Treatment Options

IVF + PGS + FET

Single Frozen Embryo Transfer

On the day of your frozen embryo transfer, report to RFC approximately 30 minutes prior to your scheduled pre-embryo-transfer time. While partners are encouraged to be present, their presence is not imperative. However, you will need someone to drive you to and from our infertility clinic.

The frozen embryo transfer procedure is similar to a pap smear. A speculum is inserted into your vagina. An abdominal ultrasound examination is performed, then a catheter and guide is inserted into the cervical canal and the catheter is fed into the uterus. Occasionally, you may feel some cramps as the catheter is placed into the uterine cavity. The embryos are then placed into the uterus. The embryologist then inspects the catheter under a microscope to make sure that all the embryos were transferred.

Frozen embryo transfer is usually a short procedure. There is generally little discomfort, if any at all. Following the procedure, you may get dressed and be driven home. You will NOT be able to drive yourself home. Bed rest is recommended for the next three days. Please remember that you are to continue your progesterone (and any other prescribed medications such as heparin, estrogen, or baby aspirin) until we have the results of your pregnancy test. Following transfer, some patients may pass a small amount of bloody fluid or air from the vagina. Please do not worry about this, it does not mean that you are expelling the embryo(s). From the time after bed rest until your pregnancy test, you are to continue the medication, including progesterone shots and suppository until you are specifically instructed to stop them. If your pregnancy result is positive, you will be on the medication for at least a few weeks.

It is normal to blame yourself or something you may or may not have done during this time if your pregnancy test is negative. Therefore, we strongly recommend that our patients adhere to the guidelines we have itemized below to encourage a more positive result and outlook:

  • No tub baths or swimming for 48 hours after replacement
  • No douching
  • No tampons
  • No intercourse or orgasms until the fetal heartbeat is seen on ultrasound or the pregnancy test is negative
  • No jogging, aerobics, tennis, skiing, mountain climbing, etc.
  • Do not begin any new physical activity
  • Do not taken any non-prescription medications or other prescribed medications without the approval of the IVF team
  • No heavy lifting
  • Try to keep busy; remaining mentally distracted will help the ten to twelve days pass easier
  • It is not unusual for you to have some vaginal spotting or bleeding prior to your pregnancy test. Approximately 50% of our pregnancy patients have spotting prior to pregnancy tests, or even afterwards. Think Positive! You must have the blood work drawn even if you think your period has started.

Intracytoplasmic Sperm Injection (ICSI)

This procedure involves direct injection of a single sperm into a mature egg. This procedure is selectively used in cases involving significant decreases in sperm counts, motility, or morphology. This procedure may also be used in cases where there is a history of previous failed fertilization despite normal sperm testing.

Assisted Hatching

This procedure involves making a small hole in the zona pellucida (sugar-protein membrane) that surrounds the pre-embryo at the 6-8-cell stage approximately 1 hour prior to embryo transfer. As the embryo continues to grow, the hole becomes larger, making it easier for the embryo to “hatch” out of its shell, which is necessary for implantation to occur. This procedure is performed in patients with a thickened zona pellucida, as well as in patients over 35, or with other histories.

Low stimulation/ natural cycle IVF

A low stimulation or natural cycle IVF typically refers to an in vitro fertilization cycle that uses an oral medication in lieu of an injectable gonadotropin medication. The oral medication provides milder stimulation of the ovaries than the injectable medication. Currently, the advances in reproductive medicine point to the use of genetic testing of embryos as the best option for patients, as the testing provides more information about the embryos, lowers miscarriage rate, and increases pregnancy rate per embryo transfer procedure. Therefore, the downside of a low stimulation/natural cycle IVF is that much less eggs are stimulated hence retrieved, and the patient has a much higher chance of having no “normal” embryo to transfer.

Day 3 Embryo Transfer and Day 5 blastocyst transfer

An embryo can either be transferred back to the uterus for implantation on Day 3 or Day 5. Most IVF cycles will involve a Day 5 blastocyst transfer of an embryo that has been tested normal by Pre-implantation Genetic testing. However, under some circumstances, a Day 3 transfer may be considered based on what’s best for that patient.

Transferring Embryos to the Uterus

Embryos are transferred on either day three or day five of development. The embryologists at RFC are highly skilled in identifying “healthy” embryos, and in some cases will recommend that a patient extend embryo development to day five, known as the blastocyst stage. Blastocyst transfer has become quite common in IVF cycles as it can increase chances for success of pregnancy while decreasing the likelihood of multiples. Your physician will work closely with the embryologists to determine if a day three or day five transfer would be ideal for your cycle.

Embryos are transferred to the uterus through a small tube (catheter). This procedure is very similar to  a pap smear, does not require any anesthesia, and is usually painless. The embryos are placed in a small amount of fluid inside the catheter, which is passed through the cervix at the time of a speculum examination. The embryos are placed in a manner so that they reach the top part of the uterus. The number of embryos transferred depends on individual circumstances of the couple, and this decision will be made collectively by you, your fertility doctor, and the embryologist.

Typically, two to four embryos will be transferred in one treatment cycle.

During the embryo transfer, the embryo(s) may be displaced through the cervix, (causing loss of embryos) or into the fallopian tubes (causing possible tubal pregnancy); however, this is unlikely. Although the embryo transfer can cause mild cramping, there is only a small risk of bleeding or infection as a result of the transfer procedure.

After the transfer, the patient may get dressed and leave after a brief recovery period. A pregnancy test will be done twelve to fourteen days after the transfer, regardless of the occurrence of any uterine bleeding.

The transfer of several embryos increases the probability of success. A multiple embryo transfer also increases the risk of a multiple pregnancy. Any multiple pregnancy carries an increased risk of miscarriage(s), premature labor, and premature birth, as well as an increased financial and emotional cost. Pregnancy-induced high blood pressure and diabetes are more common in women pregnant with more than one fetus. Prolonged hospitalization may be necessary for these pregnant women and for the mother and babies after delivery. Tubal (ectopic) pregnancy is also possible, and a combination of normal pregnancy and ectopic pregnancy may occur. A tubal pregnancy is a condition that may require laparoscopy or major surgery for treatment. Like spontaneous (natural) conceptions, pregnancies that arise through IVF may result in miscarriage. In the event of a miscarriage, a dilatation and curettage (D&C) may be necessary. Couples have a choice of what to do with the remaining embryos that are not transferred. The following are the options:

  • Freezing (cryopreservation) of remaining embryos for use by the couple in future treatment cycles
  • Allowing the embryos to develop in the laboratory until they perish, at which time they would be disposed of in a manner consistent with professional ethical standards and applicable legal requirements (this usually occurs within six to eight days after egg collection)

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