What to Expect at Your IVF Embryo Transfer | A Nurse’s Perspective

Fertility treatment can be a long, challenging process with unexpected roadblocks. Knowing what to expect at your IVF embryo transfer can help alleviate any concerns and allow you to approach this big milestone feeling more empowered. 

In this article:

• What to Expect Before IVF Embryo Transfer
• Your Embryo Transfer Questions Answered
• Frozen vs Fresh Embryo Transfer
• Why do we freeze embryos?
• When will my embryo transfer take place?
• Embryo Transfer Day Do's & Don'ts
• Is IVF embryo transfer painful?
• What happens after embryo transfer?
• What to Expect at Your Embryo Transfer
• How to Increase Your Chances of Embryo Transfer Success
• A Note from Your Fertility Nurse

What to Expect Before IVF Embryo Transfer

Most fertility journeys begin with fertility testing (bloodwork and vaginal exams), then move into the diagnosis and planning phase. If you're proceeding with IVF treatment, that will mean studying injection videos, ordering medication, scheduling appointments, and learning a lot about the process). After that, it’s game time!

You begin injections and you hope you’re doing everything correctly. Night after night, morning after morning, there's something else to remember, to adapt to, to stress about. It’s a lot of weight to carry. 

But then you turn a corner. You go in for your egg retrieval and let out a sigh of relief. The follicle stimulation phase is complete, and you’ve done all you can. It’s now your doctor's turn to take over. 

After your egg retrieval is finished and your oocyte (egg) count is complete, your Care Team keeps a careful watch over your embryos' growth. How many eggs were successfully fertilized? How many are looking viable? Growing? Multiplying? Hatching?

All the while, you’re waiting by the phone to hear updates and final numbers from your nurse. The anticipation and anxiety during the embryo growth phase can be difficult!

Sometimes, in the midst of everything, treatment cycles hit roadblocks. Whether fewer eggs are retrieved than you'd hoped for or your cycle needs to be canceled, IVF requires a lot of patience and flexibility.

Why might a cycle be canceled? The most common reasons are low basal antral follicle count before the cycle begins or low production mid-cycle.

The pressure of making it through to “the end” of this infertility roller coaster can feel overwhelming. Rest assured that your entire Care Team, including your reproductive endocrinologist, will work with you closely all along the way, doing everything they can to avoid setbacks and frustrations. 

If all goes as planned, your embryo transfer is the big final step - what you've worked so hard for. And hopefully, this will be the last stop in the journey towards growing your family!

Your Embryo Transfer Questions Answered 

Below, we walk through the process of embryo transfer from the Illume Fertility perspective. While this will look similar at any fertility clinic, we take great pride in our diligence, security, and precision when it comes to any point in the IVF process, especially the embryo transfer. 

Frozen vs Fresh Embryo Transfer

Before you begin IVF, you’re given the option to do a fresh embryo transfer or frozen embryo transfer. Often times, your doctor will make a suggestion about which option is best for you.

A “fresh” transfer is just as it sounds – the embryo will not be frozen before transfer. Instead, it will be monitored as it grows in our embryology lab for approximately five days. If your hormone levels and uterine lining look optimal, the fresh transfer will happen at that point.

A “frozen” transfer is also an intuitive nomenclature – an embryo is removed from cryopreservation the morning of your transfer to thaw, then transferred the same way a fresh embryo would be. The frozen embryo was also monitored in the lab for five to seven days to ensure viability, then carefully stowed away for cryopreservation until your eventual embryo transfer. 

Is IVF right for you?

Download our free guide to IVF to learn more about how much it costs, how long it typically takes, and how it all works.

Why do we freeze embryos?

There are many reasons why embryos are frozen. Here are a few common ones:

• You may be screening embryos for chromosomal or genetic abnormalities, a procedure known as PGT-A or PGT-M.
• It could also be that clinically, the timing of your transfer isn't going to be optimal, based on premature elevation of your progesterone levels.
• The more likely reason is that you had left over embryos from your previous IVF cycle, and you are now ready to move forward with attempting pregnancy.

When will my embryo transfer take place? 

The timing of your embryo transfer can vary, depending on if you are proceeding with a fresh or frozen embryo transfer. Here's what you can expect in terms of timelines:

Fresh Embryo Transfer

Your embryo transfer procedure usually takes place five days after egg retrieval when doing a fresh transfer. During that waiting period, the eggs are mixed with sperm so fertilization can take place. The embryology team will be carefully “babysitting” (monitoring) your embryos and working hard to ensure they have the best chance for survival. 

By day five, the embryo(s) are now considered blastocyst(s), consist of 200-300 cells, and are ready for transfer. Your official pregnancy test will take place approximately nine long days after embryo transfer.

Frozen Embryo Transfer

If you are having a frozen embryo transfer (FET), that likely means you have embryos frozen from a previous IVF cycle. Your embryos were most likely frozen five, six, or in some cases, seven days after egg retrieval. If you are proceeding with an FET, the process takes quite a bit longer, usually 3-4 weeks from the time you get your menses.

Unfortunately, it’s not as simple as just thawing the embryos and ‘popping’ them back into the uterus! It takes a bit more effort. Here's how the process works:

Once you're cleared to start a cycle, you will take an oral medication called Estrace for approximately 2-3 weeks. This helps to thicken the lining of your uterus and give your embryo the best chance at successful implantation. You will be seen for a mid-cycle ultrasound to assess your lining and your doctor will give you the “green light” to proceed.

You will then be instructed to begin intramuscular progesterone injections (often referred to as PIO shots) along with vaginal progesterone inserts. Not the most glamorous part of the process, but an essential step that ensures your body will be ready to welcome an embryo - and hopefully, progress to a health pregnancy.

Your FET will take place six days after starting progesterone. This timing is critical to the success of your transfer. Similar to a fresh embryo transfer, your pregnancy test will take place about nine days after transfer.

What to Expect at Your Embryo Transfer

Finally, the big day has arrived! There's a lot of preparation, security checks, and waiting before your transfer, but the actual thawing of your embryo takes very little time, just about an hour or so.

Transfers at Illume Fertility can take place every day of the week, including weekends. This can help alleviate the stress of having to take another day off of work. They are normally scheduled between 1-2pm during the week and late morning during the weekend.

Unlike your egg retrieval, your embryo transfer will not require any anesthesia, which means you can eat a healthy, light breakfast, and even lunch, depending on your scheduled procedure time.

Embryo Transfer Day Do's & Don'ts

• We advise you and your partner to not wear any perfume or cologne to your embryo transfer. The reason? Your little embryos are super sensitive to certain odors and we don't want to disrupt them in their vulnerable state.
• Most transfers require a full bladder, which helps get the uterus in optimal position to receive the embryo. Your team will advise you to drink 20-30oz of fluid, starting an hour before your scheduled embryo transfer. How full is too full? Nurse Monica explains.

How do you ensure it's my embryo and not someone else's?

We take identification and security very seriously! In addition to all the safeguards and technology we utilize in the embryology lab, a series of verifications will be performed prior to your embryo transfer to ensure you are receiving the correct embryo.

Is IVF embryo transfer painful?

The embryo transfer procedure is virtually painless, with the exception of possible mild cramping. Your embryo(s) will be carefully loaded into a catheter, then the catheter will be inserted through your vagina and cervix, into your uterus, under the guidance of ultrasound imaging.

How does IVF work?

Get a step-by-step walkthrough of the entire IVF process from start to finish, learn about the cost of IVF, how to get started, and much more.

What happens after embryo transfer?

You will be advised to rest for a few minutes after the transfer, and then you can get up, empty your bladder, and go home!

You also have the option of incorporating laser acupuncture into your transfer – a quick session before and after your transfer has been shown to raise implantation rates by up to 15%. (Bonus: it's a great way to de-stress before and after your transfer!)

There are minor restrictions after transfer. The best news is that you don’t have to be on bedrest. In fact, limiting activity has been linked to increased stress, which can affect treatment results.

Of course, we don’t want you going out and running a marathon, but keeping to your daily routine is key. Here are a few important restrictions to keep in mind:

• No hot baths or jacuzzi
• No douching
• No heating pads
• No sex (until your pregnancy test)

You can also go to work the following day.

How to Increase Your Chances of Embryo Transfer Success

• Follow all medication directions and review medication videos in advance to ensure you understand how to administer everything correctly. Feeling unsure? Ask your nurse!
• Make sure you have enough medications, especially if traveling during your cycle.
• Stress reduction is key - take a walk, listen to music, meditate, do yoga, etc.
• Try acupuncture (we even offer laser acupuncture for those who prefer to avoid traditional needle acupuncture).
• Eat healthy and continue taking your prenatal vitamin with folic acid.
• If you pray - pray! If you don't, hold positive thoughts.

A Note from Your Fertility Nurse

Take a deep breath and recognize all the strength and determination it has taken to reach this point in your fertility journey. You’ve finally made it to your embryo transfer! The clinical side of an embryo transfer is a fascinating orchestration of science and technology. It’s a day filled with hope and positivity that we want you to remember.

Next up? Your pregnancy test in nine days. We wish you nothing but good news and are always on your team, no matter what happens. You've got this!

Want to hear from a real patient about their experience on embryo transfer day? Check out Virginia's account of this big milestone - and how she felt throughout the process.