Embryo Transfer

Who Needs Embryo Transfer?

Embryo transfer is a critical part of fertility treatment for: 

• Couples with male or female factors of infertility (e.g., blocked fallopian tubes, ovulatory disorders, low sperm count),
• Women who have previous experience of recurrent pregnancy loss,
• Couples with unexplained infertility,
• Patients needing preimplantation genetic testing (PGT) to test embryos,
• Single women or same-sex couples using donor eggs or sperm, and
• Women with poor ovarian reserve need embryo transfer with donor eggs.

Overall, embryo transfer is usually the last step of the IVF cycle for most patients seeking assisted conception.

Types of Embryo Transfer Procedures

There are a number of embryo transfer procedures, classified based on where the embryo comes from and at what embryonic (developmental) stage it is transferred.

Fresh Embryo Transfer

When the embryos are transferred in the same informed cycle as the egg retrieval, usually on Day 3 or Day 5 post-fertilisation.

Frozen-thawed Embryo Transfer (FET)

When the embryos are cryopreserved (vitrified) first, and are then transferred in a later cycle. Embryos could be transferred in a natural cycle or a hormone-controlled cycle. The time taken for a patient to plan transfer and FET can be useful for embryo banking, pre-implantation genetic testing (PGT), or when the uterus is not ready for transfer immediately.

Day 3 (Cleavage Stage) Embryo Transfer

When the embryos have reached 6–8 cells, they can be transferred on the third day after fertilization, so generally suitable in patients with few embryos available or embryos slow to develop. 

Day 5 (Blastocyst Stage) Embryo Transfer

When the embryos have developed into blastocysts, they have a better chance of implantation. Day 5 transfer is preferred for patients who have several good-quality embryos.

Pre-Procedure Evaluation and Diagnostics

Before embryo transfer, an evaluation is done to maximize the chance of success. The main areas of evaluation include:

• Uterine Evaluation: This is usually done by transvaginal ultrasound, hysteroscopy, or saline infusion sonography to evaluate the endometrial lining and to exclude abnormalities in the uterus.
• Hormones: This is the measurement of estrogen and progesterone to confirm the endometrium has become receptive at the time of transfer.
• Semen Analysis: This is a measure of semen quality in the case of fresh transfer.
• Embryo Quality Assessment: Embryologists evaluate embryo growth, cell symmetry, and fragmentation to select the best embryo(s) for transfer.
• Endometrial Thickness Measurement: Typically, 7–10 mm is considered optimal for implantation.
• Preimplantation Genetic Testing (PGT): Optional screening for genetic conditions or chromosomal abnormalities.

The evaluations help to decide the appropriate timing and approach for embryo transfer.

Selection and Surgical/Procedure Planning

The decision regarding embryo transfer is made in consultation with the fertility specialist and embryology team. Planning considerations include:

• Whether to use fresh or frozen embryos
• Day 3 vs. Day 5 transfer based on embryo development
• Number of embryos to transfer to balance success rates with the risk of multiple pregnancies
• Elective single embryo transfer (eSET) for reducing the risk of twins or triplets
• Patient’s hormonal response and uterine receptivity

Blastocyst transfer and frozen embryo transfer are increasingly preferred due to higher success rates and improved endometrial synchronization.

Embryo Transfer Procedure

Embryo transfer is a simple, outpatient procedure that does not require anesthesia.

1. Preparation - Estrogen and progesterone medications are given to prepare the uterine lining for implantation. 
2. Embryo Loading - The embryos are aspirated from the culture medium into the transfer catheter by the embryologist. 
3. Guided Transfer - Guided by ultrasound, the fertility specialist inserts the catheter through the cervix and into the uterine cavity. 
4. Embryo Deposition - The embryos are expelled into the uterus from the catheter, with the latter being withdrawn slightly at the time of deposition. 
5. Completion - The catheter is inspected for any retained embryos or signs of tissue or blood. The procedure is then completed, and the patient has to wait for two weeks to determine whether the implantation was successful or not. 

The entire procedure takes about 15–20 minutes and is painless for most patients.

Risks & Potential Complications of Embryo Transfer

Embryo transfer is generally very safe, but potential risks include:

• Mild cramping or spotting post-procedure
• Rare uterine infection
• Minimal discomfort during catheter insertion
• The risk of multiple pregnancies is increased if multiple embryos are transferred.
• Possible implantation failure despite good-quality embryos
• Emotional stress associated with waiting for pregnancy confirmation

Minimizing Risks:

• Elective single embryo transfer (eSET) is recommended to reduce the chance of twins or triplets.
• Careful embryo selection and precise ultrasound guidance improve safety and success.

What to Expect After Embryo Transfer?

Following embryo transfer, patients are advised to follow a balanced post-transfer care routine.

• Medications: Continued progesterone support is essential to maintain endometrial receptivity.
• Activity Guidelines: Light activity is permitted; patients are usually advised to avoid strenuous exercise, heavy lifting, or high-stress environments.
• Implantation Timing: Typically occurs within 3–5 days post-transfer.
• Pregnancy Test: A beta-hCG blood test is scheduled approximately 12–14 days after embryo transfer.

Some patients may experience mild spotting or abdominal cramping, which is usually normal but should be discussed with the treating physician.

Post-Procedure Recovery & Long-Term Care

The post-treatment phase involves close monitoring and emotional support.

• Hormonal Monitoring: Ongoing progesterone and estrogen levels are tracked to support the early stages of pregnancy.
• Follow-Up Ultrasound: Typically performed 2–3 weeks after a positive pregnancy test to confirm gestational sac and fetal heartbeat.
• Emotional Support: Counselling and support groups can help manage the emotional challenges during the two-week wait and beyond.
• Lifestyle Guidance: A balanced diet, moderate exercise, and stress reduction are encouraged.
• Long-Term Care: Regular antenatal follow-ups continue if pregnancy is achieved.

If the cycle is unsuccessful, the fertility team may recommend reviewing the protocol or considering another transfer using frozen embryos.

Embryo Transfer Success Rate in India

Embryo transfer success rates depend on multiple factors, including the patient’s age, embryo quality, endometrial receptivity, and laboratory expertise.

Reported success rates in leading Indian fertility centers:

• Day 3 Transfer: 35–45% per cycle in women under 35 years
• Blastocyst (Day 5) Transfer: 50–60% per cycle in women under 35 years
• Frozen Embryo Transfer: Comparable success rates to fresh cycles due to improved cryopreservation techniques

Elective single embryo transfer (eSET) with Blastocyst culture has significantly reduced multiple pregnancy rates while maintaining high success rates.

Cost of Embryo Transfer in India

The cost of embryo transfer in India can vary significantly based on several factors, including the clinic's location, the technology used, and the specific treatments involved. On average, patients can expect to pay between USD 4,000 and USD 7,500 for a complete IVF cycle that includes embryo transfer. However, additional costs may arise from medication, consultations, and any necessary pre-treatment tests. It's important to consult with various fertility clinics to get a clearer idea of the pricing structure and what services are included.

Why Choose India for Embryo Transfer?

India offers world-class fertility treatments with a combination of advanced embryology laboratories, experienced reproductive specialists, and cost-effective care.

• Internationally trained fertility specialists and embryologists
• Advanced technologies like time-lapse embryo monitoring, laser-assisted hatching, and preimplantation genetic testing (PGT)
• Highly affordable IVF and embryo transfer packages compared to Western countries
• Rapid treatment cycles with minimal waiting times
• Dedicated medical tourism support for international patients, including visa assistance and multilingual care

Documents Required for Patients Traveling to India for Embryo Transfer

For international patients contemplating embryo transfer in India, it is necessary to present certain documentation to have a smooth medical journey. These include:

• Valid Passport: Valid for a minimum of six months after the date you travel.
• Medical Visa (M Visa): Granted by the Indian Embassy/Consulate on medical grounds.
• Invitation Letter from Indian Hospital: A formal letter explaining the course of treatment and how long it will last.
• Recent Medical Records: X-rays, MRIs, blood tests, and a referral note by a doctor in the home country.
• Completed Visa Application Form: With passport-size photographs according to specifications.
• Proof of Means: Bank statements dated in the past few months or health insurance.
• Medical Attendant Visa: Needed for a companion or caregiver traveling with the patient.

It is advisable to refer to the Indian consulate or your medical facilitator for the latest information and help with documentation.

NOTE: Single parents and same-sex couples should confirm legal requirements with the clinic before starting.

Top Embryo Transfer Specialists in India

Here are the leading specialists for embryo transfer in India. 

1. Dr. Firuza Parikh, Jaslok Hospital & Research Centre, Mumbai
2. Dr. Nandita Palshetkar, Fortis Bloom IVF, Mumbai
3. Dr. Kamini Rao, Milann Fertility Centre, Bangalore
4. Dr. Hrishikesh Pai, Fortis Bloom IVF Centre, Delhi, and Mumbai
5. Dr. Aradhana Kalra Dawar, Nova IVF Fertility, Delhi

Best Hospitals for Embryo Transfer in India

These are the top hospitals for embryo transfer in India. 

1. Nova IVF Fertility, Multiple Locations
2. Cloudnine Fertility, Gurgaon
3. Indira IVF, Multiple Locations
4. Apollo Fertility Hospital, Noida
5. Jaslok Hospital, Mumbai

Frequently Asked Questions (FAQs)

Is embryo transfer painful?

No, the procedure is generally painless, though mild discomfort may be experienced during catheter insertion.

How many embryos should be transferred?

Your fertility specialist will recommend the appropriate number based on embryo quality, age, and risk of multiple pregnancies. Elective single embryo transfer (eSET) is increasingly recommended.

Can I resume normal activities after embryo transfer?

Yes, light activities are permitted, but patients should avoid heavy lifting, vigorous exercise, and exposure to heat or toxins.

What happens if the embryo transfer is unsuccessful?

If pregnancy is not achieved, your specialist will review the cycle and may recommend adjustments or using frozen embryos in a subsequent cycle.

Can frozen embryo transfers be as successful as fresh transfers?

Yes, frozen embryo transfers now offer comparable or sometimes better success rates due to improved cryopreservation methods and better uterine synchronization.