By Sara Salgado BSc, MSc (embryologist), Àlex García Faura MD, MSc (gynecologist), José Luis de Pablo BSc, MSc, PhD (senior clinical embryologist), Aitziber Domingo Bilbao BSc, MSc (embryologist) and Patricia Recuerda Tomás BSc, MSc (embryologist).
Last Update: 09/20/2018

Reproductive technologies in which egg fertilization takes place in the lab instead of inside the woman’s body require the embryos to be transferred back to her uterus. This is the last step of the process in both conventional IVF and ICSI procedures.

Once the fertilization step is completed, the resulting embryos are cultured. During this time frame, embryologists evaluate their quality in order to determine how many and which ones will be chosen and transferred back to the uterus of the intended mother.

Those with the highest quality will be the ones selected. Should there be spare embryos that are viable, they will be cryopreserved for later use using the vitrification technique.

The different sections of this article have been assembled into the following table of contents.

Definition & process

IVF embryo transfer is a simple technique whereby embryos are placed in the uterine fundus of the mother-to-be using a thin catheter, which is inserted vaginally and reaches the uterus through the cervix.

Generally, the specialist performs it guided by an ultrasound in order to place the embryos in the right site. In the past, gynecologists used to do it without the guidance of an ultrasound, but today it has been demonstrated that it helps achieve better results, simply because it allows to place the embryos in the uterine fundus more accurately.

Simply put, the embryo transfer procedure involves the following steps:

  • A sterile speculum is placed in the vagina
  • The vagina is cleaned with physiological saline solution
  • The cervix is cleaned with culture medium and cervical mucus is aspirated
  • The embryos are placed in the catheter
  • The catheter is inserted vaginally through the cervix till it reaches the uterus
  • The embryos are gently placed in the uterine fundus
  • The catheter is removed gently and slowly from the vagina

The process takes a few minutes and does not require anesthesia or sedation. Although the patient may feel little discomfort, it is a painless procedure.

Only if the transfer becomes complicated, that is, if inserting the catheter through the cervix becomes a challenging step, the transfer may be painful. If that were the case, your gynecologist would try with a different type of catheter until he or she can reach your uterine fundus easily. Sedation is used in extreme cases only.

After the embryo transfer, you can leave the clinic after a 20-30 minute rest at the clinic. You can continue with your normal life, avoiding excessive efforts, though.

Embryo transfer medications

When it comes to performing an embryo transfer, there exist two possible options:

Natural cycle
Without using artificial medication or just with progesterone supplements. IVF/ICSI cycles are rarely done without progesterone.
Stimulated cycle
Using hormonal medications. Estrogen and progesterone are used to prepare the endometrial lining.

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In case any of the clinics chosen offer promotions of special prices for our readers, your report will contain this information as well.

Tips for the embryo transfer day

The following are some recommendations for the day of the embryo transfer:

Come in with a full bladder
It eases the transfer process to a large extent. With an empty bladder, inserting the catheter may become more challenging due to the input angle that forms.
Just relax
If your muscles are tense, the process becomes easier. When patients are too nervous, a muscle relaxant may help.
Don’t use perfumes, lotions or nail polish
These chemical products should be avoided, especially at the operating room, transfer room, and the lab, since they are toxic for the eggs and embryos.

Contrary to common belief, fasting is unnecessary—an embryo transfer is not a surgical procedure.

In spite of all this, and as confirmed by Dr. Àlex García Faura, gynecologist specialized in Reproductive Medicine, the majority of patients live the embryo transfer day with anxiety. In fact, they feel tense and restless during the previous days as well, especially while the embryos are being cultured.

Finding out whether the resulting embryos will be viable and have good quality is an aspect that generates great distress amongst patients.

The good news is that today, thanks to state-of-the-art systems like EmbryoScope, patients can see the development of embryos on a day-by-day basis, thereby reducing their stress levels.

After the embryo transfer, experts recommend:

  • Rest at the clinic for 20-30 minutes
  • Avoid immersion baths to prevent infections
  • Continue with normal lifestyle avoiding excessive efforts
  • Drink plenty of water
  • Abstain from sexual intercourse until pregnancy test day

Visit your doctor in case of any doubt.

Get more info by clicking the following link: Post Embryo Transfer Tips & Precautions – What Should You Expect?

Embryo transfer day

Specialists determine the day of the embryo transfer on a case-by-case basis, taking into consideration aspects such as the amount of embryos available, their quality, endometrial receptivity, and the results obtained in previous cycles, if any.

It is crucial that the uterine lining is prepared, which is to say, that it is receptive. To this end, its growth and thickness are stimulated using a series of medications.

An embryo transfer can be performed at any stage of embryo development. While some clinics to it at zygote stage, others choose day 2 or morula stage. However, the most common practice amongst clinics is to do it on day 3 (early cleavage stage), or on day 5, that is, at blastocyst stage. Both stages have a series of pros and cons.

Check out this for information: Day 5 vs. Day 3 Embryo Transfer – What Are the Pros & Cons?

Based on whether the embryos are frozen or fresh, we can differentiate two types of embryo transfers:

Fresh embryo transfer
The resulting embryos are transferred in the same cycle, that is, without having been frozen previously.
Frozen embryo transfer
Embryos are cryopreserved (frozen) for being transferred in subsequent cycles. It is commonly referred to as FET.

A FET is used when the embryo(s) cannot be transferred in the same cycle when the eggs have been collected. For example, if the patient has developed OHSS (Ovarian Hyperstimulation Syndrome).

Transfer cancellation

An embryo transfer may be cancelled in case there are no embryos to transfer or if the embryo was unprepared for implantation.

These two situations may lead to the absence of embryos to transfer:

Fertilization failure
No oocyte is fertilized, and subsequently there are no embryos.
Embryonic arrest
Due to the presence of genetic abnormalities or alterations of embryo development. It is more common with blastocyst culture.

In these cases, an IVF cycle must be started anew in order to do an embryo transfer.

If the uterine lining is not ready to receive the embryos and allow them to attach, the embryos will be frozen and transferred in subsequent cycles, that is, a FET would be the type of transfer carried out.

Quality and origin of the embryos

We can use both good and poor quality embryos for the embryo transfer. Those of exceptional quality have an increased implantation potential, and therefore the pregnancy chances will be higher. These are four embryo grading systems as established by the ASRM (American Society for Reproductive Medicine):

Grade I
top quality embryos
Grade II
Good quality embryos
Grade III
Fair quality embryos
Grade IV
Poor quality embryos. Likelihood of implantation is very low.

Recommended reading: Embryo Quality & Grading.

In case they are donated embryos or have been created using donor gametes, they will be grade I in most of the cases, which translates into high chances of success.

How many embryos to transfer

Most fertility clinics recommend single or two embryo transfers in order to reduce the probability of multiple pregnancy. In any case, however, determining the amount of embryos to transfer is not easy, since it depends on several factors, among which we highlight the following:

  • Age of the patient
  • Embryo quality
  • Characteristics of the uterus
  • What is causing infertility
  • Embryo cryopreservation methods effectiveness

There is an increasing number of specialists that recommend single embryo transfers in order to reduce the chances of getting pregnant with twins or more. It should be reminded that this type of pregnancy carries a number of risks for both the mother and the babies.

Many countries have established limits regarding how many embryos to transfer. In Spain, the law limits this amount to a maximum of 3 embryos, even though experts tend to recommend single embryo transfers. By doing this, we can reduce the chances of getting pregnant with multiples, which involves a greater number of risks.

Read this next: How Many Embryos Should You Transfer for IVF?

What is the fate of unused embryos?

Only the embryos considered optimal under the embryologist’s criteria are used for the transfer. However, there may be top quality embryos that are not used, in which case they will be cryopreserved (frozen) indefinitely. Thanks to this, they can be used in subsequent cycles.

If pregnancy occurs and the woman wants to have more children in the future, these cryopreserved embryos can be used for a new IVF cycle. The main advantage is that she would not have to start a complete IVF cycle again, but just take the medications that are necessary to prepare the endometrium for a new transfer.

There are cases where the patient or couple do not wish to have more children. The spare embryos can be donated to other couples or for stem cell research as long as they agree to sign an informed consent.

In some countries like Spain, embryos cannot be destroyed until the woman’s reproductive years have come to their end, that is, at age 50 approximately. In other words, if she does not want to use them or donate them, she will have to keep them stored in liquid nitrogen.

Click here to read more: What Is the Fate of Unused IVF Embryos?

What is the cost of a FET?

A FET is the option of choice when a patient needs to do a second attempt after a failed cycle, or when she wishes to have a second child using the spare embryos from previous cycles.

The cost of a Frozen Embryo Transfer in the United States averages anywhere from $3,000 to $5,000 per cycle. In the UK, on the other hand, the common fee is £1,400.

Some clinics offer shared risk 100% refund programs for FET, which allow patients to pay a flat fee for unlimited FET cycles for as many frozen embryos as that patient may have available. This does not include the fees for medication, which usually range between $400 and $800.

After embryo transfer

After the embryo transfer, having menstrual pains is unusual, embryologist Aitziber Domingo Bilbao states. However, they can have a brownish or pinkish spotting that is due to the passage of the catheter through the vagina.

According to Aitziber Domingo, it is more common for patients to have premenstrual symptoms. Indeed, they can be due to two causes: because their period is about to show up, or because actually they are pregnant and they are actually early pregnancy symptoms, like swollen breasts, abundant vaginal discharge, etc.

She recommends that you continue with your normal lifestyle, but avoiding major efforts such as attending dance classes, for example. Not because it can affect embryo implantation, but actually for the psychological impact these activities can have on the patient, especially if they get a negative result.

FAQs from users

Embryo transfer on day 3 or on day 5, which is better?

By Patricia Recuerda Tomás BSc, MSc (embryologist).

Existing evidence shows that culturing embryos till stage 5-6 of development, we can increase the pregnancy success rates per fresh and frozen embryo transfer. This is due to the fact that the embryos to transfer or cryopreserve can be selected more properly, since blastocysts have a higher implantation potential. It also improves embryo-endometrial synchrony.

One should keep in mind that about 50 percent of viable embryos will arrest on day 3 of development. In other words, they will not make it to blastocyst stage.

I have a history of recurrent miscarriage, when should the embryo transfer be done in my case?

By José Luis de Pablo BSc, MSc, PhD (senior clinical embryologist).

The fact that a woman has had repeated miscarriages in the past has nothing to do with the day of the embryo transfer. In most of the cases, it is associated with the chromosomes of the embryos. Keeping this in mind, ideally the best treatment option in these cases would be IVF with PGD (Preimplantation Genetic Diagnosis). With PGD, we examine 6-8 cells of each embryo. It allows us to find out which embryos are genetically norma and which don’t.

Can the success rate of IVF be increased with a 3-embryo transfer?

By Sara Salgado BSc, MSc (embryologist).

The greater the number of embryos transferred, the higher the chances for at least one of them to implant, thereby achieving the ultimate goal of IVF: a pregnancy. Nevertheless, by doing it, the likelihood of getting pregnant with twins increases too, which would entail a higher number of risks than a singleton pregnancy.

To sum up, except under special circumstances, specialists do bet on elective single embryo transfers (eSET), which consists in selecting the embryo with the best quality for the chances of implantation to be increases without the need for a multiple embryo transfer.

What are the day-by-day symptoms after an embryo transfer?

By Sara Salgado BSc, MSc (embryologist).

As explained earlier, IVF embryo transfer is a simple procedure which presents no severe symptoms or side effects at all. Once the embryos have been placed into the uterus and the woman has rested for a few minutes right after that, she can continue with her normal lifestyle.

Strong pain or severe adverse reactions are uncommon. However, there are cases in which women may develop a mild discomfort or slight bleeding as a consequence of cervical manipulation at the time of embryo transfer.

On the other hand, there are no ET failure symptoms. While some women may experience nausea, bloating or even spotting/bleeding due to hormone medications or embryo implantation, these side effects can be noticed as well without it indicating success or failure.

How can I prepare for my IVF transfer day? What are the best tips to turn it into a success story?

By Sara Salgado BSc, MSc (embryologist).

The best tip for achieving success after an ET is being relaxed at the very moment when the procedure is to be performed.

Besides, having a full bladder is strongly advisable, as it is a way for the doctor to observe your uterus through ultrasound in a better way. It allows for the doctor to place the embryo in the adequate location, without scratching the lining of the womb.

On the other hand, there are no “implantation foods” to boost your chances of becoming pregnant. If so, your clinic would prescribe them to you.

In fact, fixating on specific foods may cause more harm than good. Experts do recommend to follow a balanced diet from at least 3 months before your treatment starts. Avoiding processed foods, limiting your sugar, eating good carbohydrates, etc. could be beneficial.

Is there any after-care plan to follow after embryo transfer?

By Sara Salgado BSc, MSc (embryologist).

Firstly, it should be clear the total bed rest after an ET is unnecessary and can be counterproductive. It has been proved that bed resting for recovery does not increase the pregnancy rates.

In fact, being totally sedentary may be a disadvantage, as inactivity and high levels of estrogens can promote blood clotting and a rise in insulin resistance.

Doing exercise and leading a normal lifestyle is beneficial, as it can help reduce inflammation and cramping by promoting healthy blood flow and lowering the levels of stress.

When should I take a pregnancy test after a donor-egg embryo transfer?

By Rebeca Reus BSc, MSc (embryologist).

Like in any other IVF procedure, after an embryo transfer with donated eggs, women have to go through the two-week wait or 2WW, a time period necessary for beta-hCG levels to be detectable by a pregnancy test.

The presence of the hormone hCG in blood increases gradually from embryo implantation up until the end of the third trimester approximately. This, along with other hormonal changes, is the reason why the common pregnancy symptoms appear (nausea, vomiting, etc.)

When will I be able to find out whether the result of my embryo transfer is positive?

By Sara Salgado BSc, MSc (embryologist).

In general, women should wait for between 10 to 15 days after the embryo transfer to take a pregnancy test. From that moment on, we can confirm whether embryo implantation has been successful, that is, if the woman is pregnant or not.

What is an embryo transfer from one woman to another?

By Sara Salgado BSc, MSc (embryologist).

It refers to embryo donation and adoption, a technique which involves donating your unused embryos after an IVF cycle to another woman.

Suggested for you

There exists other type of embryo transfer known as Intratubal Embryo Transfer (IVF/IT-ET) or Zygote Intrafallopian Transfer (ZIFT), in which the fertilized eggs (zygotes) are placed in the Fallopian tube. Find more information about this option here: What Is Zygote Intrafallopian Transfer (ZIFT)?

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References

Bolton, V.N., Wren, M.E. and Parsons, J.H. (1991) Pregnancies after in vitro fertilization and transfer of human blastocysts. Fertil. Steril., 55, 830–832.

Bruno I, Pérez F, Tur R, Ricciarelli E, De la Fuente A, Monzó A. et al. (2005). Grupo de interés en Salud Embrionaria. Sociedad Española de Fertilidad. Embarazos múltiples derivado de FIV-ICSI en España: Incidencia y criterios sobre la transferencia embrionaria. Rev. Iberoam. Fertil.; 22 (2): 99-110.

Forman EJ, Hong KH, Ferry KM, Tao X, Taylor D, Levy B, et al. (2013). In vitro fertilization with single euploid blastocyst transfer: a randomized controlled trial. Fertil Steril;100:100–7.e1.

Huisman, G.J., Alberda, A.T., Leerentveld, R.A. et al. (1994) A comparison of in vitro fertilization results after embryo transfer after 2, 3 and 4 days of embryo culture. Fertil. Steril., 61, 970–971.

Ley 14/2006, de 26 de mayo, sobre técnicas de reproducción humana asistida. Jefatura del Estado «BOE» núm. 126, de 27 de mayo de 2006 Referencia: BOE-A-2006-9292

Montag M, Toth B, Strowitzki T. (2013). New approaches to embryo selection. Reprod Biomed Online;27:539–46.

Pope CS, Cook EK, Arny M, Novak A, Grow DR. (2004). Influence of embryo transfer depth on in vitro fertilization and embryo transfer outcomes. Fertil. Steril.;81:51–8.

Sallam HN, Sadek SS (2003). Ultrasound-guided embryo transfer: a meta-analysis of randomized controlled trials. Fertil. Steril.;80:1042–6.

Tomás C, Tikkinen K, Tuomivaara L, Tapanainen JS, Martikainen H. (2002). The degree of difficulty of embryo transfer is an independent factor for predicting pregnancy. Hum Reprod; 17:2632–5.

William B. Schoolcraft, M.D., for the ASRM American Society for Reproductive Medicine (April 2016). Importance of embryo transfer technique in maximizing assisted reproductive outcomes. Vol. 105, No. 4. Colorado Center for Reproductive Medicine, Lone Tree, Colorado

Reproducción Asistida ORG. Video: ¿Cómo viven los pacientes el momento de la transferencia embrionaria? (How do patients live the embryo transfer moment?), by Dr. Àlex García Faura, Feb 29, 2016. [See original video in Spanish]

Reproducción Asistida ORG. Video: Transferencia de embriones (Embryo transfer), by Aitziber Domingo Bilbao, BSc, MSc, Nov 22, 2017. [See original video in Spanish].

Rodríguez L, Pons I, Grande C, Ruesta C, Fernández-Shaw S (2007). Resultados del programa de transferencias electivas de un embrión en URH García del Real. Rev Iberoam Fertil; 24 (1): 11-16.

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Authors and contributors

 Sara Salgado
BSc, MSc
Embryologist
Degree in Biochemistry and Molecular Biology from the University of the Basque Country (UPV/EHU). Master's Degree in Human Assisted Reproduction from the Complutense University of Madrid (UCM). Certificate of University Expert in Genetic Diagnosis Techniques from the University of Valencia (UV). More information
 Àlex García Faura
MD, MSc
Gynecologist
Bachelor's Degree in Medicine and Surgery from the University of Barcelona (UB), with specialization in Gynecology and Obstetrics. Master's Degree in Breast Pathology-Senology from the UB. Several years of experience in the field, and comprehensive training in multiple fields of the branch of Medicine that have led him to become an expert in the treatment of gynecological and obstetric diseases. More information
License: 080835235
 José Luis de Pablo
BSc, MSc, PhD
Senior Clinical Embryologist
Double Degree in Biology and Biochemistry from the University of Navarra. Master’s Degree about the Theoretical Basis and Laboratory Procedures in Assisted Reproduction from the University of Valencia (UV). Senior Clinical Embryologist from the ESHRE and ASEBIR Certification in Clinical Embryology. More than 15 years of experience as the director of IVF labs. More information
 Aitziber Domingo Bilbao
BSc, MSc
Embryologist
Bachelor's Degree in Biology from the University of the Basque Country. Master's Degree in Human Assisted Reproduction from the Complutense University of Madrid, and Master's Degree in Biomedical Research from the University of the Basque Country. Wide experience as an Embryologist specialized in Assisted Procreation. More information
 Patricia Recuerda Tomás
BSc, MSc
Embryologist
Bachelor's Degree in Biology from the University of Alcalá de Henares. Master’s Degree about the Theoretical Basis and Laboratory Procedures in Assisted Reproduction from the University of Valencia (UV). Extensive experience working at several Assisted Reproduction laboratories. More information
License: 19882M

6 comments

  1. Featured
    mary g.

    Hello Sandra,

    I had my embryo transfer done 5 days ago, how early can I test for pregnancy? I’m so nervous I think I can’t go through this 2WW!!

    Keep up the good work! Thanks

    • Sandra FernándezBA, MA

      Hello mary g,

      Generally, you should test for pregnancy no earlier than day 15 post embryo transfer. However, if it was a blastocyst transfer, you can take the test on day 10 and you’ll get an accurate result.

      Best wishes

  2. Featured
    Fereshteh

    Hi,

    This the eighth day of my transfer (using frozen eggs, my second IVF). I had two morula frozen eggs transferred, but I have no specific feelings, no bleeding, no nausea, nothing. I feel under lots of stress. Can you guide me? When can I use baby check? Is it possible to be pregnant with no symptoms?

    • Sandra FernándezBA, MA

      Dear Fereshteh,

      Feeling symptoms after the embryo transfer (ET) is not an essential requirement to make sure IVF has been successful. Feeling any symptom or not depends on each woman and her own body, which means that feeling no bleeding, nausea, or whatever does not necessarily translate into IVF failure.

      The most important now is that you let stress go: anxiety and stress won’t help you throughout this process, neither in a positive nor negative way. This is a good moment to entertain yourself with the things you like or take up a new activity, such as practicing a new sport in case you didn’t use to practice some before.

      Since it was a 4-day embryo transfer (morula transfer), you can take a pregnancy test from day 11 post embryo transfer onwards and not earlier. This way you may get an accurate result. My advice is that you take a blood pregnancy test rather than a home pregnancy test, although by this time both may be accurate enough.

      Hope this helps,

      Regards

  3. Featured
    Lubna

    Hi,

    I will be 44 years old this year. I have two children and one of them is autistic. I had them both by C-section. Now, I would like to get pregnant with twins and I want them to be both girls. Is this possible at my age? I want them both to be healthy.

    Regards,

    Lubna

    • Sandra FernándezBA, MA

      Hello Lubna,

      The truth is, 44 is a complicated age to get pregnant. As you may know, the ovarian reserve keeps on diminishing over time, and by age 44 women not only have fewer changes of getting pregnant, but also the eggs they are able to produce present a poorer quality, which means they are more likely to develop some genetic disease or abnormality.

      Anyhow, you can try to achieve a natural pregnancy but if it doesn’t occur within 6 months, my advice is that you go have your fertility checked and consider egg donation or IVF, as well as PGS/PGD to select only the healthiest embryos.

      Best regards