Fertility Docs Uncensored is hosted by Dr. Carrie Bedient from the Fertility Center of Las Vegas, Dr. Susan Hudson from Texas Fertility Center, and Dr. Abby Eblen from Nashville Fertility Center. In this episode, we discuss everything patients should know when preparing for a frozen embryo transfer (FET). From what to do the day before to how the procedure is performed, we cover the steps to help make the process as smooth and stress-free as possible. We answer all of your questions about what to do before, during, and after the procedure. What should you do to prepare before coming in for a frozen embryo transfer? Why is staying well hydrated the day before so important? Which routine medications should you continue, including those for high blood pressure, diabetes, or thyroid conditions? What types of clothing are recommended for comfort during the procedure? What happens when you first arrive at the clinic? Why is a full bladder necessary for the transfer, and what happens if it is too full? How is the embryo transfer procedure performed, and how is the catheter prepared and loaded? What should you expect immediately after the procedure? How soon can you get up, use the restroom, and go home? What activities can you resume that day, and are there any restrictions? Understanding these steps helps reduce anxiety and improve the overall experience of a frozen embryo transfer.

Episode Transcript:

Susan Hudson (00:01)

You’re listening to the Fertility Docs Uncensored podcast, featuring insight on all things fertility from some of the top rated doctors around America. Whether you’re struggling to conceive or just planning for your future family, we’re here to guide you every step of the way.

Susan Hudson MD (00:22)

Hello everyone, this is Dr. Susan Hudson from Texas Fertility Center with another episode of Fertility Docs Uncensored. I’m here with my gorgeous, gleeful, and gregarious co-host, Dr. Carrie Bedient from Fertility Center of Las Vegas.

Carrie Bedient MD (00:36)

Hello.

Susan Hudson MD (00:38)

and Dr. Abby Eblen from Nashville Fertility Center. How are y’all doing today?

Abby Eblen MD (00:41)

Hi everybody.

Carrie Bedient MD (00:45)

Good. How are you?

Abby Eblen MD (00:45)

Doing good.

Susan Hudson MD (00:47)

Doing good, doing good. It’s kind of chilly here in Texas, which is a little unusual. What’s it like in your neck of the woods?

Abby Eblen MD (00:56)

It dipped down really chilly here. It was kind of warmish and then all of a sudden you get up the next day and it’s like 30 degrees lower. It makes it even colder when you’re not, used to it. When it drops suddenly, I think it’s the worst.

Carrie Bedient MD (01:08)

Mm-hmm. I left for work the other day and it said feels like 11 degrees And I and I did not move to Las Vegas for that.

Abby Eblen MD (01:14)

my gosh, this is Las Vegas. my gosh.

Susan Hudson MD (01:15)

So talking about leaving your house, I have a question. other than the obvious thing like your purse, your wallet and your keys or however you drive your vehicle nowadays, what is something that you don’t generally leave the house without?

Abby Eblen MD (01:36)

I always like to have lip balm and a little thing of hand lotion in my car because invariably I’m driving to work and I’m like, my hands feel really dry because we all wash our hands quite a lot in our field and invariably I want to at least start the day with nice hands that are soft and smooth. I wash them so many times during the day they get drier and drier by the end.

Carrie Bedient MD (01:55)

Say if I’m gonna grab anything extra, sometimes lip balm, but I’m terrible about remembering to put stuff on. So it usually doesn’t hit my pockets. AirPods are probably the next biggest thing that get shoved in my purse or my pocket or whatever. If I get five minutes and I can listen to a podcast or read the news or do whatever stupid social media waste of time that I’m doing at that particular moment that I can do that without bothering anybody else. And it blocks out everybody else’s noise, which is really delightful. What about you, Susan?

Susan Hudson MD (02:26)

That is true.

I would say probably my Stanley. It’s kind of funny because I historically have not been a very good water drinker in my life. And I guess about four years ago now, someone gifted me a Stanley and I was like, okay, I’m going to actually start using it. I’m good about it. I bring it

And what I find is there were times that I was kind of feeling bad in the past and I think I was actually feeling dehydration. And now when I start feeling that way, I’m like, I need to drink something. And especially when we’re doing consults, wow, the amount of dehydration you get from just talking can be absolutely amazing.

Carrie Bedient MD (03:13)

What color is your Stanley?

Susan Hudson MD (03:17)

My current Stanley is white with some pink writing on it.

Abby Eblen MD (03:21)

I was going to say, I thought you got a Stanley for Christmas last year.

Susan Hudson MD (03:26)

I have gotten that, that’s the one I got for Christmas back in 2024. But I really, really do like it. And I really liked the glass straws you can get. I know there’s some crazy stuff out there on the internet about people who are not intelligent using glass straws. They really are moderately indestructible.

If you need to have your coffee labeled as this is hot, perhaps you should not use a glass straw.

All right, well, let’s do a question today. Our question is, I have a question about IUI after endometriosis stage two removal. I’m 30, my husband’s 31, AFC is 16, AMH is 0.9, all other diagnostic tests were normal.

Only thing slightly off was my husband’s tests with morphology under 4%. Our lifestyle is great and we’re taking all the recommended supplements. We initially were diagnosed with unexplained until my gyno found and removed my endo at 99%. We only have six months to try naturally or with IUI. Do we have a good chance of success with IUI in this timeframe or should we cut our losses and go straight to IVF?

Carrie Bedient MD (04:45)

Those are very incongruent numbers. An AFC of 16 at 30 years of age, totally normal, that jives. The AMH of .9 doesn’t make sense. It makes me wonder if she’s maybe been on birth control pills for a long time, which will not permanently alter your AMH, but will depress it for a little while, so it can lead to a result that’s lower than normal. But this doesn’t quite…track. I wonder if when they did their surgery if they were taking out a big ovarian cyst, but she said it was stage two and a cyst automatically pumps it to stage… well I thought it was three, three and then four, that’s bilateral. But I don’t quite understand those numbers and the big thing that pops in my head is if they want more than one kid and our AMH is truly that low, yes cut your losses go to IVF. If you only want one I think you’ve got wiggle room.

Abby Eblen MD (05:37)

I wonder if the AFC count was done maybe a few months ago, and now maybe she’s had an endometriosis surgery and they’ve operated on the ovary. Because I have seen people that have had endometriosis surgery and their AMH is much different after the surgery than before they started surgery. But I do think her age is still helpful.

She’s still gonna have an egg every month if she has regular cycles. So she may wanna try three or four cycles of IUI. I don’t think there’d be any negative to that. She may or may not get pregnant, but if she does, she’s won the ballgame without having to go to IVF. But I wouldn’t wait a long, long time because endometriosis will come back. If you were having surgery because you had pain or you had a big endometrioma, that’s potentially gonna come back the longer you wait.

I think you could go either route, but I think three months of doing IUIs wouldn’t be the end of the world in somebody that’s 30.

Susan Hudson MD (06:30)

Yeah, I totally agree. Some of it has to do with what your goals are. If you’re wanting two, three, four children, then I would probably go straight to IVF. I don’t think that doing intercourse at this point in time is what I would recommend. I would recommend probably two to three cycles of ovulation induction with IUI or intrauterine insemination. And if you’re not pregnant in that timeframe, you need to go to IVF and, and really kind of be aggressive at that point.

Carrie Bedient MD (06:57)

I wonder what the timeframe is about that we have six months to accomplish this. And I wonder, is that a self-imposed timeframe or is that a timeframe imposed by the military or a job or insurance timelines or something like that?

Susan Hudson MD (07:11)

I almost got the feeling of that they have six months since surgery. So that’s the timeframe that it’s least likely to recur is almost the vibe I was getting.

Carrie Bedient MD (07:22)

All right, so that’s a little bit better than, we have six months before Partner gets shipped off to XYZ, a locale that is nowhere within bedroom distance.

Susan Hudson MD (07:27)

Yes.

Exactly, exactly. So if you have something other than just trying to get this done before endometriosis recurs, then faster, better IVF.

Carrie Bedient MD (07:43)

Yeah, agreed.

Susan Hudson MD (07:46)

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Susan Hudson MD (08:59)

Well, today we are going to talk about what exactly happens in an embryo transfer. It’s a very intense 15 minutes and it sounds crazy that we’re talking about it, but I think it’s something that actually causes a lot of people anxiety, even people who have already been through their trial embryo transfer.

not really completely getting what part is real and what part is something that’s not exactly the way it’s going to be the day of the embryo transfer. So let’s start off with morning of the embryo transfer. You wake up, what are things you should do or not do at home?

Abby Eblen MD (09:43)

Let’s start out the day before the embryo transfer. And I would say, and I was telling my patients the day before, try and drink a lot of liquids. You don’t have to just slam the liquids, but you want to be really hydrated because one of the key things is in order for us to be able to see at the time of the transfer, because we have to have your bladder full, we’re working vaginally, so we have to be able to see abdominally. Sometimes, and this is particularly common in the summertime, patients will come in, and they’ll drink and drink and drink and drink and drink and we keep looking going, okay, you gotta drink more and they’re like, but I’ve drunk five bottles of fluid and so I think a lot of times what happens, it’s kind of like if you’re already dehydrated and you’re not really full of fluid, you start to drink and it just, all your cells are like, I’ve got fluid now and it starts almost like a sponge, it starts absorbing all the fluid. Eventually, if you get hydrated enough, your bladder gets full enough and then we can start to see what we need to.

But if you’re really well hydrated the day before, if you come in and say you’re not very full, as long as, you if you drink a bottle of water, you’re probably gonna be fine. Your kidneys are gonna start working and get that urine in your bladder. I would say start the day before, drink a good amount of fluid, check your urine if it’s, clear, very light in color, then you’re probably right where you need to be.

Susan Hudson MD (11:00)

Now we tell all of our patients about doing all the good lifestyle things. One of those lifestyle things is decreasing your caffeine intake. But we all have patients who have more caffeine than we would necessarily recommend. And if you are one of those really cutting down that caffeine in that time period, and really hydrating, I can think of one patient in particular who I knew was a huge caffeine consumer and she was exactly like you described, Abby. She kept on drinking fluid, kept on drinking fluid and she was so dehydrated from her chronic caffeine intake that we couldn’t get her, the only way we could take care of a full bladder was realistically putting fluid in the bladder. And we’ll get to that in a little bit, but absolutely, absolutely. Okay, day before embryo transfer.

Get a good night’s sleep. Carrie anything else you can think of.

Carrie Bedient MD (11:57)

Make sure you’re taking your medications as your clinic is prescribing them. And this is gonna differ from clinic to clinic, because we all have our own particular favorites. In general, it’s gonna be making sure you’re taking your progesterone. There will be some people who have you add in extravaginal that day. There will be people who have you take additional medications for anxiety before your transfer. Just make sure you have…whatever it is that your clinic’s protocol is, because it will differ from clinic to clinic, and it may even differ from one transfer to the next. And even if you had one two years ago that was totally fine, and you’ve got a baby and you’re coming back from a second one, always cross-check and make sure that you have what you need to have in-house before you go so you don’t get super stressed out and run around after. Which, if you do, is not gonna cause a problem, but it’ll make you more stressed, and who needs that?

Susan Hudson MD (12:48)

I just thought of another one. If you or your partner are sick, letting us know the day beforehand is very, very valuable. That will help us know whether or not we think it’s a good idea to move forward for embryo transfer that morning. Your embryo has not been thawed the day before. And so if you’re ill or your partner’s ill and you’re like, I don’t know if this is a good idea.

waiting until the morning of is not fantastic because you could call us the morning of and your embryo may have already been thawed and though not the end of the world, it’s not the preferential status would prefer. We would much rather if you gotten ill or your partner has gotten ill and you’re like, I don’t know if this is a good idea, call us that day even if you need to call us in the evening.

This is one of those things we would rather know because we can call the embryologist and say, hold tight, we’re not going to do this. Or we may give you reassurance and be like, ⁓ this sounds okay. I think it’ll be fine to move forward. But, if in doubt, this is definitely one of those give your doc a call so that they can make that audible before the day.

Abby Eblen MD (14:05)

And also too, if this happens to be baby number two, make sure you have childcare lined up, reliable childcare, because I think it’s unfortunate when your partner comes and you have another child and a lot of times a lot of clinics don’t want you to have a baby in the room, even the pre-op holding area. And sometimes partners have to wait in the car with the child and they don’t get to go to the transfer. Just make sure you have reliable childcare lined up if you have another baby.

Susan Hudson MD (14:33)

and be taking your prenatal vitamins. I can’t even name the number of times that we come in and we’re going through all the medications and I’m like, where are your prenatals? I need to start those. Yes, every time I’ve seen you, I’ve said to start prenatal vitamins, you need to start prenatal vitamins.

Carrie Bedient MD (14:37)

Yes.

Patients think that I’m just completely flaky and not paying attention because every time I’ll say, you taking your prenatal vitamins? And they’re like, yeah, I started them last time like you told me to. And that’s fabulous. That’s great. You are sometimes the only person that day who has said that.

Susan Hudson MD (15:08)

Absolutely. Okay, so now you wake up the morning of your embryo transfer and you are at home. What are some things you should or should not do?

Carrie Bedient MD (15:20)

Don’t light up a cigarette and don’t start smoking or vaping or any of those things. And again, it seems obvious because by that point, your clinic has probably told you a dozen times, hey, you should probably stop that. But now is not the time to continue that. For our clinic, we always do one last set of labs and ultrasounds that morning. So making sure you get to that appointment early. And we schedule that very early because we want to be able to thaw the transfer, thaw and prepare for the transfer with plenty of time. And so that instruction is going to vary from clinic to clinic. But for us, we want to make sure you’re there bright and early so our lab has plenty of time to thaw.

Abby Eblen MD (15:59)

Make sure you take the medicines that you need. That means thyroid medicine. If you have high blood pressure, we get really nervous when you roll in with a really high blood pressure, even if you haven’t accidentally forgotten, didn’t take your medicine. If you’re diabetic, make sure you take medicines for that as well. We don’t want your sugars to be really, really high when you come in for your transfer.

Susan Hudson MD (16:19)

Definitely eat and drink something. This is not one of those appointments where you have to have nothing to eat or drink after midnight. This is we don’t want you being uncomfortable and hungry. We don’t want you being thirsty. This is we really want to focus on you being in a very good zone. With whenever you are showering either the night before or the day of. Nothing scented. Do not put all of your essential oils on. Do not use your Aveda hair products that smell gorgeous, but everybody in the entire office can smell. Like we really, really don’t want anything scented.

It sounds so obvious, but I don’t know how many times they’ll be like, no, I just sprayed something on my shirt. it’s avoid the sense because embryos do not like those particles in the air. Exactly.

Carrie Bedient MD (17:15)

Mm-hmm.

All of us have very, or labs have very expensive air filtration systems and they do a fabulous job, but that applies primarily to the lab where they sit most of the time. And if it’s on you, it doesn’t matter how well the treatment room is ventilated, there’s stuff that we can’t ignore. That’s definitely an important one. And that goes for your partner as well. Sometimes women are totally fine and the guys put on their cologne and it’s potent.

Abby Eblen MD (17:21)

Yes, and it kind of goes without saying, but every office has a different protocol for when to empty your bladder. Some people may say, it may depend on how far away from the clinic you are as well. But again, give yourself time to fill your bladder up. If you wake up in the morning, go to the bathroom, make sure you have plenty of time and you’re drinking liquids. The good news, as Susan was saying, we want you to eat.

We want you to drink. Most people are not thirsty when they come in. They’re the opposite of thirsty because we’re making them drink so much liquid. But just make sure that you’re well hydrated when you get there.

Susan Hudson MD (18:16)

Very good. Also wear something comfortable and it depends on the clinic. Some clinics are going to have you undressed from the waist down. Some clinics will have you totally undressed and have on the hospital gown. But this is probably not the day to wear a onesie or a jumper that everything’s all connected. Again, you know, it’s some things you just don’t necessarily think about.

But, having a dress or something that’s two pieces that you can separate can often be helpful. Anything else before you leave the house?

Carrie Bedient MD (18:55)

I think that’s all of the big stuff that I can think of.

Susan Hudson MD (18:59)

Make sure you have a driver because realistically, a lot of clinics are going to offer to give you medicines to help relax the uterus like Valium or something like that, that you should not be driving afterwards. Besides the fact that you don’t really need to be stressing out about traffic. So recommend having a driver. It’s a good thing to do.

Carrie Bedient MD (19:25)

It is also okay if you are not taking those medications to be your own driver if you need to. If your partner is taking care of childcare at work or somewhere else and your option is for you to drive yourself and it’s not your clinic’s policy to give you something that might be a mind-altering drug in any way, then you are good to drive. It’s not gonna impact your success rates. A lot of this is related to convenience for you and what makes you more comfortable.

Susan Hudson MD (19:53)

Absolutely. We get to wherever you’re going to have your embryo transfer performed. What happens when you get to the clinic or the surgery center?

Carrie Bedient MD (20:04)

Many people are going to check your ID and cross check your name and ask your birthday and it’s going to be the front desk person and it’s going to be the nurse and it’s going to be the embryologist and it might be another doc or a nurse or somebody else. We’re going to ask you a bunch of times. Again, we are communicating with each other. We are not crazy. We are not senile. It’s identification is super important at all visits, but especially this one. We’re going to cross check your name. Make sure you’ve got your ID on you. And when you get there and they put that cute little wristband on you because jewelry is always fun, make sure that that is truly everything as it should be. Birthdate, spellings, all of it.

Abby Eblen MD (20:47)

You’ll be brought back to the area that they do the transfers in. Many people do transfers in the same procedure area where they do retrieval. You may be familiar with that area. You’ll be asked to undress and like Susan said, it’s different for different clinics. Oftentimes someone may look at your bladder before you go back. I like to do that for my patients because I want to make sure really your bladder, sometimes people get have a really full bladder and I look at it and I go, my gosh, how did you even do that? How can you tolerate that? And then other times people feel like they have a really, really full bladder and then you look and there’s hardly anything in there. It’s always good to kind of look ahead of time. Just be prepared. It will be an abdominal ultrasound and that way it’ll give your clinic some idea of whether or not they need to give you more liquid or if they need to let you get up and empty a little bit before you go back.

Carrie Bedient MD (21:32)

When you are there, if you have filled your bladder and you are doing the, I gotta pee, dance, and it hurts, and you really, really hate it, please let us know. A lot of times we can say, yeah, empty your bladder, count to 10, and we’ll recheck you. And most of the time for people who are that full, that is totally fine. Now some people do have smaller bladders where, we really can’t have you empty, but most of time for someone who’s doing a serious rendition of the I Got a Pee dance, your bladder is super full and you’ve got room to empty a little bit. And we don’t particularly want to torture you. And if you need to empty a little bit, count to 10, let things go, and then clamp down and stop, which is its own special kind of obnoxious.

That’s okay. Let us know so that you’re not dying if you’re waiting, especially if the clinic is running 20 minutes behind. That’s okay. We don’t want you suffering unnecessarily from I got a P syndrome.

Susan Hudson MD (22:27)

Who are some of the main people that you’re going to talk to before your embryo transfer?

Abby Eblen MD (22:34)

Probably the key person you’re gonna wanna talk to is the embryologist. The embryologist is gonna come in and let you know how things turned out in the lab when they thought your embryo. They’re gonna let you know what the grade of the embryo is. They’re gonna be able to answer kind of any questions about, kind of that embryo. They’ll mention things about things that they see with the embryo. And if you have questions about that, often they’ll show you a picture of it and can explain kind of what that means when they say that there’s something extra there, or cells doing a certain thing, they can explain it to you when they’re in room with you.

Carrie Bedient MD (23:05)

Sometimes that information is communicated by the doctor because embryologists are fantastic in the lab. Not all of them do a whole lot of communicating with people. And sometimes they’ll just come in, scan your bracelet and keep going. And it’s your doc that’s got all that information. But that varies a lot by, not just by clinic, but by individual embryologist.

Susan Hudson MD (23:24)

Another thing that I would also recommend, and this is mainly if you’ve done multiple cycles, but I think it’s good to have a good knowledge of your embryos. And what I’m meaning by that is know what your cycle ID number is. Every IVF cycle has a cycle ID number.

Have an idea of what that number is. If you know which embryo is supposed to be transferred because you’ve chosen it based on certain results, whether it’s grading or if it’s due to PGT results or the chromosome testing results. I think that having some personal information about that is, it’s a good double check. I can say 99.9 % of the time this has been checked

a bajillion times and we have neat devices called matcher and things like this to help prevent anything from falling through the cracks. But I also think that there is a level of good personal responsibility of making sure you know what should be happening as well that day.

Carrie Bedient MD (24:32)

The other piece of information that you may get at that point is if another embryo had to be thawed. And a lot of times this is information you’ll know going in the door, but not always. And what happens is when they thaw the embryo, they’re going to check and make sure it survived the thaw. And the vast majority of embryos will. And it’s unusual that one flat out does not survive, but it can happen. And so sometimes they’ll have to thaw another one.

Our clinic tends to watch them for a couple of hours and make sure that they’re fully expanded before we put them back, because we want to make sure that the machinery is working. You’ll get that information as well, just to stick that in your knowledge banks of make sure you ask not only is this my embryo, but did you have to thaw any extras? Because in the bustle of that day, you want to make sure you know that information.

Susan Hudson MD (25:21)

Okay, so you go into whatever room you’re going to have your embryo transfer performed in and what’s going to happen?

Abby Eblen MD (25:33)

Matcher is gonna kick in. It’s a way to look at your ID, make sure that the embryo that the embryologist has ready for transfer has a little barcode on it. And there’s different versions of this, but with Matcher, that’s what we use. And the embryologist will come in and scan your bracelet so that they know who you are and the number on your bracelet should match what they scan, the barcode that they scan that’s on the Petri dish with your embryo to make sure when you get in the room that that’s your embryo. And I think that’s a really important step and is something over the last couple of years that’s really made this a safer process. That’s number one. The nurse will probably speak with you as well if you’ve not already met her, but you probably will have met her at that point. And then in our room, we’ll start getting you prepared and draped for the transfer. And then the embryologists will bring the embryo in the Petri dish in our lab with us. Sometimes there’s sort of a window thing where the embryologists can hand the embryo through the window or someone will carry the embryo over. Different ways that’s done, but essentially everything will get prepared for the actual transfer of that.

Carrie Bedient MD (26:36)

Normally when you’re sitting there, you lay back, put your feet up in the position you know so very well by that point, scoot your bottom down to the edge, have to be told again, yes, come scoot further because it’s the law of gynecology offices. I don’t think we’re not allowed to say that when we’re doing an exam on someone. And then we’ll start to place things. But at that point, looking around you, you’ll have likely a nurse in the room, there’ll be an embryologist either in there or nearby, you’ll have your doc, and you’ll have an ultrasonographer who are all kind of in that area hanging out waiting to do their thing.

Susan Hudson MD (27:10)

Okay, so you’re in the position and we’ve placed the speculum. What happens then?

Abby Eblen MD (27:16)

So the cervix is cleansed and I’m sure different doctors do different cleaning techniques, but essentially we kind of wipe away cervical mucus using culture media that your body can tolerate and the embryo can tolerate quite well. Sometimes we’ll take Q-tips and clean out the cervical canal. Sometimes we’ll even irrigate out the canal with a little bit of fluid. If in some practices, if we think it may be a difficult transfer, in other words, if we’ve done sort of a practice transfer ahead of time and we know that there’s a curve in the cervix or something that can make it difficult. In our practice, and I know in many other practices, sometimes ahead of time we’ll have you come in and we’ll put a stitch right in the cervix. And so if you think of the cervix as a round circle with a little hole in the middle of it, which is where we would transfer the embryo, we put a stitch, a single stitch, just like the kind that you would get if you had a cut on your arm and you went to the emergency room. We put just a single stitch there, we tie kind of an air knot and we use those strings to kind of manipulate and move the cervix. And so again, this takes place the day before, a few days before we tuck the strings in the vagina so you don’t feel them. On the day of transfer after we’ve washed and cleansed the cervix, we’ll take those little stitches and we’ll be able to use those just sort of as a way to kind of give counter-traction to your cervix and help manipulate kind of where the cervical canal is to help out. So once all that’s in preparation or has been prepared, then you’re ready for the transfer generally at that point.

Susan Hudson MD (28:39)

Okay, and leading into kind of pre-transfer versus transfer. This is something that is going to vary from doctor to doctor, practice to practice. When we describe what we do, realize that there’s a lot of different variations. Do you guys do a preload type of situation where you place a trial catheter first?

Abby Eblen MD (29:04)

I usually do, yeah.

Carrie Bedient MD (29:05)

Typically what I’ll do is I’ll place a stylet under ultrasound guidance and I’ll get right to the internal loss of the cervix, which is the internal end of the tunnel. And then once we see that, I’ll take the stiff part of it, the guide, and we’ll just leave the little tunnel so that when I get the actual catheter, which is like a pretty limp noodle of spaghetti, I can guide it through easily.

Susan Hudson MD (29:30)

Abby, how do you do it?

Abby Eblen MD (29:32)

Exactly like Carrie. Yeah, I usually, sometimes I use a stiffer catheter, sometimes I use a regular catheter, but I make sure that the empty catheter is right at the internal opening. And the way I describe it to patients, I always say, it’s kind of like if you’re going into a football field, have to go through the narrow tunnel to get to the wide open football field. And sometimes the tunnel into your cervix can be different than the tunnel into a football field in that it can be curvy and twisty.

So I wanna get through that and once I get to the opening there, then it’s pretty easy to thread the catheter straight on through and release it up in the uterine cavity.

Susan Hudson MD (30:04)

And during this timeframe, the ultrasound or the nurse who’s doing the ultrasound does have the abdominal probe on your tummy. And that can be a little uncomfortable because of that full bladder, but know that we’re really wanting to have good visualization because the least traumatic we can make the embryo transfer the better success rates we can have. So we have the little sheath around the catheter in place and then what is the embryologist doing?

Carrie Bedient MD (30:36)

Once we state that it’s in place, what we’ll do is the nurse or however far away your embryologist will communicate with the embryologist saying, okay, we’re ready. And that’s because they don’t take the embryo out of its nice warm happy home until we are 100 % set in the room. So that means that if there’s a surprise with the cervix, every so often you’ll get in and there’ll be twists and turns that weren’t there before when you did whatever your prep was.

And that’s okay because we have all the time in the world that we need to take our time and get through there.

We can switch around catheters, we can adjust, whatever we got to do because that embryo is safe and warm and happy in its nice little home. Once we are totally ready in the room, we let the embryologist know and in the lab, they’re going to take the embryo out. Typically, they’re doing one last check with another embryologist to confirm the name. They’ve already done the electronic check, so there’s manual check as well, and they are loading up the embryo into the catheter.

The way that they do this is with a little bit of fluid or media that the embryo has been cultured in. Very safe, very easily tolerated. There’s usually just a tiny, tiny amount of fluid in there and they drop the embryo into the end of the catheter and will then very carefully bring it in, usually with the nurse in front of them to hold the doors to make sure there’s nobody in the way. In general, these transfers happen in the back part of the lab, the office, the operating room where there’s really not a lot of traffic. It’s of low concern, but they’ve usually got somebody in front of them clearing their way to make sure they’re set.

Susan Hudson MD (32:15)

Okay, so then the little catheter is essentially handed over and usually held by both embryologists and physician at the same time. That little catheter is gently threaded through the sheath and on ultrasound, oftentimes these catheters are embedded with little fibers or other technology that make them be bright so you can have good visualization on the ultrasound and we introduce that catheter up into the uterus ideally with the tip being about a centimeter from the top. Once we get into that position what do we do?

Abby Eblen MD (32:39)

Little bit of milk. Yeah. We then release the embryo into the uterine cavity. And so I tell patients when I push the plunger, I can’t see the embryo come out, but when the catheter is loaded, most embryologists will load a little tiny air bubble at the tip so that when I push the plunger gently, the embryo comes out gently and you can see the little air bubble come out and sometimes even kind of float up depending on kind of where you release it. In order to make certain though that the embryo did actually get released, even though we saw the air bubble come out, we’ll hand the catheter back to the embryologist. The embryologist will take it back and look under basically the microscope to make sure that the embryo actually got released. So I tell patients, we’ll kind of be in limbo for a couple of minutes and that’s normal. Don’t think something bad has happened. It’s just the embryologist should be really careful to double check and make sure the embryo didn’t get stuck to the tip of the catheter. Because remember when we do the transfer, we put the catheter up through the cervical canal and there’s a lot of mucus there.

And we do as best we can to get rid of as much of that mucus as we can. But sometimes if there’s a little bitty tip or a little bitty tiny amount of mucus on the tip of the catheter, it’s sometimes when we release the embryo, can get stuck there in that mucus. As long as we recognize that, that’s okay. And so we really want the embryologists to take their time and look really closely and just make sure that the embryo didn’t get stuck for some reason. It’s very unusual for it to happen, but it can. And if it does, it doesn’t mean all is lost. We just need to…reload it again and put it back up inside the uterine cavity.

Carrie Bedient MD (34:24)

How many times have you guys had a retained embryo, same embryo, that’s had to get placed back in?

Abby Eblen MD (34:29)

Not often, maybe once every couple of years or so.

Carrie Bedient MD (34:33)

I’m thinking about how many times has the embryologist walked back in, said embryo is retained, bring it back in, place it, they walk back, embryo is still retained. How many times have you had to do an embryo transfer on the same person in the same half an hour timeframe just to get the embryo in?

Susan Hudson MD (34:52)

I think that’s happened to me. It was a retained embryo and I tried to pass it again and it still was retained and I had to do it essentially a third time. I think I remember doing that one time in my entire career.

Abby Eblen MD (35:04)

We recently had a catheter that we switched to and it was more prevalent for that and that happened a couple of times actually. I’ve switched back to the catheter I use before now, but it can happen.

Carrie Bedient MD (35:15)

I remember I had one, and this is several years ago now, where that embryo stuck four times. Yeah. Four times. Yeah, well, no, it was sticky. And that baby stuck too. And I always wanted to go back and ask her, like, is this child super, super stubborn because of how many times? I mean, we were in there for forever. Yeah, just is. Sticky little guy.

Susan Hudson MD (35:23)

That was stubborn! Stubborn!

Abby Eblen MD (35:36)

It did not want to come out of the catheter.

Susan Hudson MD (35:41)

Absolutely, no it it happens and I mean I think there’s pretty good evidence to say it really doesn’t change success rates It’s just we have to recognize it now the one thing I would like to mention is during that time frame that the that the catheter is getting flush that little moment We generally keep the speculum in place. So unfortunately, I think that’s probably almost the worst part because you’re like, woohoo, we’re done. I’m gonna get to be able to sit up and go to the bathroom. It’s like, hold tight for just a moment. Let’s make sure everything is where it needs to be. But once we get that reassurance from embryology, then generally we take out the speculum and we actually let you sit up. You do not need to stay laying down. And why is it that we let you sit up?

Abby Eblen MD (36:10)

Yeah.

Well actually we don’t always do that. We generally take our patients back into bed, so it’s maybe a little bit different, but within three or four minutes, five minutes, you’re back in room and you can sit up.

Carrie Bedient MD (36:38)

The upshot is that most of the time when we’re having you stay laying down, it’s not because there’s any data for it. It’s as much to make everyone feel psychologically a little bit better because that embryo is going to be floating around for the next 12-ish hours, six to 12 hours anyway. And so there’s nothing that we do when we place it that actually glues it or buries it in place. It goes in there and it floats around for a few hours and then it’s going to take its sweet time to implant and go where it wants. So you could stand up right away and do jumping jacks and you’d be fine.

Abby Eblen MD (37:16)

One time when I was at one of our national meetings in American Society for Reproductive Medicine, someone won a prize video because they videoed somebody every five minutes for maybe three hours. And it must have had to be somebody that worked there. I don’t think a patient would have wanted to stay for three hours, but they videoed him every five minutes and then they put it to Fly to the Bumble Bee, that song that’s like, da-da-da-da-da-da. And you could see the air bubble just like go everywhere. the air, and don’t know for sure that the embryo did that as well, but if the…If the air bubble did that, probably the embryo did that as well. like Carrie just said, we can put the embryo in there. There’s no way we can stick it or glue it to the wall. It’s gonna do what it’s gonna do. But our goal is just to get it up in the big part of the cavity so it can find a good place to implant.

Carrie Bedient MD (38:00)

One of my standard set of instructions slash reminders for patients is it is impossible to poop pee, cough sneeze, laugh or giggle an embryo out. So you’re good.

Susan Hudson MD (38:11)

I was just about to say, can you pee your embryo out?

Abby Eblen MD (38:14)

No!

Carrie Bedient MD (38:15)

Nope.

Sometimes you will see a little bit of extra fluid there, especially depending on how much media we’ve had to use to clear out cervical mucus and whatnot. That is nothing to worry about because the amount of fluid that we are using to put the embryo in is so minuscule and it is so far up there. It’s not going to come out and even if it did, it is so tiny you would never notice it. And if you’re actually noticing fluid come out, it’s either because your bladder is super full and you’re peeing on yourself, which no judgment. We ask a lot and we’re fully aware of it. And if you pee on your doctor, you’re not gonna be the first one nor will you be the last one. Don’t worry about any fluid or mucus discharge that you see at that time. It’s pretty normal.

Susan Hudson MD (38:49)

That is true.

Abby Eblen MD (38:55)

One last word I wanted to add, and this doesn’t happen often, and Susan alluded to this earlier too, every now and then we’ll have a patient who just cannot keep her bladder full, she’s just miserable. And so sometimes what we can do, and sometimes I think psychologically it makes people feel better, maybe physically not as much, but we can put a catheter in the bladder and we can actually fill the bladder, and that way we can control how much is in there. Right after we do the transfer, we can immediately just let…the catheter empty your bladder so it’s not full. But sometimes that’s the best solution for people who really truly have a bladder that just can’t hold a lot of fluid. I some people will have instability of the muscle that releases urine and sometimes people just can’t hold that much urine. And if you’re in that category, let your doctor know and they can talk to you about that.

Susan Hudson MD (39:42)

And if you can’t get your bladder full, we can actually put in a little catheter and put water back into your bladder. And we’ve all done that and we like to avoid it if we can, but again, it’s not a big deal. All right, You are done with your embryo transfer. What would be your advice for the rest of the day?

Abby Eblen MD (40:03)

McDonald’s french fries are good and you can stop and eat some, but it’s probably not gonna change your outcome.

Carrie Bedient MD (40:10)

Same with pineapple. I always tell my patients, get your Netflix ready, be prepared to binge whatever your favorite program is. You have doctor’s orders to be a bump on a log. You do not have to be a bump on a log. And if you are getting up, sitting at the table, going to the bathroom, walking around the grocery store, just kind of basic stuff, no, we don’t want you running a marathon that day or riding roller coasters or going mountain biking or all these wild and crazy things.

You can pretty much live your life mostly normally.

Susan Hudson MD (40:39)

What are your thoughts about traveling the day of your embryo transfer if you have to get back home and your embryo transfer is a distance away from your home?

Abby Eblen MD (40:50)

Probably fine. As long as you do kind of normal things, it’s probably okay. If you feel like it’s gonna be really stressful, you’re gonna be sitting in an airport, you’re worried about missing your flight, maybe it might be best just to kind of take a day wherever your clinic is and then go back the next day. But probably it’s really not gonna make a difference at all.

Carrie Bedient MD (41:07)

We all have patients who are coming to us from all over the country, all over the world. There is long flights, there’s long road trips, all those things. You’re just fine. If you are on those hormones and you’re going to be sitting for a long time on a flight or in the car, do your ankle pumps, roll your ankle, get your calf muscles going, wear your compression stockings, stand up and walk every hour if you have the ability while you’re awake and pay attention to that. Stay well hydrated. But you’re good to travel. It’s not going to do anything one way or the other, whether it’s car or flight or train, if that exists.

Susan Hudson MD (41:41)

All right, well, I think we did a great job at talking all about what actually happens on the day of embryo transfer. And to our audience, thank you so much for listening and subscribe to Apple Podcasts to have next Tuesday’s episode pop up automatically for you. Also be sure to subscribe to YouTube. That really helps us spread reliable information and help as many people as possible.

Abby Eblen MD (41:44)

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Carrie Bedient MD (42:17)

Check out our Instagram and TikTok for quick hits of fertility tips between weekly episodes. And as always, this podcast is intended for entertainment and is not a substitute for medical advice from your own physician. Subscribe, sign up for emails, and we will talk to you soon.

Bye.