For each patient undergoing IVF treatment, embryo transfer is the most stressful and exciting process of treatment. After weeks of drug use and follow-up, eggs were collected and the embryo development was followed up enthusiastically. It’s the last step. Insertion of the embryo into the uterus is the last procedure before the patient is formally pregnant.

Embryo transfer is a simple procedure that follows in vitro fertilization (IVF) and is often considered the simplest and final step of the in vitro fertilization process. The objective of embryo transfer is to facilitate conception following fertilization from the in vitro fertilization procedure.

When does the embryo transfer procedure occur?

Embryos are generally transferred to the woman’s uterus at the 2-8 cell stage. Embryos may be transferred anytime between day 1 through day 6 after the retrieval of the egg, although it is usually between days 2-4. Some clinics are now allowing the embryo to reach blastocysts stage before transferring, which occurs around day 5.

WHAT IS EMBRY TRANSFER?

The last step in IVF treatment is embryo transfer. The embryo is obtained by combining the egg collected by OPU with sperm. Embrio transfer (ET) is the process of transferring the fertilized fetus (embryo) in the laboratory into the uterus with a catheter on the gynecological examination table. Selected embryos of the highest quality 1 – 2 embryos are left into the mother’s uterus and embryos are expected to hold into the uterus (endometrium) to form pregnancy. The day of the transfer is determined by evaluating many factors such as the age of the woman, treatment history, number and quality of embryos. Embryo transfer is usually done on the 2nd, 3rd or 5th day.

In our clinic, most of the fresh transfers (7575%) are planned 5 days after egg collection (5th day, blastocyst stage) and almost all of the freeze thaw applications are planned in blastocyst stage. Distinguished IVF centers and competent embryology laboratories make intensive 5-day transfer-weighted planning.

However, if there is no chance to choose; For example, because the patient’s ovarian reserve is low or very rarely the quality of the embryo is low, we have a plan to transfer 1 embryo to the patient, and if there are 1 beautiful embryo in hand, we transfer on the 3rd day.

Embryo transfer is the final stage in which all labor is finalized. It is very important to be done very kindly. In this context, the experience of the transfer physician is very important.

Your IVF treatment has ended and your embryo transfer has taken place. You have endured many difficulties during the treatment, you have experienced stress with your partner, but the result is worth it when your treatment is successful.

You have done your best so far to improve treatment success, and now we’re guessing what you can do to increase your chances of having a child (embryo attachment) after embryo transfer.

In vitro fertilization treatment was a treatment that resulted in the transfer of the embryo formed after the merger of the egg from the mother and the sperm taken from the mother in the past years to the mother after a day, and if this embryo was not transferred to the mother’s womb, unfortunately, it was necessary to return to the beginning of the treatment and collect eggs. Because while waiting for the pregnancy to take place, the other embryos formed were wasted and it was impossible to use them again.

Frozen embryo transfer emerged as a savior in cases where pregnancy did not occur and should be resumed. Thanks to this process, there is no need to collect and fertilize the eggs from the mother every time, and the embryos that were formed before can be transferred back to the womb.

However, in the past, the slow freezing technique used in embryo freezing procedures led to the survival of one quarter of the embryos, and disturbances could also occur in survivors. The recent vitrification, the rapid freezing process, helps you to overcome these problems easily because the embryos are now brought to the desired coldness much faster, thus allowing them to maintain their viability when thawed.

What is the procedure for embryo transfer?

The patient returns to the clinic to have the embryos transferred. Anesthesia is often not necessary, although a sedative may be used. An ultrasound may be used to help guide the physician as he transfers the embryos. A predetermined number of embryos are loaded into a fine transfer catheter that passes through the vagina and cervix, into the uterus.

The embryos are deposited from the catheter into the uterus. Following this procedure, the patient usually remains in a recovery room resting on her back and is discharged 4-6 hours after the procedure. The couple will then wait and optimistically watch for early pregnancy symptoms.

What medications may be given along with the procedure?

Progesterone is often the main medication that a woman will continue to take after the embryo transfer. Taking supplemental progesterone will not only help increase the chances of pregnancy, but progesterone is also vital to sustaining a pregnancy. Progesterone is often discontinued once a pregnancy has been confirmed and is producing adequate amounts of progesterone on its own.

What risks are there with embryo transfer?

There are minimal risks associated with the embryo transfer procedure.  They include the loss of the embryos during transfer or implanting the embryos in the wrong place such as the fallopian tubes. Although some women experience mild cramping, the procedure is usually painless.

How to Embryos Freeze?

In the rapid freezing technique, embryos consisting of fertilized eggs are placed in a special liquid mixture and then placed in plastic tubes. After this, the tubes placed in liquid nitrogen are dropped to temperatures of -196 and lower, allowing them to freeze immediately.

With this method, embryos that are found to be healthy can be kept for five years according to the laws of our country and the mothers do not have to undergo the same hormone treatments each time. When the five-year period expires, a new five-year period can be opened with a permit, and if the treatment is attempted again, the old embryos are destroyed.

How are embryos transferred?

When the frozen embryo is transferred, it is one of the questions our patients wonder. The stages of transfer of frozen embryos are briefly as follows:

The basic philosophy in the preparation of the patient for transfer is the preparation of the endometrium (inner lining of the uterus) and reaching a sufficient thickness. Natural cycle or estrogen-containing drugs may be preferred for this purpose. The success of these two methods is the same.

We follow follicle in the natural cycle and expect the endometrium to thicken in its own state. Transfer is usually done 2-3 days after ovulation. We monitor blood hormone levels (E2, LH and Progesterone) because it is decisive. We do not give any medicine until the day of transfer. After the embryos are transferred, we initiate supportive treatment with progesterone.

The prepared cycle is preferred if the woman’s menstrual period is not regular and her age is advanced. We monitor the endometrium with ultrasound until estrogen bands or pills reach a minimum of 7-8 mm. GnRH analogs can also be added to the drugs. We begin routine progesterone support after transfer.

How long can embryos be stored?

Frozen embryos can technically be stored for more than 20 years. However, due to legal and ethical reasons, there is a limitation to the storage period. While this period varies according to the laws of the countries, embryos frozen in our country can be stored for up to 5 years. At the end of the fifth year, the couple’s permission continues to be hidden or destroyed.

The couples demanding their embryos to be stored should apply to the center every year and apply with a petition saying “we want to extend the hiding period of our embryos for another year”.

POINTS TO BE CONSIDERED AFTER EMBRY TRANSFER

– Exercise and sports should be avoided.
– Do not engage in physically strenuous activities.
– Stress should be avoided.
– After the transfer, the expectant mother can continue her daily work. However, they should avoid activities that may be overly exhausting or physically impaired.
– You should not take a shower or bath for 1 day after the transfer, then it is free. Standing shower is recommended.
– Do not use medication without doctor’s advice and knowledge.
– There is no harm in air travel. You should not travel and rest only on the day of the transfer.

Should I go to bed for a period of time after embryo transfer?

The standard practice during the first years of IVF treatment was to provide long-term bed rest to the patients after embryo transfer in order to prevent the embryo from ‘falling’ before it could attach to the endometrium.

In some studies, it was examined whether the pregnancy rates obtained after short-term (1 hour or less) or long-term (24-hour) bed rest after embryo transfer were better than the pregnancy rates obtained as a result of the patient’s immediate recovery after transfer.

In one of the successful trials, they randomly selected some patients to their feet immediately after transfer, while others gave bed rest for 30 minutes; consequently, no significant difference was found between the pregnancy rates of the patients.

In another study, where the patients themselves decided what to do after the transfer (to stand up immediately or bed rest for 1 hour), no difference was found between the pregnancy rates.

Finally, in a retrospective study, it was not concluded that the pregnancy rate of IVF centers applying the policy of lifting the patients to their feet immediately after embryo transfer was compared with the pregnancy rates of IVF centers applying the bed rest for varying periods.

Therefore, based on the available evidence, it can be said that short-term bed rest does not increase pregnancy success rates and is not necessary.

In three other studies, short-term (20 min to 1 hour) bed rest after embryo transfer and long-term (one night to 24 hour) bed rest results were compared. None of these studies concluded that long-term bed rest was beneficial, and surprisingly, two of the studies reported a decrease in embryo adherence rates in women staying in bed for 24 hours. It was concluded that prolonged bed-keeping for a healthy woman is not a natural condition and increases the anxiety and stress of the patient and adversely affects the outcome of the treatment.

The fact that bed rest given after embryo transfer does not increase pregnancy rates makes sense. First, the endometrial cavity (uterine cavity) is not actually a cavity, but rather an area with potential for opening. As the result of the release of the embryo, the two opposing walls of the endometrium are momentarily separated, but then immediately reunite when the catheter used for transfer is removed. Therefore, it is unlikely that the embryo will fall from the cavity when the patient stands up. Secondly, when the air bubbles generated by the embryo transfer are observed on ultrasound, it is seen that gravity or standing up does not have a significant effect on the position of the embryo. Short-term bed rest can be removed because of no benefit. Long-term bed rest does not have a positive effect on pregnancy rates and should be abandoned as it reduces the rate of in vitro fertilization.

Can we have sexual intercourse after embryo transfer?

Women undergoing IVF care are concerned that having sexual intercourse after embryo transfer, especially having an orgasm, will prevent the embryo from adhering. Many women experience intense uterine contractions during orgasm, which, when measured, can significantly increase intrauterine pressure.

The results of two studies with patients who had and did not have sexual intercourse after the transfer showed that sexual activity had no negative effect on the success of IVF treatment. Interestingly, the more extensive of these studies identified a significant increase in embryo retention in women who had sexual intercourse within 2 days of embryo transfer. According to the authors of the study, some of the immunosuppressive factors passed on to the male’s semen prevent the immune response of the woman. Thus, the possibility of the female organism to reject the embryo is reduced.

It has been suggested that sexual intercourse after embryo transfer may pose two risks for in-vitro fertilization. First, a woman’s ovaries, which contain more than one corpus luteum and have been enlarged due to hyperstimulation syndrome (overexcitation), may be at risk of tearing during sexual intercourse, causing pain and even significant intra-abdominal bleeding. Therefore, sexual intercourse should be avoided in patients with hyperstimulation syndrome (overexcitation) in the ovaries during treatment.

Secondly, some cases of ‘priority pregnancy’ have been reported because of natural pregnancy as well as in vitro fertilization as a result of sexual intercourse during IVF treatment. However, natural pregnancy in these cases is more likely to have occurred as a result of sexual intercourse prior to egg collection, not after embryo transfer, because research following the day of ovulation and the day of intercourse has shown that the probability of conceiving one day after ovulation is reduced to zero. Since the day of embryo transfer usually occurs 2-5 days after ovulation, sexual intercourse after transfer does not create a risk of natural pregnancy.

In conclusion, when the evidence is available, couples can have sexual intercourse after embryo transfer except in cases where the woman experiences pelvic pain and discomfort due to overexcitation of the ovaries.

Can I exercise after embryo transfer?

Many patients worry that exercising at a fast pace after embryo transfer will prevent the embryo from adhering. Unfortunately, we have little information on whether it is safe to exercise after embryo transfer.

Fast-paced cardiovascular exercise for more than 4 hours per week increases the risk of failed implantation and miscarriage compared with no exercise or mild exercise less than 4 hours per week.

Exercise can prevent pregnancy from happening for several reasons. First, mechanical vibrations from fast-paced exercises, such as jogging and contact sports, can displace the embryo trying to hold onto it. Second, it is known that fast-paced exercises can increase average body temperature by up to 2 degrees. These increases in body temperature have been reported to cause miscarriages and deaths. Until more tangible evidence is obtained, the safest is to avoid intensive cardiovascular exercise after embryo transfer (after in vitro fertilization) and to perform light exercises such as walking for up to 30 minutes per day.

Should I get permission from my workplace after the embryo transfer?

Some of the in vitro fertilized patients use annual leave, hoping that some time after the embryo transfer will increase the chances of holding the embryo. Research has shown that reducing workload has no positive effect on IVF success.

Although the debate is ongoing, there is some evidence that an increase in patient anxiety and stress during treatment adversely affects IVF success. Women are often able to provide significant social support from their colleagues at work during stressful periods. Staying away from this support and worrying about the outcome of the treatment instead of sitting at home can do more harm than benefit. However, it may be appropriate to use a post-transfer permit if the work environment is very stressful or exposed to toxins (chemicals, radiation, etc.) that may be harmful to the reproductive health of the patient.

It is very common for a couple in vitro fertilization to be worried, especially during the treatment, and to find out what changes they can make to improve their chances of success. The most frequently asked questions were related to bed rest, sexual intercourse, physical activity and work life after the embryo transfer (after IVF).

The answers to these questions are absolutely crucial for patients who try not to do anything that could adversely affect the success of the treatment. Therefore, as ART Health Center, we believe that it is best to provide written and oral information to patients before the patient’s concerns appear on the subject, that is, at the beginning of the treatment.

What should you do after embryo transfer?

Short-term (less than 1 hour) bed rest after embryo transfer has no positive effect on pregnancy success rates.

Long-term bed rest (from one night to 24 hours) after embryo transfer does not increase pregnancy rates, and some studies even suggest that success is reduced.

Sexual intercourse after embryo transfer does not reduce pregnancy rates and there is some evidence that the embryo increases the chances of attachment.

It is unlikely that light exercise, such as walking for 30 minutes per day, will have a negative impact on the success of IVF treatment. On the other hand, there is some evidence that high cardiovascular exercise for more than 4 hours per week reduces the success of in vitro fertilization, increases the likelihood of miscarriage, and should therefore be avoided.

After embryo transfer, patients return to work life and normal daily life as long as there is not a very stressful environment and exposure to chemicals that may harm reproductive health has more positive results.