You are awake for an embryo transfer. It may be uncomfortable for a short time, but it should not be painful. You may feel a twinge or some cramping, or nothing at all. You may be asked to come with a full bladder so the doctor can watch on ultrasound while guiding a thin tube through your cervix to place the embryo in your uterus. The steps are the same for fresh and frozen transfers. Your clinic's own instructions come first, so keep them handy on the day.

What is an embryo transfer?

An embryo transfer places one or more embryos into your uterus. A doctor uses a catheter, a thin, flexible tube, to pass the embryo through your cervix. The cervix is the opening at the bottom of your uterus.

It works the same way whether your embryo is fresh or frozen. In a fresh transfer, it happens a few days after your egg retrieval. In a frozen transfer, the lab thaws the embryo first.

If your transfer is frozen: the thaw

For a frozen transfer, the lab thaws your embryo first. Some embryos need extra time to grow in the lab after thawing, depending on when and how they were frozen. Your team will tell you if your embryo needs this step and how it affects your timing.

Not every embryo survives thawing, and it is possible that none survive. That would mean no transfer that day. Your provider will suggest how many embryos to thaw after talking with you, based on things like your age when they were frozen and their quality.

Settle the backup plan before transfer day, so you are not deciding in a hurry. Ask:

  • If the first embryo does not survive, will the lab warm another one?
  • Who decides that, and do you need my consent at the time or now?
  • How and when will you contact me about the thaw, and what number will you call?

How to prepare for embryo transfer

Your clinic will send you instructions, and they come first. They may include points like these:

  • Eat and drink as usual, unless your clinic tells you otherwise.
  • Shower as usual, but skip scented products like lotion, perfume or hair gel.
  • Come with a full bladder. Your clinic will tell you how much to drink and when to start.
  • Bring a support person if you like. Some clinics let them stay in the room with you.
  • Wear comfortable clothes and warm socks.
  • Arrive a little early to check in.

Keep taking your medicines, such as progesterone or estradiol, exactly as prescribed.

Some people ask for a mild sedative, a medicine to help them relax. If you will have one, ask your clinic whether you need to stop eating and drinking beforehand and whether someone must drive you home.

Why a full bladder?

A full bladder helps the doctor see your uterus on an ultrasound done on your belly, and it can make the transfer easier. Your bladder should feel full, but not so full that it hurts, so tell the staff if it gets too uncomfortable while you wait.

What happens during the transfer

Here is what the procedure is like, step by step:

  1. You change into a gown.
  2. The doctor places a speculum in your vagina to see your cervix. The cervix may be rinsed.
  3. An ultrasound on your belly helps the doctor guide the tube.
  4. The lab loads your embryo into the catheter.
  5. The doctor passes the catheter through your cervix and gently releases the embryo into your uterus.

The procedure usually takes less than 10 minutes. You will be awake, and anesthesia is not needed.

Fertility experts recommend using ultrasound and a soft catheter for transfer. Both are linked to better chances of pregnancy.

Does embryo transfer hurt?

It is usually brief, and it should not be painful. You may feel a twinge as the catheter passes through your cervix, some discomfort or cramping, or nothing at all.

Tell the team ahead of time, not on the day, if any of these apply to you:

  • Pelvic exams are painful for you.
  • You have vaginismus, when the muscles around the vagina tighten on their own as something goes in.
  • A past transfer was difficult or painful.
  • You feel very anxious about the procedure.

Knowing early gives the team time to plan with you.

How many embryos will be transferred?

You and your doctor decide this before transfer day. Putting in more than one embryo raises the chance of twins or more, which carries higher risks for you and the babies, such as early birth. Ask your clinic what it suggests for you, and why.

After the transfer: what to do

You can get up and walk soon after. Fertility experts do not recommend bed rest after a transfer. Walking, standing or using the bathroom will not make the embryo fall out.

Clinics give different advice about the next few days, so ask yours:

  • Whether you can go back to work the same day or should rest the day after.
  • Which activities are fine, especially if you had an egg retrieval a few days ago.
  • Whether to avoid sex, and for how long.

Keep taking progesterone and any other hormones until your clinic says to stop.

What you might feel afterward

Some cramping, discomfort and a small amount of bleeding can happen after a transfer. In rare cases, the catheter causes an infection. If that happens, you may need antibiotics.

If you had a fresh transfer, your ovaries are still enlarged from stimulation, so some bloating and discomfort may happen. The warning signs are listed below the checklist.

Embryo transfer day checklist

Copy this list into your phone the night before:

  • Confirm your arrival time and where to check in.
  • Check how much to drink, and when to start.
  • Take your morning medicines as prescribed.
  • Skip lotion, perfume and hair products.
  • Wear comfortable clothes and pack warm socks.
  • Bring your ID, insurance card and clinic paperwork.
  • Bring your support person, if you want one.
  • Ask how many embryos will be transferred.
  • Ask when your pregnancy blood test is.
  • Save your clinic's after-hours number.

When to get help

Call your clinic right away, day or night, if you have:

  • A fever of 100.4°F (38°C) or higher.
  • Bleeding from your vagina, or a brown, watery discharge. Light spotting can happen after a transfer. Still, let your clinic decide what it means.
  • Belly or pelvic pain that is severe, gets worse, or isn't eased by the pain relief your clinic recommended.
  • Pain and bloating in your belly, or bloating that is getting worse.
  • Nausea and vomiting, nausea that won't go away, or you can't keep fluids down.
  • Peeing less than usual, even if you are not thirsty.
  • Fast weight gain. Your clinic will tell you its number, but do not wait to reach a weight threshold if you feel unwell.
  • Pain, redness or warmth in an arm or leg.
  • Blood in your urine, or pain when you pee or poop.

Tell your clinic at your next contact about other milder symptoms that are new, don't go away or slowly get worse.

Next comes the wait for your pregnancy test. Our guide to after embryo transfer covers symptoms, medicines and the test.