Embryo transfer day: what happens, and what makes no difference

Many patients arrive for the transfer with a list of tips gleaned from online forums: don’t move, don’t sneeze, eat pineapple, keep your feet warm. I understand the need to do something. But it’s better to know what really matters — and leave the rest aside.

Before the transfer

In the morning, the laboratory will tell you how the embryos have developed and which one will be transferred. For a fresh transfer, this takes place on day 3 or, more commonly, on day 5 after egg retrieval; for a frozen embryo transfer, on a date calculated based on the preparation of the endometrium and progesterone.

You will generally be asked to arrive with a moderately full bladder: this positions the uterus upright and improves the ultrasound view. Drink half a litre of water an hour beforehand, but not too much — an overly full bladder makes the wait uncomfortable.

The procedure

You will be positioned as you would be for a gynaecological examination. The doctor will insert a speculum, clean the cervix, then insert a very fine catheter through the cervix, under abdominal ultrasound guidance. The embryologist loads the embryo into the catheter and passes it to the doctor, who places it in the uterine cavity, approximately one to two centimetres from the fundus.

On the screen, you may sometimes see a small white dot: this is the tiny air bubble surrounding the droplet containing the embryo, not the embryo itself. The embryologist then checks under the microscope that the catheter is empty.

The whole procedure takes five to ten minutes. No anaesthetic is required: the sensation is similar to that of a smear test. A difficult cervix to pass through may be slightly more uncomfortable; the doctor often knows this in advance thanks to a ‘trial transfer’.

How many embryos?

The trend – and rightly so – is towards transferring a single embryo, particularly at the blastocyst stage. Twin pregnancies increase the risks for both the mother and the children. Greek law sets a maximum number depending on age, but a single embryo is often the best choice; I explain why in the article on single embryo transfer.

Immediately afterwards: should you get up straight away?

Yes. Studies comparing resting in a lying position with an immediate return to normal activities show no benefit from resting; some even suggest a slightly better outcome for women who get up quickly. The embryo does not ‘fall out’: the womb is a virtual cavity, with its walls pressed together. You can go to the toilet straight after the transfer.

The following days: what matters

• Continue your prescribed treatment exactly, particularly the progesterone. This is by far the most important instruction.
• A normal life: walking, working, showering and flying are all possible.
• Avoid strenuous exercise, very hot baths and the sauna for the first few days, as a precaution.
• Do not take a pregnancy test too soon: if the trigger was administered via hCG, it may give a false positive.

Common misconceptions

Pineapple, socks, post-intercourse positions, avoiding carrying even light loads: none of these practices has been shown to have any effect. They do no harm if they put your mind at ease, but they must not become a source of guilt. If the transfer is unsuccessful, it won’t be because you climbed a flight of stairs.

What about the return journey?

After a transfer, you can fly the very next day, or even on the same day. There is no evidence that flying reduces your chances of success. Make sure you stay hydrated, move your legs, and keep your medication in your hand luggage. The wait until the test is explained day by day in this article.

Frequently asked questions