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.
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:
- taking injectable medication (gonadotropins) to stimulate follicle growth
- coming in for frequent ultrasounds and blood tests to monitor your progress
- taking a trigger shot
- undergoing the egg retrieval procedure
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:
- Prep Work: Consultation with your reproductive endocrinologist to determine if IVF and a fresh transfer are right for you.
- 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.
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.
- Patients <35 years will have higher success than those >35.
- Patients without ovulatory disorders (such as polycystic ovary syndrome) have higher success rates than those with the condition.
- An embryo with better morphology has a higher chance of success than an embryo with poor morphology.
- a Day 5 embryo transfer may be more successful than a Day 3 transfer.
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.
A 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%).
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.
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.
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.
- Embryo Transfer Precautions: What You Should & Shouldn’t Do After A Transfer
- Pregnancy Testing After An IVF Transfer: When To Check & Why
- How Many Weeks Pregnant Are You After A Transfer?
Make An Appointment With Dr. Robles To Discuss Your Fertility Options Today!
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!