The fertilized oocytes are further cultured up to day 2 or 3, and then embryo transfer is performed. When a large number of embryos have been formed, alternative approaches could be either an extended culture to the blastocyst stage. A transfer is performed on day 2, day 3 or blastocyst stage.
Instructions for Embryo Transfer:
- The patient is informed of the fertilization rate, the number of available embryos, and the number of embryos selected for the transfer.
- The patient is assured that the ET is a simple procedure. If she is very stressed, it is better she takes Alprazolam of 0.5mg.
- The previously taken US picture of the uterus and the Mock ET is revised to get an idea about the length and direction of the uterus and the degree of cervico-uterine angulation.
- The patient is put in the lithotomy position and the cervix is visualized using Cusco’s speculum.
- The cervix and the vaginal vaults are cleaned of cervical mucus and vaginal secretions using tissue culture media and sterile gauze.
The ET catheter is flushed with tissue culture medium, and then filled with the transfer medium. The transfer medium is aspirated first and then the embryos are aspirated next. The loaded ET catheter is introduced through the cervix to pass the internal os and then gently advanced in the mid-uterine cavity and stopped from 1–2 cm short of the fundus. The screw of the vaginal speculum is loosened so that the two valves of the vaginal speculum apply a gentle pressure on the portio-vaginalis. At this moment, some patients experience suprapubic heaviness and discomfort. After one to two minutes, when this complaint disappears, the embryos are ejected and pressure is kept on the plunger of the syringe while slowly withdrawing the catheter out. The speculum is kept in place for an average of seven minutes and then removed. The catheter is checked for any retained embryos.