Preparing for our First Frozen Embryo Transfer

Today the blizzard “Stella” hit NYC as a late winter storm. As the city sits quietly under a blanket of snow and ice, it feels like an amazing gift – a blissful day of sleeping late and catching up on my thoughts, which currently are: “holy shit they’re putting a baby inside of me next week!”

Our first frozen embryo transfer is officially slated – and I’m still wrapping my head around that fact. A frozen embryo transfer (FET) is a procedure in which the frozen embryos from a previous IVF cycle are thawed and then transferred back into a woman’s uterus. 

There are two different protocols for FETs: a Natural FET and a Medicated FET. A natural FET allows the body’s natural menstrual cycle to do its thing without the assistance of medications. When the patient approaches ovulation, she begins daily monitoring at her clinic to determine the precise date of ovulation. Once ovulation is detected, the patient’s uterine lining is ready to receive the embryo transfer 5 days later, since this is the approximate time when the embryo would have naturally arrived in the uterus on its own. (This is for embryos frozen on day 5 in a previous IVF cycle. Embryos that are frozen on day 3 are transferred 3 days after ovulation).

A Medicated FET is much more involved, as it requires injections, pills, and patches to prepare the endometrium for embryo implantation. First a patient must prevent her body from going through its own ovulation cycle. This is done by birth control pills and down-regulation drugs like Lupron a month prior to the transfer. Closer to what would have been her natural ovulation point, the patient begins to take estrogen and progesterone to prepare her endometrium lining for implantation. These drugs are continued after the transfer and until approximately 10-weeks of pregnancy.

Note: Pregnancy rates have not been shown to differ significantly between a Natural FET and a Medicated FET.

It may sound crazy, but I initially wanted to do a Medicated FET. Although it’s way more work and money, it seems almost silly to count on my “natural systems” now after everything else has been so strictly controlled via medications and rigorous monitoring. However, Dr. M. recommended that we do a Natural FET since I have completely normal ovulation cycles and no issues with my endometrium lining.

Yesterday began my first day of monitoring at the clinic, but the gravity of what we’re about to do didn’t really hit me until today. I was staring at the calendar and realized that I could ovulate as early as this Saturday. This would mean that my transfer would be just five days later, which would be Thursday…as in next Thursday. Eeep! I then took it one step further (as one does) and went to this IVF calculator site to plug in my potential transfer date. When I hit “calculate” it read, “Congratulations, today you are one week and two days pregnant!”

As strange as that sounds (particularly because I’m sitting here very un-pregnant) pregnancy is calculated from the first day of your last period before conceiving. If this transfer works next week, this statement is technically true. And then it really hit me: THIS. IS. REALLY. HAPPENING. 

The reality of this transfer has also snuck up on me since we’ve decided to keep it a secret from family and friends. For the past few weeks I’ve acted so nonchalant and breezy about the whole thing, saying how we “might consider” a transfer in April or May. Perhaps this ruse has manifested itself into my actual mindset because now I can’t believe that it is really here.

I’m also very cautiously optimistic about the outcome. I’ve never been pregnant before and I’m not entirely confident that this embryo is going to automatically implant on its own. I do trust my doctor, but I’m also very cognizant that IVF transfers often do not take – particularly the first time.* The fact that we’re doing this without any medications also seems more dubious. *I have no facts to back up this claim other than what I’ve “heard” from others. Indeed, I know the opposite to be true, since each IVF transfer is considered an independent event, with the same probability of success each time.

I do feel significantly more at ease knowing that we have three embryos to make this work. Further, each embryo has successfully grown into a day 5 blastocyst and passed PGS testing. Some clinics quote a 63% live birth rate with a transfer of one PGS normal embryo, and as high as 80% for 2 normal PGS embryos. When you consider that a woman has about a 30% chance of conceiving when trying naturally every month, these feel like some pretty good odds! 

I’m happy to report that we’ve had a great past few weeks on our mental and physical vacation from IVF. We’ve hit all of our goals, including 5-weeks of my workout program and enjoying family and friends. I feel refreshed and clear-headed and ready to rock this frozen embryo transfer.