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Embryo Transfer Procedure

What is embryo transfer?

It is a process by which grown embryos  (4 cells on day 2, 8 cells on day 3 or blastocyst on day 5) is placed in the uterus using a catheter.

How does embryo transfer work?

Usually embryos is transferred at day two, third or fifth day of fertilization.

This process is very important even though it is easy to do.

It requires technical expertise and using a long thin tube, or transfer catheter, it is usually done with the aid of ultrasound. This procedure does not require anesthesia and it is similar to IUI procedure.

The difference between them is the embryo transfer required assistance of ultrasound while IUI does not used ultrasound scan.

Embryo transfer procedure as below:

  1. Embryo transfer procedure starts by placing a speculum in the vagina to visualize the cervix and can be easily cleaned with cotton and media.
  2. An  ultrasound scan is needed to help the physician to place the catheter near the fundus and reduce trauma to the endometrium.
  3. The soft catheters used for embryo transfer and loaded with the embryos and subsequently handed over to the doctor after he verifying the identity of the patient’s uterus. The catheter is inserted through the cervical canal and advanced into the uterine cavity. With the help of ultrasound,  it can perform abdominal ultrasound to ensure correct placement, which is 1-2 cm from the uterine fundus. There is  evidence of a significant increase in clinical pregnancy using ultrasound guidance compared with only “clinical touch”
  4. Anesthesia is usually not required
  5. Embryo transfers require accuracy and precision in the placement of embryo in the uterine cavity. Optimal target for embryo placement, known as maximum implantation potential  (MIP) point, identified using 3D/4D ultrasound. After inserting the catheter, the media containing the embryo is removed and the embryos are deposited.
  6. Catheter withdrawals is done very slowly. Once the catheter is removed  then,  catheter is passed to the embryologist to do a survey under a microscope to assure that all embryos are placed in the uterus. The entire procedure takes 5 minutes.
  7. Embryo transfers performed approximately 2 days after egg collection.

After conducting embryo transfer, the woman should given  luteal support medication  either in the form of vaginal tablets or injections.

The following points should be noted:

  1. Have plenty of rest and avoid excessive physical activity.
  2. Make sure you use the supplied progesterone medication every day
  3. Drinking enough water
  4. Avoid taking medicines without consult to your doctor
  5. Sexual intercourse not advisable after embryo transfer

What are the risk of embryo transfer?  

  1. Risk of multiple pregnancies
     

    As in all other pregnant booster technique, increasing the risk of twins. When couples have IVF treatment, the possibility of a multiple pregnancy is 25% and a risk of premature birth and miscarriage. To avoid such things happen, most hospitals now restrict only two embryos each time transfer done.

  2. Risk in infants

    Possible infant health problems, disability or death is higher if babies are premature (pre -maturity).
     

  3. The risk of ectopic pregnancy

    Risk of birth outside the uterus (ectopic) in IVF treatment is approximately 5%. But this is not due to the treatment procedure, but for women who do IVF treatment often has to face the problem of defective uterine vessels, so exposing them to experience an ectopic pregnancy.
     

  4. Psychological tension

    This treatment requires high emotional commitment because it is the treatment which did not necessarily successful.  Hopes are high, but  the patient is more often found as a result of failure in each round of treatment . Furthermore, the treatment involves high costs and considerable time.

What are the chances of getting pregnant after embryo transfer?        

Generally, the chances of success is around 25% -35 %, however it -dependent fertility problems you are experiencing.

Based on the study, the chance of IVF success also vary by age:

  1. Under 35 years: 35 %
  2. 35 to 37 years: 25 %
  3. 38 to 40 years: 15-20 %
  4. More than 40 years: 6-10 %

Studies have also shown that patients who have low chances of IVF success is due to the following factors:

  1. Women aged distressed ovary failure. Age is the main factor determining the success of IVF.
  2. Male partner has a low sperm count
  3. The occurrence of genetic damage in the oocyte.and sperm
  4. Women with a damaged uterus, it is  difficult implantation of  embryo to the uterus and cause a low chance of pregnancy.

References

  1. Mains L, Van Voorhis BJ (April 2010). “Optimizing the technique of embryo transfer”. Fertil Steril 94(3): 785–90. doi:10.1016/j.fertnstert.2010.03.030. PMID 20409543.
  2. Dar, S.; Lazer, T.; Shah, P. S.; Librach, C. L. (2014). “Neonatal outcomes among singleton births after blastocyst versus cleavage stage embryo transfer: a systematic review and meta-analysis”. Human Reproduction Update 20 (3): 439–448.
  3. Mains L, Van Voorhis BJ (April 2010). “Optimizing the technique of embryo transfer”. Fertil Steril 94(3): 785–90.
  4. Farquhar, Cindy; Rishworth, Josephine R; Brown, Julie; Nelen, Willianne LDM; Marjoribanks, Jane; Brown, Julie (2013). “Assisted reproductive technology: an overview of Cochrane Reviews”.Cochrane Database Syst Rev 8: CD010537.
  5. Gurnee, IL. Advanced Fertility Center of Chicago. (847) 662-1818
  6. Helmerhorst FM, Perquin DA, Donker D, Keirse MJ. Perinatal outcome of singletons and twins after assisted conception: a systematic review of controlled studies. BMJ. 2004;328:261–26
  7. Bromer JG, Ata B, Seli M, Lockwood CJ, Seli E. Preterm deliveries that result from multiple pregnancies associated with assisted reproductive technologies in the USA: a cost analysis. Curr Opin Obstet Gynecol.2011;23(3):168–173
  8. Bromer JG, Ata B, Seli M, Lockwood CJ, Seli E. Preterm deliveries that result from multiple pregnancies associated with assisted reproductive technologies in the USA: a cost analysis. Curr Opin Obstet Gynecol.2011;23(3):168–173.
Last Reviewed : 15 January 2015
Writer / Translator : Sardiana bt. Sarmidi
Accreditor : Krishnan a/l Kanniah