Knowledge is power. And with three back-to-back embryo transfers under my belt, I feel equipped to share what I wish I knew before attempting any IVF transfers. In a perfect world, all information would be clearly presented to patients before the onset of any IVF procedure, and patients wouldn’t have to depend on the “trial and error” of their own experiences. But, unfortunately, there’s a dearth of information in this industry and even the best clinics simply fail to equip patients with all the options and facts. This post aims to arm an IVF sister with the knowledge that I wish I had before undergoing our three frozen embryo transfers.
What I Wish I Knew Before IVF Embryo Transfers
1) Blind Transfer vs. Ultrasound Guided Transfer:
Would you prefer that your doctor be blind when he performs a medical procedure on your body or would you prefer that he can see? This one may seem super obvious, but it was not for me, as I (naively) assumed that any doctor who performs something as delicate as a transfer of an embryo into your uterus would certainly use the tools to visualize it.
Pro tip: Don’t assume anything.
Unless deemed a tricky transfer, my IVF clinic only performs “blind” embryo transfers, which means no ultrasound equipment is used to visualize the uterus. This requires the patient to be inverted at a 90-degree angle (with your head toward the ground) as the doctor performs the transfer using only his “mind’s eye.” Not only is this position awkward for the patient, it also causes more discomfort as the doctor uses your uterine walls as his guide.
My first transfer was done this way and I found it painful and shocking. I never thought a medical procedure in 2017 would entail being turned upside down while a doctor blindly bumped around my uterus.
I never thought a medical procedure in 2017 would entail being turned upside down while a doctor blindly bumped around my uterus.
When Dr. M. called to follow-up post procedure, I expressed my concern and she immediately said: “We do all of our transfers blind because that is how each of our doctors are trained. But since you found it uncomfortable, we will make sure that you have an ultra-sound guided transfer moving forward.”
So wait…there’s an option? Why wasn’t I informed of these choices from the beginning? When you’re investing so much time and money into one very high-stakes procedure, this information should be given to you in bold freaking print.
For those that have been told that an accredited doctor can perform blind transfers just as well as ultrasound guided, this article from Fertility File sums up nicely why that’s just not the case:
Doing a perfect embryo transfer is a challenge for many reasons. Not every uterus is the same. Some tip forwards. Some tip backwards. Some are longer. Some are shorter. Some women have a cervix that is so tight that it will require some forceful dilation to open up. Some have a twisting cervical canal that will require tricky navigation to traverse. The name of the game is to place the embryos in the right place, as gently as possible, without taking too long and without touching the fundus (the top of the uterus).
Imagine taking an empty non-transparent bottle, laying it on its side and blindly poking a pair of tweezers into the mouth of it, with the hopes of dropping a grain of rice into a spot exactly 2 cm away from the bottom of the can. Now imagine doing this without being able to see the entire bottle and without knowing the exact size and shape of the bottle. You can only see the opening and once your tweezers pass through it, your view is obscured and you can only operate by touch.
Now how much easier do you think it would it be if you had a special camera that could show you exactly where you are at all times?
Guess what? Medical science does have a “special camera” and it’s called an ultrasound. Make sure your clinic uses one!
2) Natural Transfer vs. Medicated Transfer:
When doing a frozen embryo transfer you can either do a “natural transfer,” in which you use your body’s own cycle, or a “medicated transfer,” in which a cycle is “programmed” for you via the use of drugs. I believe that this is a personal choice and each patient should do what they feel is best for them. However, make sure that both options are clearly laid out for you in the beginning. Without any review of our options, our doctor suggested doing two natural transfers back to back, even though I expressed interest in starting with a medicated transfer.
During my natural transfers, my body felt so “natural” to me that I kept wondering: “Is this thing on?” Even with the use of progesterone suppositories, my body felt completely normal, and thus completely unsupported. Each time our natural transfers failed, I was not surprised since it almost felt like we had done nothing at all.
Conversely, the minute I started protocol for the medicated transfer I began to feel changes in my body that felt completely aligned to preparing for an embryo transfer. The drugs – particularly the progesterone in oil injections – instantly affected me and I felt amazingly receptive and fertile. It also must be mentioned that we did achieve several positive pregnancy tests during this transfer, if only for a brief 48-hours.
Overall, I regret not “trusting my gut” and insisting that we try a medicated transfer in the beginning. I feel like we wasted our two best embryos on the natural transfer and used our weakest embryo on the transfer that was best for my body.
Pro tip: Learn all that you can about the two transfer techniques before deciding which one works best for you.
3) Your Doctor vs. The On Call Doctor:
Large fertility clinics have a “you see one doctor, you see them all” approach to your individual treatment there. This means that although you have a personal doctor whom you will be communicating with on a one-on-one basis, your daily monitoring sessions and blood work will be conducted by whomever is attending that day. This never bothered me before. My clinic and its doctors are some of the best in the country and I loved the idea that I’d be receiving the benefit of their collective minds and expertise. However, after three failed transfers, with three different doctors, I don’t feel this way anymore.
Pro Tip: Request that your doctor perform your transfer.
My first two transfers were performed by the attending doctors on those days. Although both were professional, nothing could compare to the individualized treatment I received from Dr. M., who performed my last transfer. She just did the job at hand more carefully, more slowly, and with much more determination. Rather than a number amongst the many transfers scheduled that day, I am an actual person to Dr. M. – a person with hopes, with past failures, and with a lot on the line. She knows my story and she has a vested interest in my success.
I’m in no way implying that the other attending doctors didn’t perform up to par. But I was a number to them – not a person – and there’s no substituting the quality of care a patient receives when they’re viewed as an actual human being.
Conclusion: Be Your Own Health Advocate
The single most important lesson I’ve learned throughout this endeavor is to unabashedly be your own health advocate. No one – not your doctor, not your nurse, not your spiritual advisor – is as invested in the success of this undertaking like you are; and you must speak up or push back whenever you feel it’s necessary.
This may sound easy to some, but voicing your opinions and pushing your agenda within the intimidating, often male dominated, medical office is often harder than you might think. But once you find your voice and use it, you’ll become an active player in your own medical journey.