A Complete Guide to Embryo Transfer for Surrogates

A Comprehensive Guide to Surrogate Embryo Transfer

Embryo transfer is one of the final steps in the surrogacy IVF process and the beginning phase of the pregnancy. Before this stage, the Surrogate has already undergone the application process, preliminary screening, and consultation. She has also been matched, done her medical screening at the Intended Parents’ clinic, signed the legal contracts, and started taking medications to prepare her body for pregnancy!

Quick Facts about Embryo Transfers:

  • It is the last step in the IVF process in which the fertilized egg (embryo) is inserted into the Surrogate Mother’s womb.
  • The embryo is put in a hollow tube (catheter), which is inserted via the vagina and the cervix into the womb, where it is transferred. 
  • Generally, an embryo transfer occurs within 3 to 5 days after the egg retrieval procedure if it is a fresh cycle transfer and within 1 month to years if the parents are undergoing a frozen transfer.
  • Embryo transfers can be classified into various types depending on the stage of the embryo and the numbers:
    • fresh
    • frozen
    • blastocyst
    • cleavage
    • single and
    • multiple embryo transfers.
  • The standard practice nowadays is to transfer a single embryo (sometimes two embryos) at once. This reduces the odds of multiple pregnancies without lowering the rates of live birth per transfer. Any unused embryos are stored in a frozen state (if the first transfer is done with a fresh embryo) or stay frozen (if the first transfer is with a frozen embryo).

Cycling and Embryo Transfer

The preparation for cycling commences once the legal contracts have been signed. This can take about 2 to 3 months after the Surrogate and Intended Parents are matched.

The intended mother or Egg Donor will start taking medications to induce her ovaries to produce multiple eggs. An egg retrieval procedure will be done at a fertility clinic, and the eggs will be sent to the IVF laboratory, where they will be “mixed” with sperm to create an embryo.

In most cases, the embryos are tested for genetic abnormalities and some are frozen for later use.

When it’s time for the Gestational Carrier to start her medication, she will be provided with a comprehensive calendar explaining which drugs to use daily and how. The surrogate embryo transfer will take place within 3 to 5 weeks after she begins her medications. One or two of the healthiest embryos will be chosen by the IVF lab technician, and the doctor will insert the embryo(s) into the Surrogate Mother’s womb.

The implantation of the embryo generally occurs within 2 to 3 days after the transfer. A blood test will be carried out 10 to 14 days after the transfer, at the fertility clinic, to check whether the Surrogate Mother has conceived or not. A transvaginal ultrasound will also take place approximately 2 weeks later.

If a fetal heartbeat is detected by the ultrasound, the Surrogate will start receiving parts of the base compensation and monthly allowances.

The procedure depends on a number of factors, i.e., whether donor eggs or the intended mother’s eggs are to be used. In general, embryo transfer is a short procedure that is carried out without the use of anesthesia.

Preparing for Embryo Transfer

The first and foremost thing to do before a surrogate embryo transfer takes place is to incorporate rest and relaxation into the daily schedule. The hustle and bustle of everyday life can make you overlook this important step.

Sleep earlier, stay in bed longer and try to take several quick naps during the day. Concentrate on eating healthier meals that contain a lot of fruits and veggies. By taking good care of yourself, you can help make sure you feel very healthy when it is time for the transfer.

Below are some other things you can do in preparation:

  1. Go through your IVF plan and begin to ask questions. Ensure that you are okay with every little detail and confident that you will be able to fulfill your responsibilities before going ahead with the process.
  2. Make sure to follow the directions for each drug. These medications have been shown to help increase the odds of implantation, but that is if they are used in the right amounts and combinations based on a particular IVF timeline.
  3. Get in touch with your fertility clinic to discuss the logistical details for the day of embryo transfer. Find out what time you should be there and who can come along with you to support you during the procedure.
  4. Jot down the questions as they come to your mind before your visits to the IVF clinic. It’s hard to remember the questions at the moment, and having all your questions answered before the transfer day can give you greater peace of mind.
  5. Make plans for your clinic appointments in advance. Arriving earlier and in a relaxed state can help lower feelings of anxiety. You may also want to lodge in a hotel close to the clinic in order to avoid an early morning rush and long drive.

Where Does the Embryo Transfer Occur?

The procedure takes place at the Intended Parent’s chosen IVF clinic. This is the same clinic the Surrogate Mother had her medical screening done, so she is already familiar with the team there.

Embryo transfer rooms are usually maintained at a cool temperature, with soft lighting and relaxing music to provide a peaceful environment. Before the procedure commences, the Surrogate Mother is first introduced to the reproductive embryologist and probably, an ultrasound technician, who will help the doctor with the transfer. 

At times, Surrogates are administered medication, such as Valium, to help them feel relaxed during the procedure. This drug is also believed to help calm the smooth muscles in the womb, which aids implantation.

In most cases, Intended Parents will need to travel for the surrogate embryo transfer so that they can be present at the clinic on the “actual transfer” day. This also enables the Intended Parents and Surrogate to connect and build a long-lasting relationship.

If the Intended Parents are unable to travel for the embryo transfer due to covid 19 restrictions, the Surrogates can have video calls with them during the procedure, so they can witness the entire procedure.

A lot of our Surrogates have video chats with their Intended Parents even when there are no travel restrictions since not all parents can travel for the embryo transfer appointment.

Do Surrogates Need to Travel for the Embryo Transfer?

A lot of times, the Surrogate lives very far away from the Intended Parent’s fertility clinic. In that case, she needs to travel for her transfer.

This will be the Surrogate’s second visit to the clinic, and the trip may take up to 3-7 days long.

The Gestational Carrier will come along with her Primary Support Person, i.e., a close friend or family member. Note that this trip will take longer than the Surrogate’s first visit to the clinic, so it is important that she packs what she’ll need there, such as her clothes, medicines, blanket, phone charger, book, etc.

Our advice for Surrogates preparing for their embryo transfer is that they relax, have fun, and be hopeful. We know this may be more difficult during this time, but they can find ways to explore the city while remaining safe and staying indoors, i.e., you may look for local restaurants in advance and order their takeouts when you are there.

What Is the Embryo Transfer Like?

The embryo transfer is a relatively short procedure, and the fertility doctor will give the Surrogate instructions she needs to follow after the transfer. One of the things our Surrogates like about the embryo transfer procedure is how fast it is completed.

One of our Surrogates said,

“The entire procedure happens very fast. In fact, you spend more time waiting for the physician and trying not to urinate than for the main thing. It’s also extremely easy. The doctor inserts a speculum, puts in a tiny tube, and prepares the ultrasound machine, and within 30 seconds, you are done!” 

Another Surrogate who has completed up to four embryo transfers also said a similar thing:

“All my embryo transfers were really quick, painless, and a positive experience overall. The clinic staff were very friendly, supportive and answered all my questions. It felt so good to be in such safe hands!”

Our experienced Surrogates are even surprised at how fast the whole procedure takes place!

Once the Surrogate embryo transfer is done, it is time for her to relax, have fun, and, yes, have some healthy snacks.

What to Expect the Day of the Embryo Transfer

Try to be at the fertility clinic at least one hour before your appointment on the day of your embryo transfer. The process is just like that of a regular Pap test. The physician will insert a speculum into your vagina keep the vaginal walls wide open.

Ultrasound-guided embryo transfer technique

As said earlier, the embryo transfer procedure is similar to that of a pap test. Usually, the woman will not feel any pain, and no sedation or other medications are needed. 

The Surrogate is expected to keep a moderately full bladder for the procedure. This is beneficial in two ways.

First, it enables good ultrasound visualization of the catheter, which ensures smooth transfer of the embryos to the ideal location. Secondly, it helps the womb unfold to a more accommodating angle, making the transfer smoother and less disturbing for the womb lining and the embryo(s).

The doctor puts the embryos in the catheter and passes the tube through the opening of the cervix up to the middle of the womb cavity. A pelvic ultrasound is performed concurrently to watch the tip of the catheter arrive at the ideal location. Although it is not easy to keep the catheter tip in the plane of the ultrasound all the time, it is essential to control the placement of the embryos into the womb.

When the tip of the catheter gets to the right location, the embryos are “deposited” into the lining of the womb cavity (endometrium) by the IVF physician. Once the embryos are unloaded, the catheter is gently removed and examined under a microscope to check if there are any embryos remaining. If the catheter has an embryo left (which is very rare), the transfer is done again instantly, and the catheter is re-checked.

Some patients do experience a little discomfort due to having the speculum inserted into the vagina or from keeping a full bladder, which is needed for the ultrasound. The process does not take much time, and you can empty your bladder immediately after the transfer.

As we mentioned earlier, feeling rushed is not a good way to start this memorable event. You need to continue taking your medications as prescribed and remember that you will need to keep a full bladder during the process.

Here are the steps you can expect once the embryo transfer procedure begins:

  • You will remove your clothes from the waist down, and you’ll be positioned similar to when you are undergoing a gynecological examination.
  • Your doctor will discuss the procedure with you and answer any pending questions you may have.
  • The ultrasound technician will get a clear picture of your womb on-screen
  • Using the ultrasound images, the doctor will insert a prep catheter into your womb via the cervix.
  • The physician will pass a tiny catheter containing the embryo through the prep catheter into the womb.
  • The embryo will be deposited into the womb.
  • The reproductive embryologist will examine the catheter to check if the transfer is complete.
  • And that’s that. You just need to rest and relax for some minutes while the embryo “gets familiar” with the womb. You will continue using your drugs as directed.
  • Approximately 2 weeks later, you are going to have a follow-up appointment to know if you are pregnant.   

Types of Embryo Transfer

There are various options for embryo transfer that can be considered once fertilization has taken place. 

Fresh embryo transfer: After fertilization, the eggs are grown in a culture media for 1 to 2 days, and the healthiest embryos are selected for transfer into the woman’s womb.

Frozen embryo transfer: Unused embryos from the first transfer may be frozen and stored in the lab for later use. They can then be de-frozen (thawing) and transferred into the womb to achieve a pregnancy in the future.

Blastocyst embryo transfer: If multiple healthy embryos are formed after fertilization, the IVF doctor may wait to see if the embryos will grow into blastocysts. Blastocyst embryo transfer has significantly higher implantation rates than the standard day-3 embryo transfer, according to a study published in the Indian Journal of Clinical Practice. However, a new study has found that blastocyst embryo transfer may increase the risks of complications later during pregnancy and is therefore not always advised.

Assisted hatching (AH): According to a study published in the Reproductive Biomedicine online, assisted hatching – the thinning of the hard outer shell of the embryo before it is transferred into the womb – does not increase the rates of implantation and pregnancy in women undergoing fresh embryo transfers. However, the procedure was found to be beneficial for women who are having frozen embryo transfers.

Single embryo transfer (eSET or simply SET): An elective single embryo transfer is the transfer of a single embryo into the woman’s womb during IVF. This helps reduce the odds of multiples while maintaining approximately the same rates of pregnancy per initiated cycle. eSET is the standard practice for transferring human embryos because of its lower risks and similar pregnancy rates compared to multiple embryo transfer.

Multiple embryo transfer: This is the transfer of two or more embryos into the woman’s womb. Although this may be done for some patients, there are stringent guidelines that limit the transfer of many embryos during IVF. 

Is a Frozen Embryo Transfer Different?

There is no difference between a frozen embryo transfer (FET) and a fresh embryo transfer – at least for the Surrogate Mother. In a FET cycle, the thawing of the embryo occurs at a certain time before the procedure. However, this does not imply that it is easier to schedule for the parties involved.

In a fresh cycle, the embryo transfer date is a bit flexible since it can change based on the Egg Donor’s or intended mother’s response to the fertility drugs.

The Surrogate transfer date can be chosen in advance during a frozen cycle, giving the doctor and the nurse the chance to fix her medication start date and other key milestones based on that date.

How Many Embryos Are Transferred?

The number of embryos transferred into the Surrogate’s womb will depend on the initial agreement between the Surrogate Mother and the hopeful parents. In most cases, just one embryo is inserted into the womb, although some doctors think transferring two embryos raises the odds of a pregnancy.

Actually, the number of fresh embryos to transfer during IVF varies based on the woman’s age and prognosis. However, one or two embryos are transferred in most cases.  For women below 35 with a great chance of conception, physicians often prefer transferring a single embryo.

A study published in the Fertility and Sterility journal found that a single embryo transfer lowers the risk of multiple pregnancies in women below 35 without reducing live birth rates. This study shows that there may be no need to use multiple embryos.

When a  woman has low chances of pregnancy, the doctor can decide to carry out a technique known as heavy load transfer (HLT), in which a higher number of embryos (3 or more) are transferred into the womb.

How Is the Recovery From an Embryo Transfer?

The recovery process will be a bit different for each Surrogate, and each fertility clinic has its own protocol. When discussing with our experienced Surrogates, a lot of them said the same things about recovery post-transfer. Some said they felt absolutely normal and do not experience cramping or anything.

One of our Surrogates said, “I had an easy recovery each time after embryo transfer. Although I did take things easier, it did not really affect my normal life.”  A lot of Surrogates said that the recovery after the process is all about having plenty of rest and relaxation.

While some clinics do ask Surrogates to bed rest after the transfer, others only advise that the Surrogate Mother take things easy and avoid too much physical activity.

One key point from the experiences of our Gestational Carriers is that relaxing and resting are very important for the recovery process.

What You Can Do after Embryo Transfer to Improve Chances of Success

The majority of the prep work for a successful embryo transfer occurs before the procedure.

After the transfer is done, there’s really not much you can do to influence the outcome.

But it is advised that women have another round of acupuncture treatment shortly after the embryo transfer since studies have shown that acupuncture helps before and after embryo transfer. 14 scientific studies in the journal of Fertility and Sterility suggest that acupuncture done before and following an embryo transfer raises the pregnancy rates by around 35 to 50%.

Navigating the Two-Week Wait

Surrogates and Intended Parents find it hard to wait for two weeks to get the result.

A lot of women feel like doing one or several pregnancy tests while waiting for the blood test. However, it’s important to know that pregnancy tests may not give an accurate result until the blood test.

Also, getting a false negative result can make a Surrogate not take her medication seriously or follow other important instructions just because she does not think she’s pregnant. But it is crucial to keep to instructions until the physician or nurse tells you otherwise.

Post Embryo Transfer Precautions

The embryo implantation can take place up to 72 hours after the transfer, and post-transfer instructions differ from one fertility clinic to another. Although doctors used to recommend having bed rest after the procedure, this is no longer necessary.

Our experts at Physician’s Surrogacy suggest that patients go back to their regular routines, but stay away from strenuous physical activity, sexual intercourse, or taking hot baths during this period.

We usually advise our Surrogates to go home, resting and having a lot of sleep.

It is also important to keep a positive mindset, look for ways to relax and connect with your spouse during the 2-week wait between embryo transfer and a blood pregnancy test. Plus, don’t focus too much on your do or don’t lists. Instead, focus on yourself and doing the things you love.

Bear in mind that women do conceive all the time without altering their activities.

Keep using your medications as instructed.

To summarize:

  • Act like you are pregnant: Eat and behave like a pregnant woman.
  • Remain active: You can go back to your normal routine. You just have to make sure you avoid strenuous exercise.
  • Abstain from sex: Allow Nature to run its course
  • Stay away from hot temperature: No hot yoga, saunas, hot baths, heating pads, etc., as these can increase the temperature of your womb.

If you want to know more about embryo transfer or would like to become a Surrogate, complete an initial application and our experts will answer your question.

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