Frozen Embryo Transfer Using Hormone Replacement: A Step-by-Step Guide

For patients with
1. Irregular cycles or ovulation disorders
2. Who need to plan their therapy around time constraints,
We can create an artificial menstrual cycle for FET. This involves treatment with an oral estrogen medication and progesterone (usually administered intramuscular).
Pregnancy rates are equivalent when compared to natural cycle FET

The steps involved in FET with hormone replacement include:

FET Cycle

  1. Hormone therapy (Estradiol and progesterone)
  2. Embryo transfer
  3. Hormonal studies and pregnancy test
  4. Follow-up consultation

Step 1 - Estrogen Therapy

It is important that you start estrogen therapy on the first day of your period. A dose of estrogen is usually administered for 10-14 days, although shorter or longer cycles may be used, Estofert® is the most common form of estrogen we use. This is a pill containing 2 mg of estradiol, the same hormone produced by the ovaries. We will have you take one pill thrice a day for about a fortnight. After about 14 days of Estofert®, (your physician may vary the dose or duration of therapy) progesterone is added. This may be administered vaginally or as an intramuscular injection. Estofert® and progesterone are continued until the day of the pregnancy test (usually 9-12 days after embryo transfer). If the test is positive, these medications may be continued for several weeks. Depending upon the individual physician’s protocol you may also be treated with oral medications such as methylprednisolone and doxycycline prior to the transfer.

Step 2 - Embryo Transfer

Embryo transfer is usually performed on the fourth to seventh day of progesterone therapy varying with maturity of your embryo. Embryos are thawed or defrosted on the morning of the scheduled frozen embryo transfer. We usually transfer 1 to 2 embryos during each FET cycle. However, this number is flexible, and your physician will discuss this issue with you. The transfer of more embryos may increase the likelihood of a multiple pregnancy, which increases the pregnancy risks for the woman and the babies.
Embryo transfer is accomplished under ultrasound guidance which will require the bladder to be full. A small plastic catheter is passed gently through the cervix into the uterus. After waiting for 1-2 minutes to allow any mild cramping to resolve, the embryos are deposited into the cavity along with a small amount of fluid. You will be discharged after resting for 20 minutes. No anesthesia is required for the embryo transfer.

Step 3 - Hormonal Studies - Pregnancy Test

We will usually perform a serum pregnancy test 9-12 days after the embryo transfer. If the test is negative, hormone therapy is discontinued and a period usually begins in a few days.

Step 4 - Follow-up Consultation

If the pregnancy test is positive, we will perform a vaginal sonogram about two weeks later. At this point, we are usually able to identify the number of embryos and can often see a heartbeat. The risk of pregnancy loss is low after this developmental milestone. If the procedure is unsuccessful, you should schedule a consultation with your physician. We will review the procedure and discuss further treatment options.