You’re at a juncture and choosing whether to do a fresh or frozen embryo transfer (FET). Let me help if I can. In case you don’t know, this isn’t always something we have control over. An FET may be the only option if you’re at risk of OHSS and if you have a high Antral Follicle Count or if you need to do a surgery after retrieval. These are just a few of the many medical and circumstantial reasons that might prevent you from having a choice. If it is your decision, then like everything surrounding fertility, it’s about what’s right for you and your unique situation.
When you hear about IVF you usually think about a fresh embryo transfer where you transfer an embryo(s) a few days after the egg retrieval. But then there’s the option for an FET where the embryo(s) is frozen and transferred at a later date. Don’t worry, the decision making will end one day, I promise. But right now it’s decision time.
Let me share one more thing before we get into the pros and cons. If you’re doing reciprocal IVF or a donor egg cycle then it does change your opportunities. I’ll mention that below. Let’s go!
The benefits of a fresh embryo transfer
- It happens sooner. It’s understandable, when you’ve been waiting probably years to get and stay pregnant, that you’d want to choose an option that brings this chance at a healthy baby as soon as possible. An FET wouldn’t happen until your period in the next cycle or another future cycle at the earliest.
- It usually costs less. With an FET you often have to pay extra, whereas a fresh transfer is usually built into the cost of an overall IVF/ICSI cycle. It could be a little or a lot more. Then add the cost of medication because it’s common for a medicated FET to require more medication than a fresh cycle. The overall cost also depends on what your insurance or your government funded cycle or employee benefits covers, if any.
- If FETs have failed in the past, then a fresh transfer might be a wonderful new option for try.
- If you’re trying Day 3 embryo(s), for various reasons, then a fresh transfer may be the better option.
- If you have to travel for transfer it might be more convenient to do a fresh transfer.
The downsides of a fresh transfer
- A frozen transfer has a slightly higher success rate than a fresh transfer but that should be determined by your specific case with your doctor.
- You can’t do PGT-A on the embryo(s) if you do a fresh transfer because there’s not enough time to get the results back to determine which embryo(s) to transfer.
- You can’t do an ERA endometrial biopsy with a fresh cycle, in most scenarios.
- Some people prefer taking time after egg retrieval to heal their body, but a fresh cycle doesn’t give much time. You might even be recuperating from OHSS, unless you’re doing reciprocal IVF or a donor egg cycle. Others don’t want to wait. I loved having the month to rest after my egg retrieval. I was eager to get started but I had OHSS and did PGT-A so I couldn’t do a fresh cycle but in the end I appreciated the time to heal.
- If you have known or suspected endometriosis and you want to have a deferred embryo transfer with a protocol that requires some priming, a fresh cycle doesn’t give you enough time to do that, but an FET will.
- It could be better to try for a frozen transfer if fresh transfer(s) haven’t worked in the past.
Other considerations
- How many embryos you get from that cycle. If you have one or two embryos from a fresh cycle, then you might want to get started sooner in case you need to do another round or start exploring other options. It’s common to be working on the contingency plan for if your current cycle has failed, even before the current one has had a chance to reveal whether it’s successful. That said, you might already have planned to bank your embryos over multiple egg retrievals before a transfer. This is common with diminished ovarian reserve (DOR).
- When you’ll want to schedule your two week wait. The two week wait is the period after embryo transfer and before you have your test to to see if you’re pregnant. Unlike so much of the fertility journey, you do have control over when you have your two week wait. Perhaps you want to plan around a personal or family life event that you don’t want to miss that makes it ideal to go through the two week wait soon after egg retrieval versus at another time.
- What would you potentially regret if you choose one option over the other?
- Would it make a difference if you’re doing a single embryo transfer or transferring 2 embryos?
Please make sure to consult your fertility doctor for their expert advice. Then feel free to give me a call or shoot me an email if you have questions or want a sounding board. Good luck!!
References:
Bozdag G, Polat M, Yarali I, Yarali H. Live birth rates in various subgroups of poor ovarian responders fulfilling the Bologna criteria. Reprod Biomed Online. 2017 Jun;34(6):639-644. doi: 10.1016/j.rbmo.2017.03.009. Epub 2017 Mar 21. PMID: 28366519.
de Ziegler D, Borghese B, Chapron C. Endometriosis and infertility: pathophysiology and management. Lancet. 2010 Aug 28;376(9742):730-8. doi: 10.1016/S0140-6736(10)60490-4. PMID: 20801404.
K M Wong, M van Wely, H R Verhoeve, E M Kaaijk, F Mol, F van der Veen, S Repping, S Mastenbroek, Transfer of fresh or frozen embryos: a randomised controlled trial, Human Reproduction, Volume 36, Issue 4, April 2021, Pages 998–1006.
Li H, Sun X, Yang J, Li L, Zhang W, Lu X, Chen J, Chen H, Yu M, Fu W, Peng X, Chen J, Ng EHY. Immediate versus delayed frozen embryo transfer in patients following a stimulated IVF cycle: a randomised controlled trial. Hum Reprod. 2021 Jun 18;36(7):1832-1840. doi: 10.1093/humrep/deab071. PMID: 33885131.
