Frozen Embryo Transfer (FET)
Depending upon your history, a few studies may need to be updated including lab studies, cervical cultures, a pap smear and hysteroscopy. Once the workup is complete, you will be started on an oral medication called Estrace (estradiol).
Estrace will develop your uterine lining and prepare it for implantation. Once you have been on the Estrace for about one week, we will confirm that your uterine lining is ready and we will instruct you to start your progesterone medication. Your embryo transfer will be 5 days after the start of your progesterone. After your embryo transfer, you will remain on your Estrace and progesterone and follow up with the office for a hormone study to confirm no change needs to be made to your medication regimen. Your pregnancy test will be approximately 10 days after your embryo transfer.
Our dedicated and knowledgeable IVF team will guide you through the entire ART/IVF process to ensure that you have the best possible experience. To find out more information on proceeding with an FET cycle, please contact our IVF team to discuss any questions you may have.
You will be asked to lie on your back with your feet placed as for a pelvic exam. A device called a speculum is inserted into the vagina to allow visualization of the cervix. The vagina and cervix is then cleaned with sterile water.
First, a practice embryo transfer is performed, to ensure placement visualization and nothing is impeding entrance into the uterus. This is done by placing a transabdominal transducer on the lower abdomen and pelvic area to visualize the uterus. Once in view, an empty catheter is passed through the cervix and into the uterus. After Dr. Russell is satisfied with the visualization and placement, the catheter is removed.
Next, an embryologist will provide Dr. Russell with a catheter containing your embryo(s). The embryo transfer procedure is repeated as during the practice transfer. 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.
Following the embryo transfer, you will be asked to lie still for 5 minutes. Finally, you’ll be given instructions for the next 2 weeks until it’s time for the pregnancy test.
The 2-week wait is the period of time between the end of your fertility treatment cycle and beta hCG blood test—the test that determines whether or not you’re pregnant. It takes about 2 weeks from the time a fertilized egg implants in the uterine wall to start emitting enough of the hormone hCG (human chorionic gonadotropin) to be detected by a blood test. We sometimes call the test a “beta” because the test actually measures a beta chain portion of the hCG hormone molecule and is officially named a beta HCG test..
We recommend that you refrain from performing a home pregnancy test as they can render false results, either a false negative or false positive. A false positive result may be due to the fact that in many of our treatments, hCG, the same hormone that measures pregnancy, is given to “trigger” ovulation in many of our patients. Traces of the administered hCG can still be in your bloodstream and detectable by a test, even if implantation has not occurred.
A false negative might occur as a low level of hCG may be undetectable in a urine test despite a pregnancy starting, as home pregnancy tests are less sensitive than the blood hormone tests we use.
On average, about 2 weeks following your embryo transfer you will come back to our office for your pregnancy test. This test is done by blood draw and measures the hCG levels produced by the developing embryo. The most reliable pregnancy test is the blood test we perform in our offices.
During this time, you may feel as if you are about to start your period. Your body has been through a lot and the medications you’re taking are designed to promote the optimal environment for pregnancy. You may experience some cramping, spotting or light bleeding, abdominal bloating, fatigue, and breast tenderness. While you may be slightly alarmed to experience some of these symptoms, they are normal and do not signify that you are or are not pregnant.
Yes. Most patients need to continue to take progesterone supplements in order to produce the same levels of hormones that would occur in early stages of pregnancy.
While most patients will supplement their progesterone via pill or vaginal insert, patients who are using donor egg or frozen embryos will use the injectable form of progesterone for their cycles.
Additionally, patients who undergo in vitro fertilization (IVF), donor egg, or frozen embryo transfers may also be prescribed estrogen supplements to help thicken and maintain the uterine lining.
Please do not stop taking these medications until you have been advised by your medical team to do so.
We tell all of our patients to be cautious during their first 5 days after their treatment. We recommend that you refrain from strenuous physical activities as well as sexual activities during that time as they may cause uterine contractions that might impair the implantation process. There is also a greater risk during that time of ovarian issues arising since, for many patients, the ovaries are still slightly enlarged at that point.
After those first few days, you can to start light aerobic activities such as yoga, swimming, moderate walking, and lightweight training on a stairmaster or elliptical trainer. Activities that can get your heart rate up, but are not demanding, are suggested rather than high-impact activities such as jogging or aerobics.
No special diet is required, but we recommend that you start making nutritional choices as if you’re already pregnant. This means eating well-balanced meals, no sushi or other raw or undercooked meats, avoiding high-mercury fish and soft cheeses, no alcohol, and continuing to take a preconception supplement.
We prefer that patients avoid traveling for the first few days post-treatment, primarily so that you are close to our center for examination should any problems develop. This also is true during and following the time of your pregnancy testing and ultrasound. Early pregnancy complications such as hyperstimulation, bleeding, or pain can occur and we would want you near your team for care. In addition, the rigors of travel, time zone changes, luggage, etc. leave you vulnerable to complications. Before you schedule travel during this period of time, check with your nurse and team to see what is advised.
Any positive level of beta hCG above 5 mIu/ml indicates a pregnancy has started (unless the test is done too early following an HCG trigger injection). A blood hCG number over 100 is a good first beta result but many, many ongoing pregnancies start out with a beta hCG level below that number.
Higher numbers cannot predict a multiple pregnancy, only the ultrasound can determine that.
Additional beta tests will be performed every 48 hours after the first positive test to confirm the hCG level continues to rise. We look for the level of hCG to rise about 60 percent or more in each of the additional tests. If the number continues to increase, we’re more confident that it’s likely a viable pregnancy.
We will then have you come in for ultrasounds usually between 6 and 7 weeks to determine if the embryo continues to develop into a fetus. At about 13+ weeks, we will refer you back to your OB/GYN to continue your prenatal care.
If it turns out that you are not pregnant, your nurse will advise you to stop your medications. You will have the opportunity to talk with your physician to review the past cycle and make a decision together about your next steps.
For many years, embryos were transferred back into the uterus three days after the egg retrieval procedure. At this stage, the embryos are usually between 6-8 cells. With new advancements in the embryo culturing techniques, we are now able to grow the embryos for 5 to 6 days. This embryo is called a blastocyst. There are many benefits to transferring embryos at this stage of development. A Day 5 embryo has a longer time in culture and any embryo that may have abnormalities or genetic defects may stop developing naturally on their own during this period. Thus, this self selection culture process allows the “healthier embryos” more time in culture to make the selection process of which embryo to be transferred back to the uterus a lot easier because one or two of the embryos may have grown a little faster than its sibling embryos, allowing it to be chosen for embryo transfer. This accounts for a high rate of pregnancy performing embryo transfer on Day 5 versus Day 3. Additionally, Day 5 embryos have a high rate of being successfully frozen and transferred during a Frozen Embryo Transfer Cycle.
Preimplantation Genetic Testing (PGT) helps identify embryos that have recognizable chromosomal abnormalities and an embryos gender, prior to transfer to the uterus. Embryos that were previously cryopreserved can now be thawed, biopsied and refrozen for genetic testing.