Embryo transfer is an important step in the IVF process. There are two methods which we use to prepare the lining (endometrium) for embryo transfer]. We commonly use the hormone replacement method. The other is letrozole – ovulation method.

Hormone Replacement Method Steps:

1. Here, we advise you to see us on day 2 of your period.

2. If your day 2 falls on a Sunday, we will see you on day 3

3. You will have a scan to ensure that the uterine lining is thin and that there are abnormal cysts in the ovaries

4. You will be advised to start estrogen tablets two to three times a day (every 8 hourly)

5. This prevents natural ovulation from occurring in that month.

6. We will review you for a scan 10 days later to see if the endometrium is thick (usually more than 8 mm)

7. We will then advise you to have a progesterone blood test to ensure that your progesterone test is normal.(<1ng/ml)

8. Occasionally, women may ovulate despite measures taken in which case they have a raised progesterone level and may need cancellation of the cycle.

9. We then start progesterone (injections or vaginal gel)

10. If you have day 3 embryos, transfer will be done on the 4th day of progesterone and if you have a blastocyst, transfer will be done on the 6th day of progesterone.

Letrozole – Ovulation Induction Steps:

1. On day 2 of your period (day 3 if it falls on a Sunday), you will have a transvaginal scan

2. This is to rule out the presence of any cysts in the ovaries and to ensure that the uterine lining is thin

3. We will start letrozole tablet – usually 5mg / day for 5-7 days and then scan you

4. The aim is to encourage the growth of one follicle and thicken the endometrium simultaneously

5. Once we are satisfied with the follicle growth and endometrial thickness, we will advise you to check your progesterone levels

6. If the progesterone level must be less than 1ng, we will trigger ovulation with an HCG injection

7. We will confirm ovulation after 36+ hours and then start progesterone support

8. Once again, a day 3 embryo will be transferred on post ovulatory day 4 and a day 5 embryo will be transferred on post ovulatory day 6.

Embryo Transfer Steps:

1. On the day of the transfer, you will be asked to come in the morning

2. Most transfers are done without anesthesia, but the consultant may on occasion advise you to have anesthesia

3. You will be requested to fill your bladder before the procedure

4. This helps to straighten the uterus, making transfer easier

5. A full bladder also helps us to scan your uterus

6. The transfer procedure involves placing the embryo/embryos within the uterus under ultrasound guidance (simultaneous scan)

7. The embryos are microscopic and not visible to the naked eye. Therefore, we place air bubbles (which are seen as bright spots) on either side of the embryos to ensure correct placement

8. After the transfer, we advise you to lie down for 15 to 20 minutes before you empty your bladder

9. You can walk, climb stairs, and carry out your activities as normal. Movement does not reduce your chance of getting pregnant

10. 80% of a pregnancy is due to the potential of the embryo and 20% is due to the endometrial receptivity.

11. The pregnancy blood test will be done here at Jananam on day 14 after a day 3 embryo transfer and on day 12 after a blastocyst transfer.

12. You will be informed about your results around 4 pm on the pregnancy test day.

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