Embryo transfer (ET) is the procedure during which one or more selected embryos are non-surgically transferred to the uterus under ultrasound guidance. The procedure is relatively simple, usually painless, and lasts approximately 30 minutes, including preparation time. Embryo transfer is most commonly performed on the third or fifth day after egg collection (for Day 3 and Day 5 embryos, respectively). Depending on individual circumstances, ET can also be performed on the sixth day following egg collection, but this occurs much less frequently.
Prior to the procedure, the clinical team, in consultation with the patient, determines the number of embryos to be transferred to the uterus. At that time and if applicable, informed consent for extended culture and potential blastocyst cryopreservation is also obtained. Because the decision regarding the number of embryos to be transferred is critical, we strongly advise that both partners be present during the ET consultation. If the male partner is not available then the female partner must have a Power of Attorney (POA) in order to make decisions on his behalf. The male partner is also encouraged to be present during the actual ET procedure. To allow for the best ultrasound visualization of the uterus during an ET, the patient must have a full bladder.
At the beginning of the ET procedure the patient will be asked to identify herself on a number of occasions. The patient must also confirm that the female partner’s full name and the Sponsor’s last 4, which are written on the bottom of the embryo culture dish, are in fact her correct identifiers. The name is displayed on a television monitor linked to a camera attached to the microscope. Through the same monitor, the patient will be able to briefly view her embryos.
Once these identification procedures have been completed to everyone’s satisfaction, the actual transfer procedure will begin. When the physician has finished initial patient preparations, he/she will notify the laboratory that he/she is ready for the transfer catheter with the embryo(s). The embryologist will then load the catheter with the patient’s embryo(s) (visualized on the monitor) and bring the catheter into the ET Room from the IVF laboratory. The thin transfer catheter has an outer and an inner part. The outer catheter or outersheath is placed through the cervix in proper position within the uterus by the physician during the initial patient preparation; the embryos are within the inner catheter and this is attached to a syringe. The inner catheter will be passed through the outersheath and into the uterus. When the physician has determined that the inner catheter is in the optimum position, the plunger of the syringe at the end of the catheter will be depressed to expel the embryo(s). The inner catheter will be carefully removed and taken back to the IVF laboratory and examined by the embryologist to confirm that no embryos were retained. Once this procedure has been completed, the patient will be transported back to a private area to remain recumbent for approximately 10 minutes before being allowed to proceed with her day. The transfer physician will discuss post-transfer care with the patient. Most importantly, strenuous physical activity following ET is strongly discouraged.