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Frozen Embryo Transfer

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Frozen Embryo Transfer India,Cost Frozen Embryo Transfer Delhi  India,Cost Frozen Embryo Transfer Mumbai India,Frozen Embryo Transfer, Frozen Embryo Transfer, Frozen Embryo Transfer Mumbai Bangalore Delhi India,  Frozen Embryo Transfer Hospitals, Frozen Embryo Transfer Surgery Center, Frozen Embryo Transfer Clinic, Frozen Embryo Transfer Surgeons IndiaThe timing of the embryo transfer depends on a number of factors including the cell stage of the embryo when frozen and uterine receptivity. It is essential that a Frozen cycle procedure form be completed and returned to the clinic well before the scheduled thaw date.

Protocols for Frozen Embryos Transfer

Hormone preparation for FET

Using hormones to prepare the uterus is the most common way in which a frozen embryo transfer is performed. The first step is to suppress the pituitary gland. This is necessary to reduce the chances of ovulation occurring unexpectedly. Typically, Lupron is used for pituitary suppression. For most women, this will require approximately two weeks of daily Lupron injections.

The second step in a frozen embryo transfer cycle is to use hormones to duplicate the changes that normally occur in the uterus during a regular menstrual cycle. This requires the use of two hormone medications: estrogen and progesterone.

Estrogen preparation for FET

During a normal menstrual cycle, estrogen is produced by the developing follicle. This estrogen acts on the uterus to thicken and mature the uterine lining. Estrogen is given in a FET cycle for the same reason.

There are many different ways that estrogen can be given in a frozen embryo transfer cycle : -
  • Estrogen pills - Estrace, Premarin
  • Estrogen patches - Estraderm, Climera
  • Estrogen injections - Delestrogen (estradiol valerate), Depogen (estradiol cypionate)
  • Vaginal estrogen - Vagifem, Femring
There is no data that any one method works better than another and a method is usually chosen based on physician preference. We like to use estrogen pills since it is easy to do, inexpensive and very well tolerated.

During the time when estrogen is given, the woman will come to the office periodically to be monitored. A transvaginal ultrasound is performed to determine the thickness of the uterine lining and a blood test is performed to look at the level of estrogen in the blood. On occasion, if the lining is not thickening as it should, the dose or type of estrogen must be increased or prolonged. The length of time the estrogen can be given is very flexible. During this phase, for example, the duration of estrogen may be prolonged to delay the day of embryo transfer to accommodate the patient's schedule.

The monitoring in a thaw cycle is very flexible. Unlike a fresh IVF cycle during which the required days for monitoring are determined by the growth of the follicles in the ovary, in an FET cycle, the days can be adjusted at any time. Thus, a frozen embryo transfer cycle is much less stressful on the patient.

Progesterone in an FET cycle

Once the uterine lining has been thickened sufficiently, progesterone is added. Once the progesterone is added, the Lupron may be stopped. Progesterone matures the uterine lining and makes it receptive to an embryo to implant. Once the progesterone is begun, there is a certain "window of implantation" during which the embryo must be transferred. The stage of the embryo must match the stage of development of the uterus. Therefore, the only factor that locks the patient into performing the transfer on a certain day is starting the progesterone. Once the progesterone is begun, if the embryo transfer is not performed on a certain day, the cycle must be cancelled and a new preparation with hormones must be begun after allowing a period to occur.

There are many different types of progesterone that can be used in a frozen embryo transfer cycle. Some of the more common methods include : -
  • Progesterone pills - Prometrium
  • Progesterone injections
  • Progesterone vaginal suppositories
  • Progesterone vaginal gels - Crinone, Procheive
There is considerable uncertainty in the medical literature concerning which type of progesterone is the best for FET cycles. Again, the choice of progesterone for an FET cycle is up to the discretion of the physician. A few things, however, most experts would agree on. Progesterone given by mouth is unreliable due to variable absorption and subsequent metabolism in the liver.

In our practice, we give progesterone as intramuscular injections and with a vaginal gel. In this way, we can ensure that we have used whatever method of progesterone is ultimately determined to be the best.

Once the uterine lining is adequately thickened with estrogen, the progesterone is usually started on a particular day to allow for scheduling of the embryo thaw and embryo transfer for a time that is convenient for the in vitro fertilization laboratory staff.

In our practice, we commonly freeze embryos at the blastocyst stage. This is an embryo that has developed for five days in the laboratory. It must be placed into a uterus that has been exposed to progesterone for five days. Our protocol is to start progesterone on a Sunday and then thaw and transfer the blastocysts on a Thursday, in the afternoon. This allows my laboratory staff to be able to prepare ahead of time for all of the frozen embryo transfer cycles on one day. The afternoon transfer allows them to thaw the embryos in the morning, assess for viability during the day, thaw additional embryos if necessary and still have the transfer the same day.

FET during a natural cycle

If a woman has regular, ovulatory menstrual cycles, a frozen embryo transfer can be performed without the use of hormone preparation. Several studies have shown that the pregnancy rates in natural FET cycles are equivalent to that of hormone prepared cycles. In practice however, these cycles are much more difficult logistically to perform.

In the section above, it was stated that there is a precise window of implantation for transferring frozen embryos. This must be maintained in a natural FET cycle as well. This requires precise determination of the time of ovulation. This can be done by using a home ovulation predictor kit. However, as anyone who has ever used these kits knows, it is sometimes difficult to read them accurately. Although the instructions accompanying the ovulation kits usually recommended that women test the urine once each morning, for FET cycles we recommend testing in the morning and evening. It is also possible to monitor natural cycles using blood tests and ultrasounds just as we do for a hormone prepared frozen embryo cycle.

Unfortunately, during a natural cycle, we cannot control the day of ovulation. If the day of embryo thaw and transfer falls regularly on a Sunday or holiday, the laboratory staff will become very unhappy.

Frozen Embryo Transfer

This brief, painless procedure involves the doctor placing a catheter that has been loaded with a selected number of embryos by the Embryologist, through the cervix and into the uterus to deposit the embryos. When possible Blastocyst transfers are done, which occur around day five of embryonic growth. Blastocyst transfers allow a more mature embryo to be transferred, allowing the Embryologist to select fewer embryos for transfer, achieving a high pregnancy rate with a lower risk of multiple gestations above twins. Occasionally, cleavage stage, day three of embryonic growth transfer are done at they recommendation of the Embryologist based on the quality of the embryo.

When more eggs are retrieved than needed, we can freeze them for future use (cryopreservation). Embryos can be frozen at any stage between day one and day six after egg retrieval and can be stored for up to five years. We offer frozen embryo transfer at our Valencia, Beverly Hills, and Burbank offices to allow you the chance of conception when the time is right for you.

The frozen embryo transfer process is less invasive than standard egg collection. Frozen embryo transfer can be done during your natural cycle, or we may need to control your cycle with medication depending on whether we can monitor the time of your natural ovulation. The embryos are placed into your uterus at the time of ovulation and the when the thickness of the endometrium (lining of your uterus) is right.

Before the frozen embryo transfer can be performed, your embryos will need to be thawed so the age of the embryos corresponds to the age of your uterine lining. The timing of frozen embryo transfer usually depends on the stage at which the embryos were frozen.

Not all embryos survive the cryopreservation process. Before the frozen embryo transfer, we will evaluate your embryos to make sure they are ready for transfer. If they are, then the frozen embryo transfer can go forward.

The embryo transfer is usually performed two days after ovulation. During the procedure a catheter is inserted through the cervix and the embryos are placed injected into the uterus. The frozen embryo transfer usually takes about 15 minutes.

The success rate of frozen embryo transfer is almost as successful as standard IVF. Success depends on several factors, including the number and quality of embryos, your age, and the cause of infertility.

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