The most important of days…

REMINDER

The below can be found on the Monash IVF Australia website…

Stage 7: Embryo transfer

If your embryo develops in the lab, you’re ready for it to be transferred into your uterus.

Your fertility nurses will contact you to explain what you will need to do to prepare.

The embryo transfer is a very simple process, like a pap smear. It takes about 5 minutes, you’ll be awake, there’s no anaesthetic, and you can get up straight away. You can continue with your day, the embryo can’t fall out if you stand up or go to the toilet.

A scientist prepares your embryo by placing it in a small tube called a catheter. It’s critical this is done by an expert to disturb the embryo as little as possible.

Your fertility specialist places the catheter through your cervix and into your uterus. They use ultrasound guidance to pinpoint exactly where to place the embryo. An embryo is only 0.1 millimetre, and the specialist has a target area of approximately 1 millimetre to play with. If it’s placed in the wrong spot, the embryo may not ‘stick’ and there is a risk it’ll find a home outside the uterus.

DISCLAIMER
My blog is based on my personal experience. Our personal infertility journey. Everyone’s is different. I do not want to worry or upset anyone. I also know of many women extremely happy with the care they received or are receiving from Monash.

It was embryo transfer day. We had never done this before. We hadn’t gotten this far round one. We had been told it was a very quick and simple procedure. Somewhat like a pap smear.

I can’t remember the time of my appointment just that Anni had wanted me to arrive about an hour earlier so she could conduct a pre-transfer acupuncture session. I remember being excited. Jittery. Nervous. Her session helped calm and centre me. I would see her again post transfer for another acupuncture session intended to help settle the embryo and encourage implantation.

It was time to go in. But as most doctors’ do they were running late.

Whenever anyone is going to be probing my vagina I feel the urge to pee. This urge hit as soon as my name was called by one of the nurses. I quickly asked if it was ok to visit the bathroom before going in. The nurse stated it was. My bladder wasn’t exactly full I hadn’t been told to drink any water…

REMINDER
Before beginning IVF we had undertaken a fact finding mission. We’d undergone numerous tests looking for our fertility issue. I had even had a laparoscopy to rule out endo etc. During this surgery, my specialist discovered I have both an anti-verted uterus and a very tight /small cervix. This was told to me verbally and listed in my file.

FUN FACT:
The cervix is a cylinder-shaped neck of tissue that connects the vagina and uterus. Located at the lowermost portion of the uterus, the cervix is composed primarily of fibromuscular tissue. There are two main portions of the cervix:

  • The part of the cervix that can be seen from inside the vagina during a gynecologic examination is known as the ectocervix. An opening in the center of the ectocervix, known as the external os, opens to allow passage between the uterus and vagina.
  • The endocervix, or endocervical canal, is a tunnel through the cervix, from the external os into the uterus.

After my visit to the toilet Tristan and I were taken into one of the procedure rooms and greeted by our specialist. I scrambled up onto the chair, stuck my legs in the “holders” for lack of a better word and we got started.

There was a TV like screen up on the wall with our details displayed. We had to confirm our names etc. were correct. Next our blastocyst was shown to us on screen. I wasn’t prepared for how emotional this was. That little embryo was the closest we’d ever been to a baby. Looking at it produced a big lump in my throat. A lump made from hope, love, and heartache.

THE PROCEDURE
The text in italics has been copied off the internet. It explains the transfer procedure. The bold text in inverted commas is a recount of my experience.

The embryo transfer procedure starts by placing a speculum in the vagina to visualize the cervix, which is cleansed with saline solution or culture media. A soft transfer catheter is loaded with the embryos “One embryo as per our clinics policy” and handed to the clinician after confirmation of the patient’s identity. The catheter is inserted through the cervical canal and advanced into the uterine cavity. “This is where things became difficult. My specialist couldn’t get the catheter to pass through my cervix. I was in a lot of pain. Tensing. Gripping the bed. Crying. Bleeding. I distinctly remember her saying “oh that’s right you’ve got some endo don’t you?” To which I responded, “No you did a laparoscopy and didn’t find any, you said I have a tight service though.” She then removed the catheter handed it back to the embryologist who expelled our precious embryo back into the petri dish. A picture was again shot up onto the screen to prove I suppose it wasn’t still in the discarded catheter. I don’t remember much being said to us. Just that it can be difficult sometimes but not to worry she was going to try again with a different catheter. One that was curved. I remember Tristan asking if I was ok. Holding my hand. Our embryo was sucked back up and she tried again. More pain. Fuck a lot more pain. I remember gritting my teeth just wanting it to be over. Finally she declared it was in.”
There is good and consistent evidence of benefit in ultrasound guidance, that is, making an abdominal ultrasound to ensure correct placement, which is 1–2 cm from the uterine fundus. There is evidence of a significant increase in clinical pregnancy using ultrasound guidance compared with only “clinical touch”. “At that stage we didn’t know anything about ultrasound guided transfers. I hadn’t read anything on it. Nor seen the advertising on their website. She didn’t use an ultrasound to guide anything that day.” Anaesthesia is generally not required. Single embryo transfers in particular require accuracy and precision in placement within the uterine cavity. “We had a single embryo transferred. Due to the pain I was in my body was under stress and my uterus would have been contracting. I have since been told by another specialist that this isn’t an environment conducive to a successful pregnancy. Our teeny tiny embryo was undoubtedly floating around unable to settle where needed.” The optimal target for embryo placement, known as the maximal implantation potential (MIP) point, is identified using 3D/4D ultrasound. However, there is limited evidence that supports deposition of embryos in the mid-portion of the uterus.
After insertion of the catheter, the contents are expelled and the embryos are deposited. Limited evidence supports making trial transfers before performing the procedure with embryos
“We hadn’t had a trial transfer.” After expulsion, the duration that the catheter remains inside the uterus has no effect on pregnancy rates. After withdrawal, the catheter is handed to the embryologist, who inspects it for retained embryos. “The catheter was expelled into the petri dish. We viewed this on screen. No embryo that we could see. But there was a big blob of blood.”

I left the room feeling disheartened and a little lost. It was meant to be easy. I remember telling Anni about how it had gone during my post transfer appointment and tears running down the sides of my face as I lay there being stabbed by her little needles.  She said she could feel my stress. So she focused on steadying my pulse. Thank god for Anni. She was like my spiritual counsellor. To this day that’s the closest I’ve ever come to seeing one. A counsellor that is!
Anni provided far more post care advice than the clinic. She advised I go home and lay down. Rest. Drink broth and rub my head! The head rubbing can be explained next time.
I got into the car with Tristan and cried some more…

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