Embryo transfer and implantation

After the embryos are grown in the lab, and the best ones are selected, they are transferred into the uterus. The woman lies on a table and the embryos are put in the uterus through a thin catheter, similar to that used for intrauterine insemination. The doctor may use ultrasound to guide the catheter into the uterus. After the procedure, you will rest for about half an hour. After that, clinics give varying advice on how long to rest. Your doctor might advise you to get right back to your normal activities, or to rest for several days or longer.

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The number of embryos transferred is based on the medical and reproductive history of the patient, the quality of the embryos, and the quality of the uterine lining. The woman's age also is part of the decision, as well as how she feels about the risk of having twins or triplets and whether she is at higher risk for pregnancy complications, which are worse with multiple pregnancies. The more embryos transferred, the higher the risk of a multiple pregnancy. So, a woman who is 42 years old and has had three failed IVF cycles might get five embryos, while a 29-year-old on her first cycle might have only one or two transferred.

Most transfers are done on day three (day 0 is the day the eggs are retrieved). In some cases, the transfer does not happen until day five. This is more common with patients who are at high risk for having multiple pregnancies, which means doctors would prefer to transfer fewer embryos. It is also more common in patients who have a lot of good-looking embryos on day three and can wait a few days longer to see which are the best. Five-day-old embryos have had a longer time to develop, which means the embryologist may be able to better tell which ones are healthiest. However, most patients do not need to wait until day five. Embryos that are not transferred may be frozen to use in later cycles.

A week after fertilization, one or more embryos may implant into the lining of the uterus. Then the hormones of pregnancy are detectable in blood.

Two weeks after the egg retrieval, the woman will take a pregnancy test. If she is pregnant, the IVF doctor will continue to monitor the pregnancy with blood hormone tests and ultrasound. If all is going well, she'll be transferred to her obstetrician by the end of her first trimester.