On either the third or fifth day after your retrieval, you will be instructed to come back into the office for your embryo transfer. Which day your transfer is depends on a number of factors that your doctor and embryologist will look at along with your medical history to determine which day is better for you.
On day five after your retrieval, your embryos should have progressed to the blastocyst stage. If your embryos are able to reach that point for transfer, it's generally better because that is the stage that embryos are in when they reach the uterus after fertilizing “the natural” way in the body. This is not always possible, however, depending on how the embryos have developed and your center's policies. Some clinics perform a majority of their transfers on day three; others will be more aggressive in extending embryos toward day five. Whichever day your transfer is, the procedure will be the same.
What to Expect
The procedure is very simple and is similar to having an insemination or pap smear. It's not painful and won't take very long at all. Many clinics will prescribe Valium for you to take approximately thirty minutes before your scheduled embryo transfer. Yes, it will help your anxiety, but this isn't the reason why you're taking it. The Valium is also a smooth muscle relaxant, which means it will help the muscles in your uterus avoid contracting when the catheter is placed through the cervix.
Once you have changed into a gown and have been prepped by a nurse, your doctor will come in and discuss the quality and number of your embryos with you. Quite likely, he'll make recommendations about how many and which embryos to transfer. He will notify the laboratory staff, who will also double check your identity and the number of embryos that are being transferred.
Once the embryos are ready to be transferred, you will be asked to lie back on the exam table and put your legs in the stirrups. A speculum will be inserted into your vagina and the doctor will clean your cervix. While all of this is happening, a sonographer will be looking at your uterus using an abdominal ultrasound. A special catheter will be placed through the cervix and into the uterus. It will then be advanced to the measurement that was taken when you had the special water sonogram before starting your IVF cycle.
The doctor will check the ultrasound to make sure that the catheter is in the correct place, then slowly load the embryos through the catheter and into your uterus. After it is removed, the catheter will be examined under the microscope to ensure that none of your embryos are left in it. Once the all clear is given, the speculum will be removed. You will likely be asked to remain in this position (though covered up) for a short period of time, usually around thirty minutes, and then allowed to head home.
An embryo transfer
After Your Embryo Transfer
Most doctors will ask that you remain on bed rest for one to three days after your transfer to keep your uterus as relaxed and calm as possible. This is thought to facilitate implantation of the embryos into the uterine wall. After your period of bed rest is over, you may be asked to modify your activity and rest as much as possible until your pregnancy test. You should be given detailed instructions about what to avoid and what medications to take after your transfer. You will continue taking the progesterone and estrogen supplements until you know the results of your pregnancy test, but the doctor may need to alter your regimen depending on your hormone levels.
You may feel fluid dripping out after the transfer, but this is just the fluid that was used to clean your cervix. Your embryos will not fall out once you stand up or go to the bathroom. They are safe and sound in your uterus and no amount of activity, even straining to go to the bathroom, can push them out.
Finally, you will be given a date to come back for your pregnancy test. You may be tempted to cheat and take a home pregnancy test earlier then your scheduled date, but don't forget that the hCG you took to prepare you for your egg retrieval is the same hCG that is detected by urine pregnancy tests. You will get a false positive if you test too early!