Should I do a fresh or frozen embryo transfer?? There are sooo many choices to make when doing IVF! One of the most common questions I get is-should I do a fresh or frozen embryo transfer (hint-it’s usually frozen!)? Fresh transfers were waaaay more common when the “freezing of embryos” process wasn’t as perfected. The survival rate of embryos for freeze and thaw was low-because of this, we tried to do fresh transfers more (and with more embryos) which didn’t end up in the best outcomes-high order multiples, severe OHSS (for those that were already hyper stimulated, etc.) Now, freezing and thawing of embryos has a survival rate of about 98-99%! The truth is, I usually only recommend fresh embryo transfers for a select group of people- -people who are young -people who don’t need genetic testing (see above) -people who have a known reason for infertility like tubal disorder, male factor, ovulation disorder, etc. -people who only want 1 child-I’d rather have patients bank embryos first (2-3 euploid embryos per child desired) before moving on to transfers. The uterus doesn’t age, but unfortunately we still have a biological clock that IVF can’t overcome. It’s easier to come back for an embryo transfer for a sibling in the future than to start the process over years later when it may be harder to get not only eggs, but chromosomally normal eggs! -someone who doesn’t have a lot of eggs-this is because when you produce many eggs, your estrogen levels can get really high! In a normal cycle, your estrogen only gets to about 200-300 picograms at its peak! When it’s in the hundreds to thousands levels like in IVF stims, that can affect the way the uterine lining grows, which can affect the way the placenta implants. Because the pregnancy is implanting in such an abnormal hormonal environment-this can be associated with complications like small for gestational age, pre-eclampsia, pre-term birth, etc. It can also be life threatening if you develop worsening OHSS (HCG hormone is like throwing gasoline on a fire if estrogen levels are already too high). Make sure this is a conversation you’re having with your provider to determine what type of transfer is best for YOU and YOUR goals!
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