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About Frozen Embryo Transfer (FET)

The transfer of frozen embryos to the uterus is similar to the fresh IVF cycle. However, the preparation of the uterine lining does not include expensive gonadotropin medications and hyper-stimulation of the ovaries. Studies have shown that Assisted Hatching improves outcome and we perform this on all transferred embryos.

1.  Basic Timeline for FET

Generally a 2 month period is required for FET:

Month 1:  
  Begin Lupron
Month 2:  
  Estrogen and Progesterone priming, then embryo transfer

2.  Medications to stimulate receptive endometrium.

A. Lupron (Luprolide acetate- 2 week kit)

Lupron acts upon the pituitary gland in the brain to alter the secretion of FSH and LH (the two hormones responsible for egg development and ovulation). Initially Lupron will cause increased secretion of the two hormones, with a subsequent rise in estrogen secretion. Continual administration of Lupron, however, will lead to a suppression of the pituitary hormones, with subsequent drop in estrogen production and suppression of the ovaries. In FET, Lupron will not allow ovulation and let us control the development of a normal uterine lining.
Administration: Lupron is taken as a subcutaneous injection, once per day, beginning on or about cycle day 21 in the month prior to egg retrieval.
Side effects: headaches, fatigue. mood-swings. hot flashes. delayed onset of your period, bruising or irritation at the injection sites.

B. Progesterone

This hormone will act upon the lining of the uterus (the endometrium) to make it receptive for embryo implantation. There is a window of implantation that requires appropriate estrogen and progesterone stimulation. Progesterone is vital for endometrial development and continued embryo support. It is absorbed by the body most efficiently through intramuscular injections.
Administration: Intramuscular injections as noted on the protocol. Intravaginal Progesterone may reduce uterine contractions.
Side effects: breast tenderness, soreness at the injection sites, delayed onset of your period (even in the absence of pregnancy).

C. Pre-natal vitamins

Studies have shown that increasing the intake of folic acid prior to conception helps to decrease the chances of certain spinal cord defects in babies. It is also a good idea from a general health point at view to be on these multi-vitamins prior to and throughout pregnancy. Administration: 1 tablet per day, usually at bedtime.
Side effects: stomach upset, nausea and constipation.

D. Methylprednisolone (Medrol)

This steroid hormone is sometimes taken when the Assisted-Hatch procedure is being done in conjunction with the Embryo transfer. It is taken to suppress any inflammatory reaction that might occur between the embryo(s) and the endometrial lining.
1 (16mg) tablet by mouth, once per day, or 4 (4mg) tablets. by mouth once per day.
Side effects: fluid retention.

Embryo Transfer

The procedure to place the embryos into the uterus is referred to as the “embryo transfer”. It is normally performed after 4 days on progesterone support in the FET protocol. The transfer is done in the procedure room and does not require any sort of sedation or medications like the egg retrieval.

We will ask you to arrive 30-45 minutes prior to the scheduled procedure and change clothes in preparation for the procedure. We may have you take a Valium 10 mg pill to help you relax one hour before the transfer. Additionally, you will place the progesterone suppository in the vagina when you awake in the morning at home. This may help the uterus soften and not contract during the transfer procedure. The placement of the embryos into the uterus is done with ultrasound guidance, but this time, the ultrasound will be done abdominally. It will be necessary, therefore, for you to have a moderately full bladder when Dr. Donahue performs the transfer. Plan to drink 2 to 3 glasses (8 ounces) of fluid about an hour before the scheduled transfer time.

Husbands are encouraged to be present for the transfer procedure. Dr. Donahue will cleanse the cervix and vagina, similar to the retrieval procedure, and then do a test pass of a catheter into the uterus. Once this is comfortably done, he will instruct the embryologist in the lab to “load the embryos”. At this time, they are removed from the incubators, placed into the transfer catheter, and brought into the transfer room. Dr. Donahue will pass the very slender catheter through the cervix, and guide it to the proper location in the fundal area of the uterus. You will be able to watch on the ultrasound monitor as the embryos are expelled from the catheter into the uterus. The embryologist will then check the catheter under the microscope to be sure it has been emptied of the embryos.

In order to give the uterus ample time to calm down, and the embryos a chance to “settle down”, we will keep you in recovery for about 1 hour after the transfer. You will need to lie flat for this time. Once discharged, and for the next 2 days, it will be important for you to keep your activity to a minimum. You should plan to rest on the couch, recliner, or in bed as much as possible. Activity restrictions for the next two weeks will include:

  • No heavy lifting or strenuous exercise
  • No hot-tubs or Jacuzzis

Some studies have suggested that you should have regular intercourse during this period. It is possible that seminal fluid has factors that may help with implantation. Progesterone and Estrogen levels will be checked one week later. A blood pregnancy test can be performed at 14 days after the transfer. if you have not started a period by that “target date”, please call the office to make arrangements for testing. Keep in mind that it is possible to have not begun a period by the target date, and still not be pregnant. This is due to the large amount of progesterone you will be taking for those 2 weeks after the FET. Progesterone can cause a delay in the onset of a menstrual period. If the blood test is positive (>5.0). we will want you to have a second pregnancy test in two more days. This second test lets us know if the pregnancy is developing normally, and gives a clue about the possibility of twins. Progesterone levels will also be checked on these positive tests- and Dr. Donahue will adjust your continued need for progesterone and estrogen support accordingly. If your blood test is negative, or if you start a full period, we will instruct you to stop the progesterone injections. A period should start (if it hasn’t already) within 3 to 4 days of stopping the shots. Those patients who experience an unsuccessful cycle are strongly encouraged to come in for a follow-up consult with Dr. Donahue to review and discuss the cycle and future options.


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Phone:  317-865-0411 and 317-595-3665