What factors are key to a successful embryo transfer?

Transfer Day – the day you have been working towards

Is there anything you can do to help make it a success? We turned to Dr. Lenka Hromadova, Head Physician at the Repromeda clinic to answer our questions.

What exactly happens on transfer day?

The transfer day can be divided into two timelines.

One relates to the patient herself and the other one to her embryo, which is still in the incubator.

The patient and possibly her partner are firstly instructed on the development of the embryo and on the course of the transfer itself. Then they head out to the transfer room and together with the performing physician they await a message from the clinical embryologist that the embryo is ready for transfer. The patient is then placed in a gynaecological chair, the physician inserts a speculum and prepares the ultrasound.

The embryologist selects the embryo for transfer on quality basis. Such embryo is assessed by observing its development using the time lapse and its genetic quality is evaluated by preimplantation genetic testing. If there are more than one good-quality embryos available, the unused embryos are vitrified and stored for further possible transfer.

Both couple and transferring doctor can see the selected embryo on a screen. Then the embryologist loads the embryo into an embryo transfer set and passes it to the transferring doctor from the embryological laboratory to the transfer room through the window. The transferring physician inserts the transfer set into the uterine cavity and deposits the embryo while using an ultrasound.

Since the patient can eat prior to the performance and go home right away afterwards, the procedure is not perceived as burdensome. It is not recommended to lift heavy objects or otherwise overburden the body and to travel long distances immediately after embryo transfer. The patient can talk to the physician about acupuncture or other relieving methods prior to transfer.

What factors are key to a successful transfer?

Quality of the embryo 

The quality of any embryo represents a crucial condition for successful transfer. Of course, a good-quality embryo can only be obtained from a good-quality oocyte and no less it depends on the quality of the sperm, the quality of the culture method (top quality culture media and solutions, first-class incubator with time lapse system).

Another factor influencing the quality of embryo culture and treatment is the qualification of the clinical embryologist who fertilizes the oocyte and cultivates the embryo. The optimal embryo for transfer is one that has reached the blastocyst stage on day 5 of culture. It is necessary to select an embryo that has a complete set of chromosomes, ie. that the number and structure of its chromosomes are normal. Such embryo can be chosen by using a method called preimplantation genetic testing.

The ultimate success of embryo transfer also depends on the number of embryos transferred, whereas paradoxically the transfer of more embryos may lead to a lower probability of giving birth to a healthy child. The current trend is the transfer of only one embryo, and this trend is thoroughly followed at the Repromeda clinic.

Perfect lining of the uterus 

The second essential condition for the success of embryo transfer is the quality of endometrium. The good-quality signs are sufficient thickness at least 8 mm and so-called Triple line image during the ultrasound examination. Further precision can be achieved by determining the day of the transfer on the basis of the ERA method, when the so-called implantation window is precisely found.

In preparation for transfer day, what can you do to help ensure you have a top quality embryo and a perfect lining?

Key factors are high performance standards of the entire IVF clinic, use of top quality materials and frontier equipment and ultimately qualified personnel. Very important are also precise preparation for oocyte collection, good-quality embryo culture and evaluation of the embryo’s morpho-kinetic parameters and its genetic status. Prior to the transfer itself, the endometrium should be well prepared, preferably by determining the implantation window by using the ERA method.

Can you as a patient improve the quality of your lining? If yes, how?

First of all, it is important to strictly follow the instructions of the physician and other staff of the clinic and take the medication accurately. It always helps to follow the principles of healthy lifestyle and maintain mental wellbeing.

At this point, as well as within the whole infertility treatment process, it is important to talk to the staff in case the patient doubts any part of the procedure.

Smoking can have a significant negative effect, as well as in other areas of reproductive health.

Can you explain what assisted hatching is? Can this assist in the implantation of an embryo?

Assisted hatching is a very simple procedure in which an embryologist makes a small crack in the zona pellucida (embryo coat). Some experts are not convinced of the effectiveness of assisted hatching; however, this method can be used on patient’s demand.

What are your thoughts on embryo glue?

The so-called embryo glue is a transfer medium with an increased content of hyaluronan, which is basically a common part of all media. Elevated hyaluronan levels may be beneficial to the embryo, but the perception of embryo being glued to the uterine lining is misleading. If the concentration was high enough to have a sticky effect, the embryo would also stick to the transfer set and the likelihood of its transfer to the uterus would be reduced.

What are your thoughts on the importance of keeping your body warm during transfer?

The blood flow to the uterus is not managed by periphery circulation. Cooling of the peripheral parts of the body does not ensure a larger blood flow to the uterus, nor does it contribute to a greater probability of embryo implantation. Overheating of the body, such as fever or being in a hot environment, is detrimental to the development of the embryo.

What are your thoughts on balancing your hormones to ensure you try and stay balanced?

Hormonal balance is certainly very important for the success of the transfer. In necessary situation (unless it is a native cycle) estradiol and progesterone are used as hormonal support of endometrial development. Equally important is proper thyroid hormone function and prolactin levels within normal range.

After transfer, is there anything you can do, or things you should avoid to enhance the chances of that embryo sticking?

After the transfer the patient should avoid vigorous activities and stress, which can negatively affect the embryo implantation. It is advisable to pay attention to lifestyle, healthy eating, not to smoke and not to use unnecessary medicine or drugs. On the other hand, it is important to mindfully take the medication that your doctor prescribes and recommends.

What are the chances of the transfer working if this is your first round of IVF?

The chances depend on the quality of the oocytes and sperm obtained, the health of the embryo recipient and the standards of the IVF clinic. The quality of oocytes and, to some extent also of sperm, is influenced by age and lifestyle. Depending on the couple’s circumstances the average success rate of pregnancies per transfer of one embryo is 45-55%. If the embryo indicates optimal parameters during time lapse observation, the chance of its implantation at our clinic is increased up to 75%.

Your clinic offers a refund scheme, can you explain how this works?

Repromeda partners with Redia IVF, the leading European provider of IVF refund guarantee programmes. Through Redia, Repromeda offers refund schemes. The benefit of the refund scheme is that the patient no longer has the stress of cycle failure or financial uncertainty from multiple cycles. The scheme offers up to 3 IVF stimulation cycles with all the transfers included depending on the amount of the embryos developed in each stimulation cycle, and all medication costs. So, by paying a set amount for the scheme, the patient can undergo as many attempts as needed to achieve a child (live birth is guaranteed) or in the case that this is not achieved, the patient gets her money back. More information about this can be found on Redia IVF’s website

Enormous thanks to Dr Lenka Hromadova, Head Physician at Repromeda clinic, Czech Republic and Dimitris Kavakas, Chief Executive Officer of Redia IVF Travel

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