For patients undergoing cryopreserved embryo transfer we can create an artificial cycle. This involves treatment with Lupron, estrogen, and progesterone. This treatment is well established. If you have been pregnant since your initial freezing of the embryos, a repeat trial transfer or uterine measurement will need to be done. In addition, blood work, physical examination, Pap smear, cervical culture, and hysterosalpingogram must be updated or have been performed within one year of he procedure.
The frozen embryo transfer involves four steps:
- Hormonal therapy including Lupron, estrogen patches (in some cases pill or injection), and progesterone (injection or vaginally)
- Embryo transfer will be scheduled when hormonal tests confirm that the uterus is ready to receive the embryos. This occurs approximately 18 days after estrogen patches are started. Progesterone supplementation will be continued.
- A pregnancy test is performed 10 days after embryo transfer.
- Follow-up consultation
It takes two menstrual cycles to prepare the uterus for embryo transfer. Oral contraceptives may or may not be used. Daily subcutaneous injections of Lupron will be taken to prevent ovulation during the cycle in which you will receive your embryos. Next, estrogen patches will be used to thicken the lining of the uterus. You will have been on estrogen patches approximately 18 days at the time of embryo transfer. Blood work and ultrasound will be done to confirm that the uterus is ready for you to receive your embryos. Progesterone will be started approximately three to four days before the embryo transfer. Estrogen patches and progesterone will be continued until pregnancy status is known. The IVF team will provide you with a detailed calendar as well as instructions.
Embryo transfer is usually performed on the fourth day of progesterone therapy. Two to four embryos will be transferred during each frozen embryo transfer cycle. However, this number is variable and your physician will discuss this issue with you.
The actual procedure is identical to the transfer of embryos following in vitro fertilization-embryo transfer with fresh embryos. A small plastic catheter is passed gently through the cervix into the uterus. The embryos are deposited into the cavity along with a small amount of fluid. You will be discharged after resting for two hours. No anesthesia is required. However, we do give you an oral dose of Valium, which will be taken approximately one hour before the transfer procedure.
Hormonal Studies/Pregnancy Test
We will perform a serum pregnancy test 10-12 days after the embryo transfer. We also measure serum progesterone. We will be repeating the pregnancy test every two to four days. If the test is negative, progesterone will be discontinued and a period usually starts within a few days.
If the pregnancy test is positive, we will perform a vaginal sonogram approximately three weeks later. At this point, we are usually able to identify the number of embryos and can often see a heart beat. If the procedure is unsuccessful, you should schedule a post IVF consultation with your physician to discuss further treatment options.