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Infertility Podcast Series: Journey to the Crib: Chapter 21: Things You Should Know About Your Embryo Transfer

By David Kreiner MD

July 1st, 2013 at 9:43 pm

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Twenty-One: Things You Should Know About Your Embryo Transfer. You, the listener, are invited to ask questions and make comments.  Dr. Kreiner will answer himself. You can access the podcast here: http://podcast.longislandivf.com/?p=116

Things You Should Know About  Your Embryo Transfer

As many embryos as you transfer may implant.  There is also about a one per cent chance an embryo can spontaneously split resulting in identical twins.  For young patients with high quality embryos, the implantation rate is high enough that transfer of one embryo offers a 50% pregnancy rate or better and transfers of two a slightly higher pregnancy rate but a twin rate of 40%.  For this reason it is recommended that patients under 35 with a high quality embryo transfer one embryo to minimize their chance of having a higher risk multiple pregnancy.

At Long Island IVF, we offer the Single Embryo Transfer (SET) Program to minimize the cost implications of freezing the excess embryos by eliminating the fee to cryopreserve and store these embryos for up to a year.  We also offer for SET participating patients, three frozen embryo transfers for the price of one.

Embryos are typically transferred three to five days after retrieval. The longer duration allows the embryos to develop further giving embryologists an opportunity to judge better which embryos have the best pregnancy potential.  Otherwise, a day five transfer does not improve an embryo’s chance to implant.  Many embryos fail to develop further after the third day and therefore are not ideal for transfer on day five.  The embryologist will decide whether delaying transfer improves a woman’s pregnancy potential based on the number and grade of the embryos, the woman’s age, and her history.

The embryo transfer procedure, which we studied in the late 1990′s and presented at the ASRM in 2000 includes first passing a thin very pliable tube (trial catheter) through the cervix under ultrasound guidance.  Occasionally, a suture has been placed in the cervix during retrieval so as to not cause any uterine contractions at the time of transfer.  This suture can then be used to manipulate the cervix to straighten the cervical canal for easier atraumatic passage of the trial catheter.  The inner part of the trial catheter is removed leaving the trial open at its distal end.  The embryologist loads the embryo/s in the transfer catheter which is fed through the trial catheter noting on ultrasound when the transfer catheter has reached the center of the uterine cavity.  The embryo/s contained in a microdroplet are then gently expressed with visualization of an air bubble usually adjacent to the microdroplet noted on the ultrasound.  The catheter is then examined by the embryologist to insure that the embryo/s did not stick to the wall of the catheter.

If it does we repeat the procedure.

Results of our study of this transfer procedure, I called the two-step transfer method, showed shockingly higher implantation rates compared to transfers with different catheters, with a one-step approach, without ultrasound, and with a tenaculum at the time of transfer instead of the suture. 

In the 27+ years I am performing IVF, this advance in the embryo transfer stands out as one of the top three most significant advances in IVF along with the radical improvement in media preparation and the ultrasound-guided transvaginal follicular aspiration.

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