Embryo transfers are optimally undertaken on day 5 of embryonic development (blastocyst) for at least two important reasons. Firstly, only embryos which have reached the blastocyst stage have implantation potential, therefore, embryo transfers which are convicted to a negative outcome are avoided. Besides enabling the correct choice (quality-wise) to be made by the embryologist, one or maximum of two embryos are selected for replacement in order to minimize the risks of high order pregnancies resulting.
On the morning of the embryo transfer procedure, the patient will be advised to arrive at the clinic with a full bladder at least 15 minutes before the designated replacement of her embryos. This minimal time is necessary for discussing with a specialist the results of the laboratory culture pertinent to the number and quality of her blastocysts. Advice is also given with regards to the optimal number which should be replaced.
The patient will have to wear special gowns prior to entering the embryo transfer suite’s sterile environment. All embryos which developed will be demonstrated on a monitor at the time and live images will be taken. These are kept in the clinic’s records for future reference. A copy can be given to the patient if requested. Surplus good quality embryos are cryopreserved for the patient’s subsequent utilization following informed consent.
The embryo transfer at Genesis is performed by initially accessing and cleaning aseptically the orifice of the cervix with sterile water followed by the insertion of the embryo transfer introducer which serves as a guide to the actual catheter the embryos are to be loaded. The exact position of the guide is confirmed amid abdominal ultrasound guidance. Once in position, the embryologist will load the embryo(s) onto a very thin and flexible embryo transfer catheter and within seconds this is threaded through the guide into the uterus. The surgeon will inject the embryos with a minimal volume of culture medium at a specific area of the endometrium (1 cm from the fundal end) while the patient can witness the procedure.
The successful replacement of the embryo(s) into the uterus is confirmed immediately thereafter by the embryologist who will flush the catheter several times into a sterile dish in the lab. Although extremely rare an embryo may get stuck within the catheter during the procedure. If this occurs it will be reloaded using a fresh catheter so it is replaced successfully. The patient is advised to rest for approximately 10 minutes following the embryo transfer before she is accompanied back into her recovery room. A final consultation then takes place with a specialist so the couple can address any queries which may have at the time while medication administration is revised and a pregnancy test date is assigned.
Following an embryo transfer, the recipient is asked to resume normal life and certainly not restrict herself in bed between that time and the day of her pregnancy test. Literally there is nothing one can do to influence the outcome of the IVF procedure other than taking the prescribed medication.
An initial positive pregnancy blood test will be assessed approximately 10-12 days post the embryo transfer procedure and a preliminary indication of how valid the pregnancy is can be determined at the time. A second blood test will be advised so to confirm on an ongoing pregnancy. Traces of the hormone hCG secreted by the embryo confirms on the occurrence of a pregnancy. The units of this hormone should double every 48 hours for an ongoing pregnancy to be confirmed. With the onset of pregnancy the clinic advises the administration of folic acid at a dosage of 5 mg although this compound can be taken before and during IVF. A date will be given to the couple for the first ultrasound scan which aims at assessing the order and validity of the pregnancy. Normally this is arranged at 6.5 weeks gestation and at the time a fetal heart pulse should be evident on the monitor. When unfortunately the pregnancy test proves negative the patient is advised to discontinue medication so a withdrawal bleed is allowed to occur. A new appointment is scheduled for the couple to meet with a specialist very soon thereafter.