Embryo transfer day: a key hurdle for every IVF patient. It’s that moment when your fertility treatment and hopes converge. And the fact that it’s happening at all needs celebrating, since some fertility cycles don’t make it this far. The medication worked. You’ve got one or more viable embryos ready to transfer. Here we go.
So what should you do before, during and after your embryo transfer to maximise your chances? It’s the no. 1 question our patients ask us. A spectacular amount of myths abound, from drinking pineapple juice to doing handstands. We think it’s time to separate the wheat from the chaff. So we present our top ten tips – based on facts, not fiction – for making your embryo transfer a success.
1. Request the most experienced doctor.
An embryo transfer is routine, your clinic will tell you. But you’re the patient and you’re paying. Insist the senior doctor or consultant in the team carries out your embryo transfer. With any luck he or she will be the person who’s managed your care so far.
Experience matters. A skilled practitioner has a steady hand, and you want the best. Someone who won’t touch the fundus and cause uterine contractions (okay, that really would be negligent). Someone who’ll follow the ultrasound images like a hawk. And someone who’ll release your hard-won embryos at the MIP point like a pro.
2. Do a dummy run.
An embryo transfer should be quick and easy. Consider asking your doctor to do a mock transfer before the real thing. He may argue it’s not necessary. Ask why not. It can sometimes help to re-evaluate the uterine cavity, locate any potential barriers to entry (e.g. a cervical growth) and reveal if an alternative catheter should be used. A research fellow (not the consultant we’d requested) did our embryo transfer at a UK clinic. She didn’t read our notes properly, used the wrong catheter and delayed the transfer for over three minutes. The cycle failed, as did our request for a refund. Enough said.
3. Don’t have a hydrosalpinx.
High up on the embryo transfer no-no list are hydrosalpinges. No, we can’t pronounce them either, but they’re not nice. A hydrosalpinx is fluid in one or both fallopian tubes, often associated with a previous sexually-transmitted disease or endometriosis. It makes normal pregnancy almost impossible.
But it can also affect IVF treatment. The pesky fluid can leak into the uterus, meddle with your womb lining and cause havoc with the embryos you just transferred. It’s sensible to have ultrasound testing and/or a hysterosalpingogram (HSG) well in advance of your treatment. Your tubes can, and must, be repaired before your embryo transfer can happen.
4. Test, test and test again.
This may seem obvious, but don’t trust clinics that skimp on essential pre-treatment tests. If they don’t request key results, they care more about their bank balance than your embryo transfer. For IVF patients using their own eggs, hormone profiling (FSH, AMH, etc.) is a must. As is a male-partner semen analysis, and a trans-vaginal scan of your ovaries, fallopian tubes and uterus mid-cycle.
For donor-egg IVF patients, hormone testing is desirable but not always necessary. But, once again, a semen analysis, and a trans-vaginal scan on day 13 or 14 that includes a measurement of your lining thickness, is. And don’t get us started on STD results. If your clinic doesn’t insist on these, get a refund and/or run a mile.
5. Take folic acid – ideally within a multivitamin.
Tried, tested and proven, a folic acid supplement helps reduce the risks of birth defects. That holds true for couples trying naturally and through IVF. So start taking one a day from at least three months before your expected embryo transfer. But here’s the important bit. A recent study said that folic acid can boost the chance of an IVF twin birth, perhaps by improving implantation prospects.
Speak to your doctor about how much to take and consider a vitamin/mineral supplement that includes folic acid, vitamin D and all your B vitamins. We took one throughout our five years of IVF treatment.
6. If you’re over 40, consider transferring two embryos.
Don’t get brainwashed into thinking a single embryo transfer is best. That PR bandwagon still rumbles on. If you’re over 40, a recent IVF study took issue with the somewhat heavy-handed diktat from the HFEA back in 2008 that one embryo transfer is plenty when it comes to your own eggs (donor eggs are different).
A single embryo transfer is sensible in certain circumstances. Multiple births have come down. Pre-eclampsia cases and pre-term births probably have too. But the new study stood up for older women. Let them decide, it said, they’re a special case. So if you’re in your forties, consider putting in two, even if they’re blastocysts (day-5 transfers are becoming more common).
Talk about your preference for a double-embryo transfer at your first appointment. If the consultant looks doubtful, challenge him. Recent figures from the Office of National Statistics show a rise in multiple births for the over-40s. So older fertility patients ARE putting in more.
Of course, the number you put it depends on the age, quality and quantity of your particular embryos, and your specific medical history. But on a point of principle, why let a state-sponsored quango like the HFEA tell you to transfer one, without discussion? The tide is, in any case, turning on restricting the risk of multiple births. The HFEA, following a recent court case, is relaxing its licensing rules on clinics that were limiting multiple birth via IVF. The decision to transfer multiple embryos (e.g. for older women) is now set to be a wholly medical one. The nanny state is backing off.
7. Don’t head for bed after your embryo transfer.
Duvet day after your embryo transfer, right? Wrong. It’s a myth that bed rest after embryo transfers helps. You’re better of relaxing and staying upright. Tell your partner to take you out for a nice lunch – minus the alcohol and postprandial coffee, of course. Then take a stroll round the park, but don’t do strenuous exercise. No heavy lifting or trampolining, either, and no hot baths. Those embryos want you active, calm and dry.
8. Try not to cough or sneeze.
If you have a cold on the day of your embryo transfer, tell your doctor. You shouldn’t really cough or sneeze during the procedure. It probably won’t affect your implantation chances once the embryos are in, but sneezing with the catheter inside your uterus isn’t wise. Ask for a cough remedy to keep the splutters at bay. Keep quiet and zoned-out.
9. Book a clown – or give your partner a joke book.
Your embryo transfer should be stress-free, as should the next few minutes recovering from it. Bizarre as it sounds, a recent study found that IVF patients who were entertained by a medical clown for 15 minutes post-embryo transfer were twice as likely to get pregnant than joke-free patients. We’re guessing a medical clown has a red nose, white coat and a good brief. The point is, this admittedly small Israeli study suggests low stress levels can help implantation. If your clinic doesn’t have a salaried clown to hand, tell your partner to start rehearsing his Ricky Gervais routines.
10. Own your IVF health – no one else will.
Preparing for your embryo transfer isn’t just about following your treatment protocol and chilling out. IVF clinics never tell you anything about looking after yourself. But it’s crucial you and your partner do. Ditch the caffeine (both of you), don’t touch alcohol, take moderate exercise and (female patients only) consider acupuncture on your embryo transfer day: it may just make a difference. And take it really easy the first few days after your ET. This is when implantation happens. Don’t go back to work for a while if your office pulses with adrenaline. Do what makes you relax.