TIMING OF TRANSFER
The decision to perform a 3 day versus a 5 day Embryo Transfer will likely depend on how many embryos develop and how healthy or viable they appear. Most fertility clinics now prefer waiting 5 days until they become “blastocysts” and will typically attempt to bring the embryos along to that point to determine which embryos are the strongest. If there are only a few embryos, the transfer will likely be on the third day to avoid risking the loss of embryos that tend to be very delicate when outside the body. With a larger number of embryos, the doctor has more flexibility in allowing development until day 5. You will be notified as soon as the decision has been made, but you will need to be available to undergo the procedure on either the 3rd or the 5th day.
NUMBER OF EMBRYOS TRANSFERRED
First, a few comforting words: The days of “litters” of babies are over. The norm is to transfer a maximum of two fresh embryos. In fact, in a situation in which Intended Parents know that they only want one child at a time, the trend, increasingly, is to transfer only one embryo. This is commonly referred to as eSET, or Elective Single Embryo Transfer. Moreover, you will participate fully in the decision of how many embryos to transfer. The decision concerning the number of embryos to transfer, while typically made on the day of the transfer, is an important part of the matching process.
A number of factors will affect this decision:
- Uterine Lining: If your lining develops to the optimal thickness, then the likelihood of pregnancy increases and the doctor can transfer fewer embryos.
- Embryo Grade: All embryos are not created equal. The higher the quality of embryos, the fewer number that will be transferred.
- Fresh or Frozen Embryos: Fresh embryos are more likely to result in a pregnancy in many clinics, so if the doctor is transferring fresh embryos, the doctor will typically transfer a lower number than if s/he is transferring frozen embryos.
- Day 3 or Day 5 Embryos: As noted above, by the fifth day, Blastocysts (5-day embryos) have had longer to develop and therefore the doctor has a better idea as to which ones are viable. In fact, many embryos that may have appeared viable at day 3 do not survive to become Blastocysts. As a result, when using the stronger Blastocysts, the doctor will only transfer one or two without reducing the chance of success.
Based on all these factors and guided by the advice of the doctor, you and the Intended Parents will make a joint decision with the guidance of the reproductive embryologist regarding how many embryos to transfer.
We typically add the following phrase to this part of our Surrogacy Agreements: “ . . . and in no case will the number transferred be greater than that which Gestational Carrier is comfortable.” If that sentence gives you, the Gestational Surrogate, comfort, then it has served its purpose.
THE TRANSFER PROCEDURE
You will travel back to the clinic where you had your original medical screening, along with a travel companion to help you after transfer. The Transfer Procedure is not a surgical procedure. You are awake and no anesthesia is needed. There is no pain. Indeed, in most cases it does not feel much different from a pap smear. Nor does it take much longer! Some clinics will ask you to lie quietly for 30 minutes or so afterwards. In your surrogacy agreement you will agree to relax and not get up except to use the rest room for the remainder of the day.
Within an hour of the embryo transfer, you will be driven home or to your hotel, where you are asked to rest for the remainder of the day, getting up only to use the bathroom.
We will also ask you to have a “quiet day” on the 6th day after the egg retrieval (that is, either 1 or 3 days after your embryo transfer), because that is the day when the embryos are believed to securely attach themselves to the uterine wall. This precaution is simply to maximize the likelihood of a pregnancy.
Following the embryo transfer, you must continue taking the progesterone injections precisely on schedule in order to prevent your body from rejecting the fetus until the placenta is fully formed. After all that you and the Intended Parents have gone through, the last thing anyone wants is a miscarriage! You must also continue to take the Estrogen.
In 10-12 days, you will have a blood test or “Beta” test. Often these will be at a local laboratory. We ask that you go as early in the day as possible to maximize the chances of receiving the results in the same day. Hopefully, the results will show that you are pregnant!
A CAUTION ABOUT HOME PREGNANCY TESTS
You will be tempted. Everyone is tempted! The problem, however, is that there is a relatively high chance that the test will show a false negative, especially if you take it too soon. Let us give you some real life examples: One of our Gestational Surrogates took a home pregnancy test that came out negative. Two days later she learned by blood test that she was in fact carrying – and has since delivered – twins! Another of our carriers tested negative at home the morning of a positive beta test. That baby girl has subsequently been delivered. So, if you simply cannot wait, please don’t despair over a negative home test. There is a good chance it could be wrong. Whatever you do, keep taking your medicines as directed!
Hopefully, your official Beta test will indicate a pregnancy. That will be your first of many blood tests. Your clinic will continue its monitoring for two reasons: First, they want to make sure you have a strong pregnancy, by confirming that your hormone numbers are climbing (they should be doubling every couple of days). Second, they want to make absolutely sure that you do not have an ectopic (tubal) pregnancy. It is much safer for you to have this diagnosed as early as possible.
If you do become pregnant, you will continue to take estrogen and progesterone for 6-8 weeks after the positive pregnancy test. As we have said, without the medicine, your body will reject the baby until the placenta is fully formed.
Finally, you will have an appointment for your first ultrasound – usually 6-8 weeks after your pregnancy was confirmed. The Intended Parents will want to be there with you if possible. Not only is it very exciting to see the fetus for the first time, but it is also the point at which the doctor will be able to determine how many embryos have implanted.
If the doctor sees a healthy heart beat (or two!), the doctor will wean you from the progesterone and discharge you to your OB/GYN. If there is anything that gives the doctor pause, or if there are two heartbeats, you will likely be asked to come back for a follow-up appointment before you are discharged to your own OB/GYN.