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How embryo transfer is done in IVF, and what happens during the procedure?

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5 fertility expert(s) answered this question

Answer from: Raúl Olivares, MD

Gynaecologist, Medical Director & Owner Barcelona IVF
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I would say that probably every clinic performs the embryo transfer in the way they feel is the best one. In our case, we think that it’s really important to make sure that when the embryo leaves the incubator, we are ready to transfer it immediately into the uterus. The catheters are usually designed in a way that they can hold the temperature. It is a very important factor that may damage the embryo. If it’s not properly kept in the right conditions for 30  seconds. We don’t want to risk bringing the catheter with the embryo and then start having problems inserting the catheter into the uterus.  This is why we have abandoned the mock transfers we were doing years ago, in which we were performing that kind of mock transfer to the patients just to write down the notes of how the transfer should be done. Why?  Because sometimes, even in cases in which the mock transfer was easy, on the day of the embryo transfer, the conditions may have changed, and you may have problems placing that catheter inside.

First, we usually clean the vagina to remove all the vaginal pressures that the patient may have taken before. Then we take an empty catheter and place it in the right position. The right position is always at the beginning of the endometrium cavity. We do that because if we need more time to place and reach that point if the catheter is empty and the embryo is at the incubator,  we don’t need to rush. We are not going to suffer that the embryo may lose quality due to this time that we are going to spend getting into the cavity.

Once we are sure and see on the scan that the tip of the catheter is at the right place, then the embryologist brings the inner part of the catheter where the embryo or the embryos are. Then we are almost sure that at least in 99% of the cases, it’s going to take less than 30 seconds from the moment that the embryo leaves the incubator until we place it into the cavity. Once we have done the embryo transfer,  the embryologist takes back the catheter to the lab and empties the catheters just to make sure that there is no embryo left at the catheter. Sometimes,  when you are transferring blastocyst, and if they are expanded, the fluid may go out, but the embryo dwells inside the catheter and remains there. You feel like the transfer has been easy, but the embryos are still on the catheter. This is why it’s important to check that the catheter is empty after that. Once the embryologist confirms that the catheter is empty and that the embryos are inside, we insert the next progesterone pessary, and the transfer is done. In normal conditions, it should take no more than 5 to 10 minutes. In cases where patients have had, let’s say, surgery of the cervix,  it could be really difficult because there could be scars inside, and it may be harder to place the catheter in the right position.

Working with an empty catheter, there is no problem. We can even spend 5,10, 15 minutes of work until we are sure that we are in the right place.

Answer from: Tomas Frgala, PhD

Gynaecologist, Head Physician at UNICA Clinic - Brno
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Usually we perform the transfer in two steps: at first adjust the cover of the catheter (without the catheter itself and without the embryo) is slowly carefully and pain free inserted in the uterine cavity under the control of the ultrasound probe when we see that the tip of this catheter cover is placed perfectly and the way is prepared for the catheter itself then, we give signal to the lab and the embryo is taken into the tip of the catheter brought and inserted through that cover. This part of the process itself takes the aforementioned 10 seconds or so. We can control the insertion of the embryo or the position of the embryo and the media which is present actually with the transfer in the uterine cavity. The catheter itself is then checked under the microscope to make sure that it’s really empty.

Answer from: Alpesh Doshi

Embryologist, Consultant Embryologist and Co founder at IVF London
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We always ask the patients to come into the clinic with a full bladder. There is usually no anesthetics involved. It’s like a smear test. The procedure doesn’t take more than 15-20 minutes, the patient comes in with the full bladder into the clinic. We take them to the embryo transfer room where they lie down. Of course we clean the vagina, the cervix very thoroughly. Catheter or a tube is a thin plastic tube passed through the cervix the consultant or the gynecologist observes under ultrasound to make sure that it is well in position. Once the consultant feels that the catheter is in position they will give the embryologist the go ahead to load the embryos in a much slimmer catheter that passes through the existing catheter that the consultant is holding. The embryologist would load the embryo or embryos in the inner or finer capital bringing it through. The consultant and the embryologist would feed that catheter and with the continuous vision under ultrasound, they would position that inner catheter in place usually around the middle or mid cavity or the middle of the uterus and we would be able to see where the catheter is and once we have visualized the catheter, we would release the embryos in the middle of the endometrial cavity or in the middle of the uterus and after that again within five minutes, the patient is ready to dress up and go home and keep on taking those hormones in the hope that the embryo will implant.

Answer from: Harry Karpouzis, MD, MRCOG, DIUE

Gynaecologist, Founder & Scientific Director Pelargos IVF Medical Group
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Embryo transfer is the last stage of IVF, we have created the embryos in the laboratory, and then we need to take them and put them back
into the endometrium where they get implanted. How can we do that? We do that by putting a catheter through the external opening of the
cervix, pass it through the cervical canal, through the internal opening of the cervix and then move it so that you can leave the embryo at the right
place, usually, in the middle or higher end of the endometrium, inside the endometrial cavity. It has been prepared before, of course, so that it can have the right thickness, and we can have the right hormones to be inside, what we call the implantation window.

Embryo transfer can be done with many catheters, sometimes it can be very easy, and the catheter can pass very nicely. Sometimes, it can be harder, especially in women who had previous LEEP procedure treatments because of HPV, CIN or past surgery.

We have a lot of different catheters that we can use depending on the case. As a general rule, embryo transfer is better to happen with
ultrasound guidance, so that we can make sure that we leave the embryo in the right place inside the endometrium. As a general rule, it’s mildly
uncomfortable but not painful. In rare cases, it is very difficult to pass the catheter, and sedation might be needed so that you can have
easier the manipulations that are needed. The easiest the embryo transfer and the less the manipulation at the time of it, the more chances of
having a successful pregnancy.

Answer from: Yanina Samoilovich, PhD

Gynaecologist, Fertility Specialist International Centre for Reproductive Medicine
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Transferring a fertilized embryo is an important part of the in-vitro fertilization process. The procedure is done in a transfer room near a laboratory. First, the doctor will confirm your name to make sure it matches the identifying formation of the embryos.

The embryo transfer typically takes place under sterile conditions, even though you are not placed under anesthesia, sedated pills can be given to you to help you relax. The studies show that reducing cramps to the point where you can’t feel it, improves the chances of pregnancy by 50%. You will be asked to lie down on the bed, you may be slightly uncomfortable because your doctor instructed you not to empty your bladder. A full bladder makes it easier to spot your uterus with an ultrasound scan. An ultrasound probe will be placed on your tummy so that the uterus can be seen. The doctor will insert a speculum into the vagina and wash your cervix removing any mucus. The speculum is left in place and the embryologist is informed that you are ready. The doctor will insert a long thin tube called a catheter gently through your cervix. An ultrasonographer will let the doctor know when the tube is in the correct place inside of the uterus. Once in place, the embryos are slowly injected through the catheter. The catheter is removed and handed back to the embryologist who checks it under a microscope to make sure no embryos are stuck in it.

So, what’s important during the embryo transfer?

First of all, it should be quick and easy; it shouldn’t hurt, although you may experience minor discomfort during the insertion of the speculum or passing the catheter. In trying to follow these conditions your doctor will have all the measures of your cervix and its features beforehand. If the transfer is traumatic in any way, for example, if there is bleeding or severe cramping, your chance of pregnancy decreases. For this reason, a mock transfer may be carried out before the real procedure. This is where a soft catheter is inserted into the uterus and the depth and angle required to get to it is mapped. Mapping your cervical canal makes it easier to see its curves and this information is used to ease the passage of the catheter during the actual transfer. It is not necessary to stay in bed after the embryo transfer, but you are supposed to have 20 minutes of rest in a special room. Then, you can go home.

About this question:

How is the embryo transfer undertaken from doctor's point of view?

How does the process of embryo transfer work? What are the important things during the embryo transfer? How can you prepare for the embryo transfer?

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