Once retrieved, the eggs are fertilized and grown in the IVF laboratory for five to six days, then frozen. About two weeks after the egg retrieval procedure, most patients will begin their natural menstrual period. On the second or third day of that cycle.
Embryo transfer is usually performed on the third to fifth day of progesterone therapy. As with natural cycle FET, embryos are thawed on the morning of the scheduled frozen embryo transfer. In our laboratory, approximately 60-70 percent of embryos survive cryopreservation and thawing.
A FET cycle will take approximately 6 to 8 weeks. A cycle typically begins with 3 to 4 weeks of daily birth control pills to suppress the normal ovarian cycle, as it would lead to ovulation. After the course of birth control, you will need a baseline assessment involving bloodwork and ultrasound.
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Women using frozen embryos for transfer had a live birth rate of 74.5 percent as compared to women using fresh embryos with a live birth rate of 53.7 percent. In addition, we observed only a 2.8 percent miscarriage rate following CCS with a frozen transfer compared to 18.5 percent in the fresh transfer group.
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Before embryo transfer on the morning of embryo transfer an embryologist will telephone you to let you know whether the embryos survived the thaw process and to give you a time to attend the unit for the replacement. This could be on the same day or after 1-3 days of embryo culture. You will be asked to attend with a full bladder, as an abdominal scan will be carried out to help the doctor with positioning the transfer catheter. The replacement procedure is relatively painless (similar to a smear test) and takes around 15 minutes. No anaesthetic is necessary and your partner can come into theatre with you. The embryologist will advise you on the number of embryos to be transferred. We aim to provide a good chance of success whilst keeping the risk of multiple pregnancy low, as this is associated with a higher risk of complications for both the mother and babies.
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Monitoring of follicle development is often performed during a FET cycle by using transvaginal sonography. To determine the day on which you should begin monitoring, subtract seventeen days from the length of your menstrual cycle. For example, if it is 30 days from the first day of one menstrual cycle to the first day of the next, you should have your first ultrasound on approximately cycle day 13 (30-17=13). You will have other ultrasounds as your dominant follicle nears maturity. These ultrasounds will continue until we have documented ovulation.
As the growing follicle nears maturity, the level of the hormone LH in the blood and urine rises dramatically. This is known as the LH surge. For the purpose of frozen embryo transfer, we define the day of the LH surge as the day the urine LH test turns positive. It is important that the LH be monitored on a daily basis, as the frozen embryo transfer will be timed from the date of the LH surge. The timing of the embryo transfer will depend upon the stage at which your embryos were frozen. Embryos frozen at a more advanced stage of development (blastocysts) will be transferred later than embryos frozen at an earlier stage of development.
In addition to monitoring your LH, your physician may also confirm ovulation with ultrasonography through the time of ovulation. If ovulation does not occur, as evidenced by failure of the dominant follicle to collapse on ultrasound, then the frozen embryo transfer may be canceled. Alternatively, hormonal supplementation may be provided during the remainder of the transfer cycle. Depending upon the individual physician’s protocol you may also be treated with oral medications such as methylprednisolone and doxycycline prior to the transfer.
Embryos are thawed on the morning of the scheduled frozen embryo transfer. In our laboratory, approximately 60-70 percent of embryos survive cryopreservation and thawing. We usually transfer 1-2 embryos during each FET cycle. However, this number is flexible, and your physician will discuss this issue with you. Excellent FET pregnancy rates occur in most cases with the transfer of one to two embryos, which also minimizes the risk of multiples. The transfer of more embryos may increase the likelihood of a multiple pregnancy, which increases the pregnancy risks for the woman and the fetuses.
The actual embryo transfer itself is identical to the embryo transfer following in vitro fertilization-embryo transfer. Depending upon the physician’s protocol the embryo transfer may be accomplished under ultrasound guidance which will require the bladder to be full. A small plastic catheter is passed gently through the cervix into the uterus. After waiting 1-2 minutes to allow any mild cramping to resolve, the embryos are deposited in the cavity along with a very small amount of fluid. No anesthesia is required for the embryo transfer. You will be discharged after resting for 20 minutes.
Patients undergoing FET may not require hormonal supplementation when we document normal follicular development and ovulation. Unlike the initial IVF-ET procedure during which the progesterone-producing granulosa cells are aspirated, those cells remain functional within the corpus luteum during your FET cycle. Progesterone supplementation may be administered to patients with ovulatory dysfunction or luteal phase inadequacy. In these cases, progesterone injections or suppositories begin before the embryo transfer and continue until the pregnancy test is performed.
We will usually perform a serum pregnancy test 12-14 days following the embryo transfer. If the test is positive, we may measure the serum progesterone level and recommend that you continue taking progesterone for several additional weeks. If the pregnancy test is negative, progesterone is discontinued and a period begins in a few days.
If the pregnancy test is positive, we will perform a vaginal sonogram about three weeks later. At this point, we are able to identify the number of embryos and can often see a heartbeat in the developing embryo. The risk of pregnancy loss is low after this developmental milestone. If the FET procedure is unsuccessful, you should schedule a consultation with your physician to review the procedure and discuss future treatment options.
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Embryo transfer is usually done on either the 4th or 6th day of progesterone, depending on which day following fertilization the embryo had been frozen. three to five days after egg retrieval, all embryos are cryopreserved. The next month or in the month after, when the endometrium has had a chance to form without the influence of ovarian stimulating drugs, a frozen embryo transfer can take place.
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