EMBRYO TRANSFER
Embryo transfer is the final step of IVF and involves placing one, two or maximum three healthy embryos in the uterine cavity under ultrasound guidance. It does not require anaesthesia and is done with a semi full bladder. Only 0.5 percent patients like cases of severe vaginismus require anaesthesia. After the procedure the patient lies down for 10 to 15 mins on the table and after that resume’s light normal activity. Patients are prescribed pregnancy supporting medications for about 14 days. The beta-HCG pregnancy test is done on 12th to 14th day after the embryo transfer. If the test comes positive, then the pregnancy support medicines are continued for 7 to 8 weeks of pregnancy.
Embryo transfer can be fresh (transfer is done 3 to 5 days after egg pickup) and frozen embryo transfer (done in the subsequent month or after a gap of a few months as per medical and administrative requirement). Our senior staff has done thousands of the procedures and has resulted in nearly 90 percent of our patients getting pregnant in three attempts.
SINGLE EMBRYO TRANSFER
IVF is associated with risk of multiple pregnancy and it’s complications like preterm birth and low birthweight babies. This risk can be avoided by doing single embryo transfer, also known as elective single embryo transfer ( eSET). eSET is a procedure in which one single embryo is selected from the cohort of multiple embryos made. By using technologies like computerised grading of embryos, video based grading of embryos using embryoscope, or genetictesting of embryos using Preimplantation Genetictesting for aneuploidy (PGTA) or Non-invasive chromosomal screening of embryos NICS one can select the best embryo for transfer giving maximum success rate , minimum miscarriage rate and a singleton pregnancy.
SEQUENTIAL TRANSFER
Repeated failure of in vitro fertilization treatment is depressing not only for the patients but also for their clinicians. Patients who fail treatment repeatedly in spite of good quality embryos pose a special therapeutic challenge. Different approaches to try to overcome this challenge:
A policy of sequential or consecutive transfer on Day 3 and Day 5 embryos in patients with adequate number of retrieved oocytes, yields the advantages of a good embryo implantation rate, satisfactory pregnancy rate and an acceptable multiple pregnancy rate at the same time avoiding complications of blastocyst transfer like cancellation of the transfer cycle and higher multiple order births. Blastocyst transfer is an approach aiming to improve the IVF outcome in repeated IVF failures. However, the results of this approach depend on the number of fertilized oocytes and the quality of the fertilized embryos. Thus, the sequential transfer approach has the advantage of blastocyst transfer without exposing the whole cycle to the risk of cancellation.
Under the assumption that embryos that cease to develop in utero result in implantation failure, growing them to the blastocyst stage will serve two goals. First, it will enable better selection of embryos for transfer and second it will promote more physiologic synchronization with the endometrium and capability of achieving the "implantation window".
The transfer of embryos that are grown to the blastocyst stage helps in overcoming the problem of random selection of impaired embryos, healthy embryos are transferred and there is decreased risk of multiple pregnancies. However, it is possible that no blastocyst forms during culture with the risk of cycle cancellation. So this is an approach that is only suitable for patients who produce many embryos.
The rationale behind sequential embryo transfer is that, during the first day-3 transfer, the embryos (1 or 2 embryos) may induce an increase in endometrial receptivity, thereby creating a better endometrial environment for the second transfer (1 blastocyst) on day 5. Our unit is specialised in this technique. We get many patients from all over India and the world, who have failed multiple times outside with other doctors. We use this technique and achieve pregnancies in most of them.