The Final Steps of IVF Treatment- Embryo Transfer to Pregnancy Test
Patients undergoing In Vitro Fertilization (IVF) have numerous appointments, medications and procedures to navigate. Before a cycle begins, patients can feel intimidated about all the steps ahead of them.
At Shady Grove Fertility, want our patients to have all the information and support they need to make treatment as stress-free as possible. As part of that commitment, we have created a four-part series of articles in which we've described in detail how IVF is performed at our center.
This article, the third in the series, will help you learn what to expect in the last stages of an IVF cycle - from the embryo transfer to pregnancy testing and beyond. During this part of the cycle, your primary job is to rest and relax...let nature take its course. It sounds simple, but many patients will tell you that deciding how many embryos to transfer and waiting for the pregnancy test were actually the hardest parts of their cycles.
We hope this information helps you formulate questions for your doctor or nurse and think through the decisions you'll need to make during this phase in the cycle. Above all, we want to reassure you that you are not alone. Thousands of patients successfully complete IVF cycles each year - and your medical team at Shady Grove Fertility is here to support you every step of the way.
After ovarian stimulation, egg retrieval and embryo development in the lab, it's finally time for the embryo to be transferred back into the patient's uterus. The embryo transfer is a simple procedure that takes about 5 minutes to complete. There's no anesthesia or recovery time needed. This experience will be similar to the mock embryo transfer performed prior to starting the cycle. The ‘mock’ transfer provided a map of the uterine anatomy, the physician will use that road map to place the embryo in the correct location to help increase the odds of implantation.
When your transfer is scheduled, your nurse will notify you, and provide specific instructions on when to arrive and how to prepare. You need to have a full bladder for the procedure and will be asked to drink a specific amount of liquid 30-40 minutes ahead of time. If you have a long drive to the center, you'll be advised to wait until you get in the car to begin drinking. Having a full bladder can be uncomfortable while waiting for the procedure, so you don't want to start drinking too soon.
Prior to the start of your embryo transfer the chain of custody procedure resumes. When you arrive for an embryo transfer, our staff will review your photo identification and fit you with an ID bracelet containing your individual identifying medical records number, along with your name and date of birth.
The patient reviews her cycle with the physician and the appropriate number of embryos to be transferred is determined. After the decision of how many embryos to transfer is made, the physician, patient, embryologist and a witness sign the Embryo Disposition form, which instructs the Embryology Lab on what to do with any remaining embryos. The embryologist then asks the patient to verbally confirm their name, last 4 digits of their social security number, and the number of embryos to be transferred.
Inside the Laboratory, the embryo transfer Embryologist will have a second Embryologist verify all identifiers, such as patient name and MPI number, the unique identification number assigned to each patient by Shady Grove Fertility’s electronic medical records system, on the embryo culture dish to the corresponding egg datasheet. The transfer catheter is loaded with the appropriate number of embryos and upon entering the patient’s room, the Embryologist will state the patient’s last name and the number of embryos in the catheter.
Patients are able to watch the process on a monitor in the exam room that shows the work being done in the lab. This enables patients to see the embryos as they are selected.
The doctor will insert the catheter into the uterus and push the embryo through with a small puff of air. The procedure is guided visually on a monitor with an abdominal sonogram.
Once transferred, the doctor will slowly remove the catheter to eliminate or decrease any uterine contractions. Since the embryo is invisible to the naked eye, the embryologist will then check the catheter under a microscope to make sure the embryo was released. You will be asked to lie quietly for 5 minutes after the procedure. Then, you'll be given instructions for the following two weeks until it's time for the pregnancy test.
How Many to Transfer
The transfer procedure is simple, but sometimes, the decision about how many embryos to transfer is more complicated. The goal of this decision is to give you the best chance for pregnancy with the lowest chance for multiples - twins or triplets.
Some patients are unaware that multiple pregnancies are high risk and can lead to a number of complications both during the pregnancy and delivery. For the safety of the patient and baby, it is the goal of Shady Grove Fertility to encourage singleton pregnancies.
The morning of the transfer, the embryologist will make a final assessment of your embryos and provide a recommendation on the number to be transferred.
These recommendations are based on overall embryo quality and the age of the embryo, day 3 or day 5-7 blastocyst stage embryo. The doctor will use the information provided by the embryology department and other factors related to your case such as your age and experience with previous treatments to make this recommendation.
Ultimately, the decision about how many embryos to transfer is the patient's though Shady Grove Fertility will not transfer more embryos than are suggested by the American Society for Reproductive Medicine (ASRM) guidelines.
It Only Takes One
Elective Single Embryo Transfer (eSET) means that the patient has elected to have only one embryo transferred, usually a blastocyst stage embryo, even though she has more than one embryo available. Shady Grove Fertility is active in promoting eSET because it reduces the rates of high risk multiple pregnancies. Even better, Shady Grove Fertility’s data has shown that patients who choose eSET have the same chances of pregnancy as those who transfer 2 embryos, when the patient meets these criteria:
- The female partner is age 37 or younger
- It is her first cycle of IVF or she has had a previous successful cycle of IVF
- She has a good quality blastocyst
In these patients, there is no reduction in pregnancy success rates. However there is a large reduction in multiple pregnancies. It should be noted that it is possible to have twins even with eSET since an embryo can spontaneously divide in the uterus, which is the natural process that creates identical twins.
After the transfer, there are several things you can do to help the embryo have the best possible chance of implanting. The first is to continue medications that support the uterine lining and help to maintain a pregnancy. These are usually estrogen and progesterone through either pill, injection, or vaginal suppository. Patients will be recommended to continue their prescribed prenatal vitamins.
Additionally, you'll be asked to do 24 hours of "couch rest" after the embryo transfer - take the day off, put your feet up and rest as much as possible.
After the first 24 hours, patients should continue to take it easy for additional three or four days. You can go back to work and lead your normal life, but strenuous exercise, chores and even sexual relations and intercourse should be avoided. Anything that causes uterine contractions could affect the implantation process.
We also tell patients that it's best to avoid travel so that they'll be near their doctor should any complications, such as bleeding, arise. Also, many aspects of travel, such as time zone changes and carrying luggage, can stress a woman's body and mind. If you have to travel, check with your medical team about what kinds of precautions you can take.
The period of time between your transfer and the pregnancy test that determines if the cycle has resulted in a pregnancy is known as the two week wait. Many patients find it to be the hardest part of their cycle. Shady Grove Fertility offers many support options for patients in their waiting period including our online community of over 10,000 including Facebook and Twitter and support groups offered in many of our local offices. The most important part of this time is to stay positive and occupied to help pass the time.
Beta Pregnancy Test
Included in the instructions you receive at the embryo transfer will be the date for your pregnancy test, which will be around 18 days after your egg retrieval. Patients are encouraged to call their local office to schedule their pregnancy blood test. This blood pregnancy test is frequently called a “beta” because the test measures a beta chain portion of the human chorionic gonadotropin or hCG hormone emitted by the developing embryo and is officially named a "beta hCG" blood test.
As tempting as it is, fertility patients are advised not to use home pregnancy tests. Home pregnancy tests can render false results for fertility patients, either negative or positive. A false positive can result because hCG is given to “trigger” ovulation and may remain in the blood and a home pregnancy test cannot determine the difference between the two. A false negative might occur because a low level of hCG may be undetectable in a urine test despite a pregnancy starting.
When the Test is Positive
If your beta test is positive, your doctor or nurse will tell you the hCG level that your test showed. The beta test result is stated as a number that indicates the level of hCG found in the blood. This number will increase fairly rapidly in healthy pregnancies, so multiple beta tests will be ordered over the next several days to confirm the pregnancy is proceeding normally.
A blood hCG level over 100 is a good first result but many, many ongoing pregnancies start out with a beta hCG level below that number. You'll be asked to repeat the test in 2 to 3 days. The goal is to have the level of hCG double every 3 days. If it does, another beta will be ordered for 2 to 3 days later.
If all three betas indicate a healthy pregnancy, then a vaginal ultrasound will be scheduled between the 6 to 8 week mark of the pregnancy. At that time, your doctor will be looking for a heartbeat and a gestational sac to confirm the pregnancy.
Most patients will continue to take hormone medications throughout this 8-week period to support the developing pregnancy. At the end of 8 weeks, you will be released back to your regular ob/gyn to begin normal prenatal care.
If the Results are Negative
If you get a negative result on your pregnancy test, it's very disappointing. It's important to remember, though, that you have a treatment plan with options for trying again. Your medical team will support you in every way they can.
They will start by instructing you to stop your medications and schedule a consultation with your doctor. At that time, you'll discuss what happened during the cycle, how you want to proceed and any changes you might make to your protocol.
Some patients may start a new IVF cycle on their next menstrual cycle while others may have to wait a month or two longer. Patients should remember that not everyone is successful on their first cycle but that doesn’t mean that success in subsequent attempts is out of the question.
The Finish Line
While there are several phases to an IVF cycle with many details to consider, it's an exciting time filled with hope and possibility. Whether you are about to start an IVF cycle or you're just exploring fertility treatment in general, don't hesitate to ask all your questions and express your concerns.
You'll find that everyone at Shady Grove Fertility, whether they are assigned to your medical team or not, will give you unwavering support. We know it can be difficult when you're in the middle of the journey, but we have seen how amazing the results can be.
Next week the last part of our IVF Treatment Series answers the question on every patient’s mind “what are my chances of having a baby?” Join us to learn how to read Shady Grove Fertility's 2011 success rates.
Read our IVF Treatment Series:
Part One of the IVF Treatment Series- Cycle Start to Egg Retrieval
Part Two of the IVF Treatment Series- In the Embryology Lab
Part Three of the IVF Treatment Series- Final Steps of IVF Treatment
For more information or to schedule an appointment with one of our physicians, please speak with one of our friendly New Patient Liaisons by calling 888-761-1967.
Have more questions? Contact us today!