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The transfer stage is when the embryos are transferred to the uterus via a catheter.

What will the transfer process be like?

The transfer process is usually uneventful and pain-free compared to the retrieval process. Your embryos are loaded into a thin flexible catheter, which is inserted into your uterus. The embryos are placed as far into the uterus as possible without touching the back wall of your uterus. Some clinics measure how long your uterus is and map out your uterus before the actual transfer date. The doctor doing the transfer tries to place the embryos 0.5-1.0 cm from the back wall of your uterus. Some clinics use an abdominal u/s to help guide embryos in place. Once the embryos are inserted into the uterus, the catheter is slowly removed. The catheter is then sent back to the lab to confirm that there are no embryos sticking to it. The embryos don't often stick to the catheter, but if this happens the stray embryo is reloaded into the catheter and the transfer is tried again. Some clinics will recommend that you rest on the transfer table for about an hour, while other clinics may allow you to leave right away.

My transfer procedure was quite simple and was over in about 10 minutes. I had to get a hospital bracelet so that the lab technician could verify that the right embryos were being transferred to me. I was made to lie down on the transfer table and my feet were put in stirrups. The doctor performing the transfer inserted a speculum and washed my cervix with the same medium used to culture the embryos. The lab technician loaded the catheter with my 3 embryos. The catheter was gently inserted into my uterus and then the embryos were released. The catheter was slowly removed and the lab technician verified that there were no embryos sticking to it. I was allowed to leave immediately after the transfer. --Brenda

Well, everyone I've talked to including 3 nurses and my RE told me that transfer was an easy and quick procedure -10 minutes top-. Well, for me it was PAINFUL and very, very uncomfortable. I have a retroverted cervix and my RE had a lot of trouble getting to it. Even when he was cleaning everything before the transfer it was very difficult. He kept moving the speculum inside and twisting and turning my God, it was sooooo painful. The whole procedure lasted over 30 minutes -at the end I was in tears- All kinds of things were going through my mind. I thought that they weren't going to be able to get to the cervix and that all this had been for nothing. Anyhow, they finally got the embies in and I just stayed there with my DH for about an hour. I was so scared of moving! A few minutes after the procedure the embryologist came back and said "I have a souvenir for you guys" and he gave us this petri dish where the embryos had been kept. It has my name and the date written with beautiful handwriting. We were so moved, I thought it was really sweet of him to do that. When we got home we put it in our curio where we keep our most delicate things. --March/April IVF member

They made me drink enough water to make sure my bladder was full. They wheeled me into the theatre (but allowed me to keep my glasses). Because I asked, my doctor had the lab staff show me the embryos (on a big screen). I then got onto the operating table. The doctor and his assistant put my feet into stirrups (probably the worst part of the whole experience), and then covered as much of me as they could (in her words "to preserve as much modesty as we can"). He then inserted a speculum (like for a pap smear). They cleaned the mouth of the uterus with some kind of sterile solution and cotton wool. He then called to the lab assistant to "load" the embryos into the catheter. Meanwhile, his assistant got the probe of the u/s machine positioned on my abdomen so they could clearly see my uterus. They brought the catheter across to him, he inserted it (using the u/s screen to see what he was doing) and then (sort of) squirted the embryos into me. They then checked the catheter under the microscope to see that there were no embryos stuck to it. Took my feet out of the stirrups, wheeled me out of theatre, took me back to my ward, and let me go to the toilet. I had to stay in the bed for an hour, and then was allowed to go home. All in all, it was a much more pleasant experience than the retrieval. --CarolAnne

How many embryos should I transfer?

The question of how many embryos to transfer is not an easy one to answer. The decision is usually made based on a number of factors: age, number of IVF attempts, blastocyst versus regular transfer, % of multiples produced at your clinic and your feelings regarding the number to transfer. Some clinics will not allow you to transfer more than 3 embryos at a time. If you become pregnant with triplets, there is still a good chance that you can have a healthy pregnancy and carry your babies close to term. Anymore than triplets and the chances of complications goes up significantly. Some clinics recommend transferring more than 3 embryos if you are older than 35 or have had several unsuccessful IVF attempts. As you age your embryo quality can start to decline, therefore transferring more than 3 may give you a better chance of success. If you will be transferring blastocysts, clinics are more likely to recommend transferring fewer embryos, because of the higher success rates with this type of transfer. Your clinic's pregnancy success rate regarding multiples may help you to make your decision. In 1996, the Center for Disease Control and Prevention (CDC) reported that 32% of all fresh, non donor ART (Assisted Reproductive Technology) pregnancies (most of which were from IVF cycles) resulted in the birth of multiples (26.3% twins, 5.8% were triplets or greater). More statistics and statistics for individual clinics can be found at the CDC web site. If you will be transferring more than 3 embryos, your clinic may talk to you about selective reduction if many of your embryos implant. Selective reduction is where one or more of the fetuses is aborted at the ninth to twelfth week of the pregnancy, in order to avoid the complications of a multiple pregnancy. I recommend talking to your clinic and spouse about the number of embryos to transfer early on, so that you feel comfortable with your decision well before your transfer time.

My husband and I debated for several months about how many embryos to transfer. I was 29 years old at the time and my husband was 34. At first the thought of having triplets scared us. We talked about only transferring 2 embryos, because we both felt that we could handle twins. The drawback of only transferring 2 was that we would only have a 20% success rate compared to 30% if we transferred 3. Our clinic will transfer a maximum of 3 embryos. As the months before my IVF cycle dragged on, the idea of having triplets started to be less scary to us and the 30% success rate became more important to us. In the end we decided to transfer 3 on a day 2 transfer. Unfortunately our cycle turned out negative. If we had only transferred 2, I would have always wondered what would have happened if we had transferred 3. I'm happy that we made the decision to transfer 3 and we will be transferring 3 again during our upcoming FET. --Brenda

We've wrestled with the question of how many to transfer and here's how we solved it: Which do you want more? To have a baby, even if it means you have to deal with the issue of selective reduction, because you transferred so many OR to avoid selective reduction no matter what, even if it means you reduce your odds of conceiving. The time to ask yourself these questions is BEFORE transfer, not when the doctor says you're carrying multiples. I've seen too many women take serious chances and just HOPE they would beat the odds. Then when the odds went against them, they didn't know what to do. It's one thing to gamble with money, but personally...I can't gamble with a baby's life/health. Some people think a multiple pregnancy is great...and I guess it is if all goes well. But most don't go well. Look ahead at your possible future (1 year, 5 years, 10 years) and ask yourself, "What is the best thing for me to do?" You need to be able to live with yourself and give the best odds of health to however many babies you might conceive. --May/June IVF member

What is the difference between an embryo, morula, and a blastocyst transfer?

Embryo Transfer: An embryo transfer is done 2 or 3 days after retrieval. A day 2 embryo usually contains anywhere from 2-4 cells. A day 3 embryo is usually around 8-10 cells in size.
Morula Transfer: A morula transfer is done 4 days after retrieval. Morula transfers are not as common as embryo or blastocyst transfers. A Morula usually contains at least 30 cells, but as the cell numbers increase the morula compacts and the cell borders become less distinguishable.
Blastocyst Transfer: A blastocyst transfer is done 5-6 days after retrieval. A blastocyst has so many cells that individual cells are no longer recognizable.

If you would like to see pictures of what embryos, morulas and blastocysts look like the Advanced Fertility Center of Chicago has some excellent pictures.

The pregnancy success rates between embryo and blastocyst transfers are almost the same. If your embryos make it to the blastocyst stage the pregnancy success rate is higher per blastocyst transferred, but not all embryos make it to that stage and sometimes none do. For example, if you have three embryos on day 2, and only one of them develops to a day 5 blastocyst, your chance of pregnancy from that one blastocyst would be around 30%. If you had transferred all three embryos on day 2 or 3, your chance of pregnancy from those 3 embryos would also be around 30% (I have used 30% as an average number for my example, but rates vary depending on the clinic and the diagnosis of the couple). Blastocyst transfer is usually only attempted when the embryo quality is good and if there are a sufficient number of embryos to work with. The main advantage of using a blastocyst transfer is that fewer embryos can be transferred without reducing the success rate, allowing for a smaller risk of multiples.