Frozen (Cryopreserved, Vitrified)

Embryo Transfer
In Vitro Fertilization, Donor Egg IVF, and Frozen Donor Egg IVF treatments
can result in the creation of more embryos than you may wish to have
transferred. It is typically possible to cryopreserve (vitrify) these extra embryos
and store them for any length of time in liquid nitrogen. The stored embryos
can be thawed and transferred into the uterus at a later date.
We will let you know whether your remaining embryos are of high enough
quality for cryopreservation. Embryo cryopreservation and storage is done on
site.
The complexity and cost of a Frozen Embryo Transfer are less than repeating
a "fresh" cycle of treatment. A large majority of vitrified embryos will survive
the vitrification and thawing process. The implantation rate of the thawed
embryos is equal to the "fresh" embryo implantation rate.
Please give us a call when you decide to have your embryos thawed and
transferred.
Frozen Embryo Transfer procedure consists of:
A. Preparation of endometrial lining
B. Thawing and culture of cryopreserved embryos
C. Assisted embryo hatching
D. Embryo transfer
E. Implantation
 
This is an example of a Frozen Embryo Transfer treatment protocol. Your
treatment is always individualized and may take less or more time to
complete:
  

A. Preparation of Endometrial Lining

The treatment begins with taking oral contraceptives. They are started within
the first four days of the beginning of a menstrual cycle.

Seven days before the estimated onset of the next menstrual period, Lupron
injections begin. Oral contraceptives and Lupron "put the ovaries to sleep"
and temporarily stop their production of estrogen and progesterone. This
estrogen and progesterone secretion by the ovaries would interfere with the
development of the endometrial lining.

After approximately seven days of taking Lupron, you will start your menstrual
period. Within one to two weeks of the onset of the period, you will begin
taking estrogen in the form of skin patches. The progress of the development
of your uterine lining is monitored with ultrasound and your blood level of
estrogen.

When the endometrial lining is sufficiently developed, you will begin taking
progesterone in addition to estrogen. The addition of progesterone opens the
"window of receptivity" of your uterus and synchronizes development of its
lining with the developmental stage of your cryopreserved embryos.
Progesterone is given as vaginal capsules.
B. Thawing and Culture of Cryopreserved Embryos
You will need to decide and communicate to us how many vitrified/thawed
embryos you would like to transfer. Please let us know if you need help with
this decision.

Most patients should select one or two embryos for the thaw and transfer to
eliminate the risk of a high order multiple pregnancy (triplets or more). With
this approach, most pregnancies from cryopreserved embryos are single baby
pregnancies.

C. Assisted Hatching
Assisted Hatching is a laboratory procedure used to create a "weak spot" in
the egg shell of an embryo. Since embryo freezing commonly hardens the
embryo egg shell, assisted embryo hatching is always a part of the Frozen
Embryo Transfer treatment.
This picture shows an embryo after assisted embryo hatching with an opening
breaching the egg shell at 12 o’clock position.
 
  

D. Embryo Transfer
Transfer of cryopreserved embryos into the uterus is identical to "fresh"
embryo transfer: Just prior to the embryo transfer, the embryos are placed into
the tip of a thin embryo transfer catheter. The catheter is then passed through
the cervical canal to within 15 mm of the top of the uterine cavity, and the
embryos are gently released.

E. Implantation
After the embryo transfer, the endometrial lining gently holds the embryo(s) at
the top of the uterus. There is no restriction on your physical activity.

A blood pregnancy test is done ten days after the embryo transfer. If the
pregnancy test is positive, an ultrasound examination is scheduled two weeks
later to visualize the implantation site and to look for a heartbeat within the
embryo. Once a heartbeat is seen, there is a 95% probability that the
pregnancy will continue to a baby.

There is no increased risk of birth defects in pregnancies from cryopreserved

embryos compared with conceptions conceived through intercourse or using
"fresh" embryos.

Supplementation of estrogen and progesterone must continue until the

placenta produces enough of its own estrogen and progesterone to sustain
the pregnancy. You will be closely monitored for 6 to 8 weeks as this transition
takes place. Once all medications are discontinued, you will be referred to
your OB doctor for the remainder of your obstetrical care.

At this point, your pregnancy becomes indistinguishable from a conception

through intercourse, and your obstetrical care should be no different than if
you conceived without any treatment.