From the Guidelines
It's completely normal to feel no symptoms on day 3 post frozen embryo transfer, and you should continue with your prescribed medications and lifestyle adjustments as advised by your fertility specialist. Many women who go on to have successful pregnancies experience no symptoms at this early stage. Implantation typically occurs between days 1-5 after transfer, and pregnancy hormones like hCG only begin to rise after implantation is complete 1. Even then, pregnancy symptoms often don't appear until weeks later.
Key Considerations
- Continue taking all prescribed medications exactly as directed by your fertility specialist, which typically includes progesterone supplementation (via vaginal suppositories, injections, or oral tablets) and possibly estrogen 1.
- Stay hydrated, maintain a balanced diet, and avoid strenuous activities for the first few days.
- Try to manage stress through gentle relaxation techniques.
Important Reminders
- Remember that symptom-spotting is unreliable as early pregnancy symptoms overlap with progesterone side effects and pre-menstrual symptoms.
- The only definitive way to confirm pregnancy is through a blood test, usually scheduled 9-14 days after your transfer.
Additional Guidance
- The recent ESHRE guideline recommends single embryo transfer (SET) to minimize the risks of multiple pregnancy and complications, especially in cases with donor oocytes, donated embryos, or gestational carriers 1.
- While the decision to transfer one or more embryos depends on various factors, including patient prognosis and embryo quality, the guideline emphasizes the importance of counseling patients about the risks and benefits of single versus double embryo transfer 1.
From the Research
Progesterone Levels and Embryo Transfer
- The studies 2, 3, 4, 5, 6 investigated the relationship between progesterone levels and embryo transfer outcomes.
- Progesterone levels were found to be a significant factor in determining the success of embryo transfer, with lower levels associated with decreased ongoing pregnancy rates 4, 6.
- The optimal cut-off for ongoing pregnancy was found to be 35 nmol/l 4 and 9.2 ng/ml 6 for serum progesterone levels.
Embryo Transfer Outcomes
- The live birth rate was significantly lower in women receiving only vaginal progesterone (27%) compared to those receiving intramuscular progesterone (44%) or combination treatment (46%) 2.
- The overall live birth rate after frozen embryo transfer of euploid embryos was 62.35% 3.
- The odds of pregnancy were higher when the endometrial receptivity assay (ERA) test was performed prior to the first embryo transfer (93.10% vs. 46.43%) 3.
Progesterone Supplementation
- Vaginal progesterone supplemented with intramuscular progesterone every third day was found to be non-inferior to daily intramuscular progesterone, offering an effective alternative regimen with fewer injections 2.
- Switching from intramuscular to vaginal progesterone after a positive pregnancy test following embryo transfer was not associated with an increased risk of miscarriage 5.
Endometrial Receptivity
- Endometrial receptivity was found to be independent of age, duration of hormonal supplementation, and plasmatic progesterone levels 3.
- The endometrial receptivity assay (ERA) test was found to be a useful tool in predicting endometrial receptivity, with a personalized endometrial transfer (pET) schedule resulting in higher live birth rates 3.