IVF: What to Expect at the Embryo Transfer

Comparing the embryo transfer to the egg retrieval, I’ll say this: the transfer was a breeze. A strange, fascinating, occasionally funny breeze, but a breeze nonetheless. Once we got the results back and knew we had a healthy little 5AA blastocyst ready to go, we scheduled the transfer for roughly a month out. The medication schedule was just as strict, but far easier to manage day to day. It started with birth control pills until the day I was cleared to begin estrogen. I took daily estrogen pills, then added progesterone shots a little over a week before the transfer.

I thought two to three shots a day leading up to the egg retrieval was bad. I had no idea.

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The single daily progesterone shot for the transfer was, without exaggeration, awful. These are intramuscular shots, straight into the muscle of your backside, and the very first one left me sore for a full week. My husband administered every single one of them in this time period, and he’s a doctor. This wasn’t user error. It’s just a hard shot to take. That first week, each shot felt fine going in, but the ache afterward built day by day, only to get worse with the next injection stacked on top of it. By day two, he barely grazed my hip getting into position, and I jerked away and yelped before the needle even touched me. Eventually my muscles adjusted to the injections. But the moment they did, the shots themselves somehow started hurting more, not less. We’ll get back to that.

You’re given the date of your transfer well in advance, but not the time. That doesn’t come until the day before, since the clinic has to schedule around egg retrievals first and fit transfers in afterward. This time, at least, I could drive myself. No anesthesia required.

Embryo Transfer Prep

The week before, I dove into research on best practices for a successful transfer. There’s no guarantee, no single protocol that magically results in a pregnancy, but the consistent advice was to avoid alcohol and smoking, both before and after. Studies pointed toward reducing stress, staying lightly active instead of going on full bed rest, and eating well: Mediterranean staples, plant-based proteins, folate-rich greens. So I spent that week stocking up on every recommended food I could find. I set up a little tea cart next to my bed, loaded with pregnancy-friendly snacks so I wouldn’t have to move far to reach them. I took the afternoon off work, planning to rest in bed and take a short walk every hour or so to keep my body moving without overdoing it.

At the facility, I was sent to the same prep room as before, changed into a hospital gown, hairnet, and surgery socks, and told to come in with a full bladder. They tell you exactly how much water to drink about an hour beforehand, and right on schedule, you start needing to pee. Badly. Of course, the day I went in, the clinic was running about an hour behind. After the first thirty minutes, a nurse checked on me and asked if I needed to pee a little bit. I said yes. They had me pee out a small cup’s worth to relieve some pressure, and I let out about half a cup, since I still felt fine.

Then another thirty minutes passed. And another check-in. I asked if I could go again, just a little. It wasn’t going to be enough, and I knew it. The doctor reassured me that, given my size, it would be fine.

It had to be fine. There was no more room to wait.

The Embryo Transfer Procedure

The procedure itself is genuinely bizarre, in the best way. As I was wheeled into the same operating room where I’d had my egg retrieval, they pulled up a live microscopic feed of our blastocyst on the screen in front of me. Real time. There he was, hatching out of his shell, which they said was an excellent sign. It’s a strange thing to hear about a future human, watching him hatch on a television screen moments before he becomes, quite literally, a part of you.

The doctor explained the process as it happened: the embryo goes into a thin, straw-like instrument, which is then used to place it directly into the uterus. They do this under ultrasound guidance, which is exactly why the full bladder matters. Water acts as a conductor, giving them a clearer image of the uterus on the screen. The whole thing took seconds. They released the embryo, snapped a photo the instant it happened, and then checked the instrument under the microscope one final time to confirm it was empty. He wasn’t in the straw anymore. He was in me.

Afterward, they tell you that even though it feels like the embryo could slip right back out, it can’t. You can walk normally, resume regular activity, no need to waddle around like something might fall. Still, with stress reduction as my personal mission and a healthy diet as my backup plan, I spent most of that day resting, getting up for a short walk every couple of hours, and eating nothing but Mediterranean food, oatmeal, whole grains, and vegetables for the better part of a week. That following month was, without question, the cleanest eating of my entire adult life.

And Then, the Fun Part

Then came the wait. Another grueling two weeks to find out if the transfer had actually worked.

Seventy percent felt like great odds. It also felt like nothing at all, because nothing is guaranteed until it is. About a week after the transfer, I couldn’t hold out any longer and took a test. Very, very faint positive. My stomach dropped instead of soaring, because we’d seen a line like that before, right before our miscarriage. I refused to let myself hope.

The next day, I tested again. The line was darker.

The day after that, darker still.

By the time we went in for our official blood test, it wasn’t really a question anymore, though I still didn’t dare say it out loud. So when the clinic called and said, “Congratulations,” it landed less like a surprise and more like confirmation of something I’d already started to believe. We’d made it.

From there came two more blood draws to confirm our hCG levels were climbing the way they should, followed by another achingly long two-week wait until week six, when we’d finally get an ultrasound and see, with our own eyes, whether there was a heartbeat. Only once that heartbeat showed up would the fertility clinic clear us to graduate to a regular OB, who then scheduled our next ultrasound for another four weeks out. I’ll remember that first ultrasound forever. Tristan was a little bloop with a heartbeat, and everything looked great.

Early pregnancy, it turns out, is just an extended exercise in nerve-wracking waiting and cautious hope, which is exactly what you don’t want to hear after a previous miscarriage. And the celebratory cherry on top? When they called to confirm the pregnancy, they also confirmed I’d be continuing the progesterone shots for another ten weeks.

Yay.