The Fresh Embryo Transfer (Timeline, Tips, & Success Rates)

Are you considering a fresh embryo transfer for your next round of in vitro fertilization (IVF)?

If you have some questions about the process, you are not alone.

This guide will help you understand everything you need to know about fresh transfers.

Fresh Embryo Transfer cover image

Disclaimer:

Although I am a physician by profession, I am not YOUR physician. All content and information on this website are for informational and educational purposes only.  It does not constitute medical advice and does not establish any kind of doctor-client relationship by your use of this website. Although I strive to provide accurate general information, the information presented here is not intended for the prevention or treatment of infertility and it is not a substitute for medical or professional advice. You should not rely solely on this information. Always consult your physician in the area for your particular needs and circumstances prior to making any decisions whatsoever. Those who do not seek counsel from the appropriate health care authority assume the liability for any damage, loss, or injury which may occur.


What is a Fresh Embryo Transfer?

A fresh embryo transfer is a procedure in which an embryo(s) created in a laboratory is transferred to the patient’s uterus three or five days after IVF and egg retrieval.

Conversely, in a frozen embryo transfer, a frozen / cryopreserved embryo from a previous cycle is thawed and transferred to the patient’s uterus at a later time.

How Does it Work?

Before you can undergo a fresh embryo transfer, you will need to undergo a fresh IVF cycle to generate fresh embryos.

The IVF stimulation typically involves:

After the egg retrieval, any egg that fertilizes is placed in an incubator and monitored closely until the fifth day of fertilization.

On the morning of the fifth day, we will check the embryo(s) to ensure they have adequately developed and are ready for transfer.

How Long Does A Fresh Transfer Cycle Last?

So how long does it take to have a fresh embryo transfer from start to finish?

On average, the entire cycle takes approximately 15-20 days.

The IVF portion alone may take anywhere between 8-12 days before you are ready for retrieval.

On the day of the oocyte retrieval, the embryologists will fertilize your eggs with the sperm you provide in the laboratory.

If the eggs fertilize successfully, we will monitor the embryos closely over the next few days. You may be eligible for a fresh embryo transfer on the third or the fifth day after the retrieval if the embryos have reached an appropriate stage of development.

If no embryos reach an appropriate level of development by the fifth day, you are no longer eligible for a fresh transfer.

The Fresh Embryo Transfer Timeline

Here is a typical timeline for a fresh embryo transfer cycle:

  • Day 1: The first day of your menstrual cycle
  • Days 2-3: Baseline ultrasound and the start of injectable stimulation medications for follicle growth
  • Days 4-11: Regular ultrasounds and blood tests to monitor your progress, along with daily injections of medication
  • Day 12: Trigger shot for egg maturation
  • Day 14: The egg retrieval procedure and insemination of all mature eggs
  • Day 15: Day 1 of embryo development- All fertilized eggs are kept in an incubator and for monitored growth
  • Day 17: Day 3 of embryo development. If you are having a day 3 transfer, the embryologist will determine if any embryos are eligible for transfer today
  • Day 19: Day 5 of embryo development. Any embryo that has reached the blastocyst stage is eligible for a fresh transfer today.
    • *If no embryo has made it to the blast stage by Day 5, you are no longer eligible for a fresh embryo transfer.
  • Day 28: Your first pregnancy test.
calendar depicting first day of period along with the start of ivf and when a fresh transfer would occur

How successful is a fresh embryo transfer? (Success Rates)

In ideal circumstances, the average success rate for a fresh embryo transfer is approximately 40 to 50 percent. However, success rates will vary depending on many factors, including patient age, the patient’s diagnosis, embryo morphology, the number of embryos generated, and the type of embryo transferred.

On average:

5 day vs. 3 day fresh transfer success rates

So what does the data show between day 5 and day 3 fresh embryo transfers?

Unfortunately, there isn’t much data on the matter.

2016 study by De Vos and colleagues found that transferring a single Day 5 embryo led to a significantly higher live birth rate than a single Day 3 embryo (38% vs. 31%).

The only other study to look at fresh Day 3 vs. fresh Day 5 transfers found a higher pregnancy rate with Day 5 (68% vs. 59%) with no difference in miscarriage rates.

Data from cryopreserved embryos show similar results using a frozen embryo transfer cycle protocol.

However, it is important to note that a blastocyst transfer assumes that the patient has good quality embryos that make it to the Day 5 stage.

For low responders and patients with a poor prognosis, a Day 3 transfer may be more successful as there is no way to know in advance which, if any, embryos will survive to Day 5.

image of a day 3 embryo with at least 6 cells
image of a day 5 blastocyst - a circlular structure with two distinguishable cell lines

Is a fresh transfer better than a frozen transfer?

Frozen embryo transfers are better in certain patients, such as high responders at an increased risk of ovarian hyperstimulation syndrome (OHSS).

However, plenty of studies demonstrate no significant difference in pregnancy rates and live birth rates between fresh and frozen embryos for many patients.

With that said, some patients are not good candidates for a fresh embryo transfer.

You cannot have a fresh embryo transfer if:

  • you are at high risk of OHSS
  • abnormalities in your hormones (for example, elevated progesterone levels create a dysynchrony between your embryo and endometrium)
  • your endometrium (lining of the uterus) is thin
  • you want to use preimplantation genetic testing (PGT)
  • you do not have an embryo that has made it to the blastocyst stage on Day 5

To learn more about a frozen cycle, check out this post.

Fresh embryo transfer tips

In the days leading up to your embryo transfer, here are some things you can do to help ensure the best possible outcome:

  • Plan ahead to ensure that you arrive at the office on time
  • Continue to take any medications that you have been instructed to take
  • Arrive at the office with a full bladder to help with ultrasound visualization 
  • Plan on relaxing after the procedure and avoiding strenuous activity

Other Related Questions

What day of my cycle is the fresh embryo transfer?

The fresh embryo transfer occurs on the third or fifth day after the retrieval. On average, the transfer can happen as early as the 15th day of your cycle or as late as the 20th day of your cycle.

How do you feel after a fresh embryo transfer?

After the embryo transfer, you will likely experience some mild cramping. You do not need bedrest, but avoiding high heat after the procedure is essential.

What other symptoms can I expect after the transfer?

You may experience some light spotting after the transfer. Spotting can be expected and does not mean that the transfer was unsuccessful. If you have heavy bleeding or cramping, don’t hesitate to contact your doctor.

How long does the embryo take to implant after a transfer?

An embryo will implant in the first 1-2 days after the embryo transfer. You likely will not experience any symptoms during this time.

The only way to know if the transfer was successful is to have a blood pregnancy test ~10-14 days after the transfer.

Can I do a pregnancy test 8 days after embryo transfer?

You should not check a pregnancy test sooner than your doctor instructs you to. Checking a pregnancy test too soon can result in a false negative or inaccurate reading.

The earliest you should check a pregnancy test after a Day 5 transfer is 9-10 days.

Also, we prefer to check a pregnancy blood test over a urine hCG test as the results are more accurate.

Can you do genetic testing on fresh embryos?

Only a few select clinics offer PGT-A on fresh embryos, as the process is complex and time-sensitive.

Most offices do not provide this option.

If you are interested in genetic screening of your embryos, you will need to freeze your embryos and undergo a frozen embryo transfer (FET cycle) at a later date.

What’s Next?

In conclusion, a fresh embryo transfer can be as successful as a frozen embryo transfer in select patients.

Speak with your fertility doctor to learn if a fresh transfer is right for your next ovarian stimulation cycle.

What other questions do you have regarding fertility treatment and assisted reproductive technology? Comment below.

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Make An Appointment With Dr. Robles To Discuss Your Fertility Options Today!


alex robles md

Alex Robles, MD

Dr. Alex Robles is a Spanish-speaking Latino-American Reproductive Endocrinologist and Infertility specialist in New York City, and a board-certified OBGYN. He has a special interest in health, lifestyle, & nutrition. Make an appointment with Dr. Robles to discuss your fertility options today!


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