nagging pain in the lower back and lower abdomen. Changes in hormonal balance can cause psycho-emotional discomfort. The patient becomes nervous, tearful, irritable, sleep is disturbed at night, bloating and appetite disorders may occur.
After the puncture of the follicles, symptoms such as:
● slight spotting;
● aching pain, discomfort and bloating;
● increase in body temperature to subfebrile figures;
● nausea;
● shortness of breath;
● constipation or diarrhea;
● discomfort during urination.
After embryo transfer, there is often a feeling of heaviness and aching pain in the lower abdomen, deterioration in general condition, weakness, drowsiness, apathy, dizziness. These symptoms do not indicate pregnancy, perhaps this is the body’s reaction to maintenance therapy.
Bleeding after embryo transfer is uncommon as the patient is taking medication to support the endometrium. But this happens, and no one can immediately know for sure the reason. Some women experience implantation bleeding, which indicates the attachment of the embryo. These secretions are light pink in color, odorless, their volume does not increase, they pass in 1-2 days. If the discharge is profuse, fetid, accompanied by itching and fever, you should immediately consult a doctor.
Possible soreness, sensitivity, swelling of the mammary glands. Taste preferences may also change, nausea, vomiting, constipation, flatulence will appear. These symptoms do not always mean pregnancy, perhaps they are harbingers of menstruation.
The most reliable signs of the onset of pregnancy are a delay in menstruation and an increased level of hCG (human chorionic gonadotropin).
How to behave after IVF
After an in vitro fertilization program, it is very important to follow all the requirements of your doctor. For each woman, these recommendations are individual. Consider the general rules of conduct after embryo transfer after IVF.
At the end of the procedure, a woman must take care of her health and follow the recommendations of the doctor:
- within 14 days it is forbidden to lift weights, physical activity (training, doing housework);
- sexual rest should be observed;
- eat right, lead a healthy lifestyle (ensure proper sleep, give up alcohol, smoking);
- refrain from taking hot baths, do not visit baths and saunas;
- avoid crowded places and patients with infectious diseases;
- psychological comfort is needed: you should not be nervous or conflict, you need to avoid stressful situations;
- walk more outdoors.
You should not do pregnancy tests from the very first days, as they will not show a reliable result, and a woman may experience unnecessary frustration. It is recommended to carry out pregnancy tests no earlier than two weeks after embryo transfer.
Compliance with all the recommendations and appointments of a reproductologist is a big step towards long-awaited happiness.
Reproductologist’s comment
— Undoubtedly, embryo transfer is the most exciting and anticipated procedure for a patient of the clinic of assisted reproductive technologies. However, if for some reason your reproductologist recommends that you refuse to transfer an embryo in a fresh stimulated cycle, then do not despair, notes obstetrician-gynecologist, reproductologist of the clinic LLC “ECO Center” in Volgograd Lyudmila Shurshina. – As world practice shows, cryoprotocols (transfer of thawed embryos) are even more effective than fresh protocols. This is due to the fact that:
- cryopreserved embryos have undergone natural selection and are the most viable;
- no hormonal stimulation of the ovaries;
- drugs are used to prepare the endometrium;
- there is no follicle puncture procedure.
Popular questions and answers
Embryo transfer is the last step on the way to a long-awaited pregnancy. We answer the most popular questions that patients have.
Why can embryo transfer be cancelled?
● receptive endometrium;
● high-quality blastocyst.
That is, the endometrium must be hormonally active and able to “accept” a high-quality blastocyst. (3) If this condition is not present, then reproductologists cancel the transfer, and the embryos are subjected to freezing (cryopreservation) with subsequent storage. The transfer process is carried out after the endometrium of the uterus is ready to receive the blastocyst.
The reasons for canceling embryo transfer may be the following:
● injuries, viral diseases;
● OHSS (ovarian hyperstimulation syndrome) is manifested by the fact that more than 20 eggs are obtained during the puncture. Of the symptoms of OHSS are possible: shortness of breath, an increase in the size of the abdomen, swelling;
● endometrial hyperplasia. Normally, for attachment and normal development of the embryo, the endometrium is 9-12 mm thick. With hyperplasia, the endometrium grows more than 14 mm, becomes “lush”, unsuitable for implantation;
● low level of progesterone;
● high progesterone levels.
It is important to understand that these causes can be eliminated during therapy, as well as following all the recommendations of a reproductive specialist.
On what day does the embryo take root after the transfer?
What to do if the temperature rises?
What to do if the embryo does not take root?
Try not to get depressed. In the absence of pregnancy, you should not blame yourself or the doctors. That happens. A second IVF procedure can be performed after 3-6 months. It is important to follow the recommendations and prescriptions of doctors, monitor the state of health, treat existing diseases and come to the new protocol with renewed vigor.
Sources of
- Application of the method of intravaginal immunotherapy in the treatment of women with infertility / Alyautdina O.S., Esina E.V. // 2016
- Optimization of single embryo transfer using time-lapse microscopy in IVF and ICSI programs / Saraeva N.V., Spiridonova N.V., Tugushev M.T., Shurygina O.V., Sinitsyna A.I.// 2020 .
- Influence of the features of the psycho-emotional state of women with tubal-peritoneal infertility on the result of treatment by in vitro fertilization / Podolkhov Evgeny Nikolaevich, Niauri Dariko Alexandrovna, Petrova N. N. // 2009