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  » Infertility  »  Risks to the child from intracytoplasmic sperm injection (ICSI)

The embryo transfer procedure is the last one of the in vitro fertilization process. It is a critically important procedure. No matter how good the IVF laboratory culture environment is, the physician can ruin everything with a carelessly performed embryo transfer. The entire IVF cycle depends on delicate placement of the embryos near the top of the endometrial cavity.

In order to get sufficient eggs for IVF, the woman is first stimulated with injectable medications to develop multiple egg development. The eggs develop in structures in the ovaries called follicles. Each follicle contains one egg and can be seen on ultrasound.When the follicles are mature, the egg aspiration procedure is performed to remove the eggs from the ovary. Sperm is mixed with the eggs about 4 hours after the egg aspiration, and the following morning we check the eggs for evidence of fertilization.The fertilized eggs (now called embryos) are cultured in the laboratory for 1-5 more days and then an appropriate number are selected for transfer to the woman's uterus. We usually transfer 2 to 4 embryos - see below for more details.

The embryo transfer procedure seems very similar to a Pap smear for the woman. There should be no pain involved and no sedation or other drugs are required .

The embryo transfer catheter is loaded with the embryos and the physician puts it through the cervical opening up to the top of the uterine cavity. The embryos are then "transferred" (squirted out of the catheter) to the lining of the uterine cavity (endometrial lining) by the infertility specialist physician.

Easy embryo transfer
Ultrasound image from just before release of the embryos from the transfer catheter. Same image: Wallace catheter containing embryos shown along yellow dots, uterine lining outlined in green, entire uterus outlined in blue, cervix in red, metal speculum in vagina along orange stripe at top right. The embryos were released from the catheter tip at the yellow dot furthest to the left.
Difficult embryo transfer
The uterus is sometimes a little "tricky". Here it is distorted by myomas (fibroids), making the embryo transfer itself - and visualization with ultrasound difficult. Same image: Uterus outlined in red, myoma in blue, endometrial lining outlined in green. Catheter needs to place embryos between green lines - in the orange area.

The catheter is then withdrawn and checked under a microscope for any retained embryos.The woman usually stays on her back for about 1 hour before going home. We suggest that she also limit physical activity for the remainder of that day. This means hang out on the couch or in the Lazy-boy recliner - watch videos, read, boss hubby around, etc...

About 11 days after the transfer (for day 3 transfer), we do a blood test on the woman to find out if she is pregnant.

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Laparoscopic image of a polycystic ovary

 

Enlarged polycystic ovary following laparoscopic cauterization

The polycystic ovarian disease, anovulation, and induction of ovulation pages have more information related to this condition