Embryo Transfer Guide: Everything You Need to Know

The embryo transfer represents hope made tangible - the moment your embryo begins its journey toward becoming your baby. Whether fresh or frozen, day 3 or day 5, understanding the process helps you prepare physically and emotionally for this pivotal step.

Types of Transfers

Fresh vs. Frozen Transfer

Fresh Transfer Occurs 3-5 days after egg retrieval in the same cycle.

Advantages:

• Shorter time to pregnancy test
• No wait between retrieval and transfer
• Single cycle completion
• Lower medication costs

Considerations:

• Higher OHSS risk if pregnant
• Potentially less receptive endometrium
• Less time for PGT testing
• All decisions made quickly

Frozen Embryo Transfer (FET) Embryos are frozen and transferred in a subsequent cycle.

Advantages:

• Better endometrial receptivity
• Time for PGT testing
• Reduced OHSS risk
• More controlled timing
• Higher success rates in many cases

Considerations:

• Additional 6-8 week wait
• More medications needed
• Additional costs
• Emotional challenge of waiting

Day 3 vs. Day 5 Transfer

Day 3 Transfer Embryo at 6-8 cell stage.

When Recommended:

• Fewer than 4 embryos developing
• Previous failed Day 5 attempts
• Concern about lab conditions
• Patient preference

Success Rates:

• Slightly lower than blastocyst
• 25-35% per transfer average
• Multiple embryos often transferred

Day 5/6 Transfer (Blastocyst) Embryo has 100+ cells and fluid-filled cavity.

Advantages:

• Natural selection to strongest embryos
• Better synchronization with uterus
• Higher implantation rates
• Usually single embryo transfer

Success Rates:

• 40-65% per transfer (age-dependent)
• Lower miscarriage risk
• Better for eSET (elective single)

Preparing for Transfer

FET Cycle Timeline

Weeks 1-2: Baseline and Suppression

• Day 1: Period starts
• Day 2-3: Baseline ultrasound and bloodwork
• Start estrogen (pills, patches, or injections)
• Sometimes Lupron for suppression

Weeks 3-4: Building Lining

• Continue estrogen
• Day 10-14: Lining check ultrasound
• Target: 7mm minimum, trilaminar pattern
• Adjust medications if needed

Week 5: Final Preparation

• Final lining check
• Start progesterone (5 days before transfer)
• Schedule transfer date
• Begin antibiotics/steroids if prescribed

Fresh Transfer Preparation

• Progesterone starts day after retrieval
• Ultrasounds to check ovaries
• Monitor for OHSS symptoms
• Transfer scheduled for day 3 or 5

The Transfer Day

Before You Leave Home

Morning Routine:

• Normal breakfast (unless specified otherwise)
• Take prescribed medications
• Start drinking water for full bladder
• Shower (no perfumes or lotions)
• Wear comfortable, warm clothing
• Bring lucky items if desired

Bladder Preparation:

• Start drinking 32oz water 1 hour before
• Moderately full bladder needed
• Helps straighten uterus for easier transfer
• Can partially empty if too uncomfortable

At the Clinic

Check-In Process (30 minutes):

1. Paperwork and consent review
2. Change into gown (keep socks on)
3. Acupuncture if offered/desired
4. Meet with embryologist
5. Review embryo quality and selection

Embryo Discussion:

• Quality grading explanation
• Number to transfer decision
• Photos of your embryo(s)
• Remaining embryo disposition
• Questions answered

The Transfer Procedure

In the Procedure Room (10-15 minutes):

1. Positioning: Lie back with feet in stirrups
2. Speculum Insertion: Like a Pap smear
3. Cervical Cleaning: Gentle cleaning with saline
4. Ultrasound Placement: Abdominal probe by nurse
5. Catheter Test: Doctor tests pathway
6. Embryo Loading: Embryologist loads embryo
7. The Transfer:
   • Catheter guided via ultrasound
   • Watch screen to see embryo placement
   • Small white flash shows embryo
   • Catheter slowly withdrawn
8. Confirmation: Embryologist checks catheter is empty
9. Rest: Remain lying for 5-10 minutes

What You'll Feel:

• Pressure from speculum
• Full bladder discomfort
• Mild cramping possible
• Emotional overwhelm common
• Most report minimal discomfort

After Transfer

Immediate Post-Transfer:

• Empty bladder (embryo won't fall out!)
• Get dressed
• Receive discharge instructions
• Schedule beta test
• Go home and rest

First 24-48 Hours:

• "Couch rest" recommended by some
• No heavy lifting or strenuous activity
• Continue all medications
• Stay warm and comfortable
• Light activities fine

Optimizing Success

Evidence-Based Recommendations

Proven Helpful:

• Taking prescribed medications exactly
• Avoiding heavy physical activity 48 hours
• Maintaining normal BMI
• Stress reduction techniques
• Adequate sleep

No Evidence of Benefit:

• Strict bed rest
• Special diets
• Pineapple core
• Keeping feet warm
• Avoiding stairs

Should Avoid:

• Hot tubs/saunas
• Heavy lifting
• High-impact exercise
• NSAIDs
• Alcohol and smoking

The Science of Implantation

Days 0-1: Embryo floats freely in uterus Days 2-3: Hatching from shell (zona pellucida) Days 3-4: Apposition (initial contact with lining) Days 4-5: Adhesion (attachment begins) Days 5-7: Invasion (embedding in lining) Days 7-10: HCG production begins

Modified Natural vs. Medicated FET

Medicated FET Protocol

Most common approach with full control.

Medications:

• Estrogen for 2-3 weeks
• Progesterone starting 5 days pre-transfer
• Continue both through 10 weeks if pregnant

Monitoring:

• 2-3 ultrasounds
• Bloodwork for hormone levels
• Highly controlled timing

Modified Natural FET

Uses your natural cycle with minimal meds.

Requirements:

• Regular cycles
• Confirmed ovulation
• Good lining naturally

Process:

• Monitor for natural LH surge
• Trigger shot for precision
• Minimal progesterone support
• Transfer 5-7 days post-ovulation

Single vs. Multiple Embryo Transfer

eSET (Elective Single Embryo Transfer)

Now standard for most patients.

Recommended When:

• Under 35 years old
• Good quality blastocysts
• PGT-tested embryos
• First or second transfer
• No history of failed IVF

Benefits:

• Eliminates twin risks
• Safer pregnancy
• Better outcomes overall
• Cost-effective long-term

Double Embryo Transfer

Considered in specific situations.

May Be Discussed If:

• Over 40 years old
• Multiple failed transfers
• Lower quality embryos
• Day 3 transfers
• Patient preference after counseling

Risks to Consider:

• Twin pregnancy complications
• Premature delivery
• NICU stays
• Long-term health impacts
• Financial considerations

The Two-Week Wait Begins

Immediate Symptoms (Days 1-3)

Normal to Experience:

• Mild cramping
• Light spotting
• Bloating
• Fatigue
• No symptoms at all

Not Predictive:

• Symptoms don't indicate success/failure
• Every woman experiences differently
• Medications cause pregnancy-like symptoms

Medication Side Effects

From Progesterone:

• Breast tenderness
• Nausea
• Fatigue
• Mood changes
• Constipation

From Estrogen:

• Headaches
• Bloating
• Breast tenderness
• Mood swings

Emotional Aspects of Transfer

Common Feelings

Before Transfer:

• Excitement and hope
• Anxiety about embryo thawing
• Fear of transfer difficulties
• Overwhelming emotion seeing embryo

During Transfer:

• Awe watching on screen
• Connection to embryo
• Vulnerability
• Partner's emotional experience

After Transfer:

• Hyper-awareness of body
• Alternating hope and fear
• Desire to "feel" pregnant
• Difficulty concentrating

Coping Strategies

• Plan distractions for wait
• Limit Dr. Google
• Connect with transfer buddies
• Continue normal activities
• Practice mindfulness
• Journal your experience

Special Situations

Difficult Transfers

Sometimes transfers require extra steps:

• Cervical dilation
• Different catheters
• Ultrasound guidance adjustment
• Full vs. empty bladder trials
• Medication to relax uterus

Mock Transfer

Done before actual transfer to:

• Map cervical pathway
• Identify potential difficulties
• Measure uterine depth
• Plan for smooth transfer
• Reduce actual transfer time

Cancelled Transfers

Transfers may be cancelled for:

• Thin lining (<7mm)
• Fluid in uterus
• Polyp discovered
• Rising progesterone (fresh)
• No surviving embryos after thaw (rare)

Success Rates by Transfer Type

Fresh Transfer Success Rates

• Under 35: 35-45%
• 35-37: 30-35%
• 38-40: 20-25%
• Over 40: 10-15%

FET Success Rates

• Generally 5-10% higher than fresh
• PGT-tested: 60-70% per transfer
• Less age-dependent with tested embryos

After Your Transfer

The Journey Continues

Whether this transfer results in pregnancy or not, you've accomplished something significant. You've:

• Prepared your body optimally
• Completed a medical procedure
• Given an embryo the best chance
• Shown incredible courage
• Moved closer to your goal

With TrackMyIVF

• Track post-transfer symptoms
• Connect with others in TWW
• Access meditation and relaxation tools
• Log medications and feelings
• Find hope in community stories

The transfer is a moment of profound hope. Whether it's your first or fifth, fresh or frozen, each transfer brings possibility. Your embryo is beginning its journey, and regardless of outcome, you've given it the best possible chance. Now comes the wait, and you don't have to face it alone.