Embryo Transfer

Embryo transfer is the placing of the embryo that has developed in the laboratory into your uterus with a thin catheter; it is the final stage of IVF treatment, coming after egg collection and embryo development. The timing of the transfer and the way the uterus is prepared vary with the treatment plan: fresh transfer done in the same cycle, natural cycle timed to your own ovulation, and medicated cycle prepared with hormone medicines are approaches commonly used in this respect. The information here draws a general framework; it does not replace a diagnosis or treatment recommendation specific to you.

What is embryo transfer?

One or more of the embryos that have developed in your IVF cycle, those considered suitable, are transferred so that they can implant in your uterus. The transfer is only one step that determines the outcome of the treatment; factors such as your age and embryo quality are among the elements that determine the result most. IVF treatment is carried out within Ota Jinemed and Liv Hospital Ulus, with the laboratory and embryology teams of these hospitals.

How is the procedure performed?

The procedure is done under ultrasound guidance. The embryo is placed in the uterine cavity with a thin, soft catheter passed through the vagina and cervix. The procedure is short and no incision is made in the abdomen. You mostly feel mild discomfort; the perception of pain varies from person to person.

What can be expected on the day of transfer?

You prepare for the day of transfer according to the instructions your doctor gives. Details such as bladder fullness, how you will take your medicines that day and whether a companion is needed may vary from centre to centre; it is a good idea to clarify these with your doctor beforehand. Your doctor assesses the condition of the embryo and the number of embryos to be transferred on that day.

With which timings is the transfer performed?

What is fresh transfer?

In fresh transfer the embryo is transferred in the same cycle in which the ovaries were stimulated. In this case your uterus is prepared for the transfer in the hormonal environment created by the stimulation medicines.

What is the difference between a natural cycle and a medicated cycle?

The lining of the uterus can be prepared in two ways. In a natural cycle your own hormonal cycle is monitored and the transfer is timed to your ovulation. In a medicated cycle, the lining of the uterus is prepared with hormone medicines and the day of transfer is set according to the plan. Both are mostly used in cycles in which embryos that were frozen beforehand are used. Each option has its own advantages and disadvantages; your doctor decides which is suitable by looking at factors such as whether your ovulation is regular.

In which situations is the transfer postponed?

Whether the transfer will be done in your stimulation cycle or in a later cycle is determined according to the response you gave to the stimulation. If your risk of ovarian hyperstimulation syndrome (OHSS) is high, or if the conditions of your uterus are not suitable in that cycle, the transfer may be postponed. Your hormone levels, ultrasound findings and general condition are assessed together.

How many embryos are transferred?

The number of embryos transferred directly affects the risk of multiple pregnancy. Current guidelines recommend single embryo transfer, regardless of age and embryo stage, to reduce the risk of multiple pregnancy and preterm birth. The number to be applied in Turkey is determined according to current legislation and the doctor's assessment.

What happens after the transfer?

What are medicine support and daily life like after the transfer?

After the transfer you mostly use medicines containing progesterone to support the lining of the uterus. The type, route and duration of the medicine depend on your doctor's plan; it is important that you use the medicine regularly and determine the time to stop with your doctor. It has not been shown that long bed rest is necessary; you decide how far to continue your daily life according to your doctor's guidance.

Which symptoms are considered usual after the transfer?

After the transfer you may see light spotting, mild cramp-like pain and a feeling of fullness in the abdomen; these are mostly expected.

When is the pregnancy test done?

You take the pregnancy test as a blood test on the day your doctor states. Home tests done early can be misleading; the positive or negative result should not be interpreted before test day arrives. The test day varies from person to person according to the treatment plan.

What are the risks of embryo transfer?

• Multiple pregnancy: It increases with the number of embryos transferred and raises risks such as preterm birth.
• Ectopic pregnancy: Pregnancies that occur with IVF can also be ectopic.
• Bleeding and infection: Light spotting related to the procedure can occur; infection is seen rarely.
• OHSS: It can arise in cycles with a fresh transfer after stimulation, and in the period after a pregnancy has formed too.
• Clotting (thrombosis): It can be seen, although rarely, while using hormone medicines.

There are also some practices recommended in addition to the transfer. Current assessments do not recommend assisted hatching of the outer shell of the embryo, tests aimed at the timing of the lining of the uterus, or the routine use of immune-directed medicines. It is a good idea to ask your doctor why a practice is being recommended and what evidence it rests on.

Waiting is also a burden. Anxiety, restlessness and sleep problems are common in the period after the transfer; in this situation it is appropriate to ask for support.