What is the procedure for frozen Embryo Transfer? How the FET do I get my embryo back?

I am lucky enough to have two frosties currently freezing their arses off, waiting for me to collect them. But how the FET do I go about getting them back? How long do I have to wait after giving birth to my first IVF baby? Can I breastfeed whilst going through treatment? What is the waiting list and how much does it cost? Honestly, I have so many questions I feel like an IVF virgin all over again.

After taking a deep breath, buckling back into the IVF ride and bracing myself, I did it. I emailed my IVF clinic about frozen embryo transfer (FET). After adding my patient number to the top of the email to make it look organised and professional, I launched into the content, which was anything but. What I wanted to ask our IVF clinic was simple: We have two embryos stored with you. How do I go about getting one from your freezer in to my innards?

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What was bamboozling me was not the medical process, but the practical steps. I had so many questions. I felt like writing ‘Imagine that I’m an idiot’, which given the contents of my email wouldn’t take too much of a mental leap on the reader’s behalf, ‘and explain in simple detail the practical process for frozen embryo transfer (FET)’. Instead I asked a series of questions, the answers to which (along with some other findings - thanks again to the comprehensive yet untrustworthy Dr Google) are outline below for your perusal.

A note of caution: As always, the advice, guidance and procedures for each IVF clinic will differ. Although I am sharing the information I received in order to be helpful, please contact your clinic to get their views as it may be very different in your circumstances.

How soon after giving birth can you do a FET? How long do you have to wait to do FET after a C-section?

My clinic usually waits until your baby is around 1 year old before beginning treatment for a FET. Luckily, this fits pretty nicely with our initial thinking on timeframes. You only have so much luck when trying for a baby with infertility. I hope this isn’t our quota used up right off the bat and it goes downhill in a toboggan from this point onwards. Initially we wanted a July start, but will now need to delay until August for one year to have passed since the birth of our son. The reason for July was simply a practical one - I return to work in August and I would prefer my first activities in the office not to involve asking for time off work for medical appointments, revealing myself to be a slacker of the first degree. It is my firm belief that this knowledge should be gathered gradually over time and not within the first week of employment.

Does it make a difference in timing that my son came out through the sunroof? I specifically asked my clinic about any differences in timeframe pertaining to a C-section birth and the response bore no mention of this, which I interpreted to mean (rightly or wrongly) that there is no difference. A quick search on the internet (a little knowledge is a dangerous thing, I know) reveals that the most common advice is to wait at least 6 months after a C-section before getting pregnant, but ideally a year. This allows time for the scar to strongly heal, before you give that bad boy a really big stretch. Given that we are waiting a year before going for our FET, whether I had a C-section or natural birth seems not to make an impact on timings.

Can you do frozen embryo transfer (FET) whilst breastfeeding?

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Our clinic said that before FET it is advisable to stop breastfeeding and for me to wait for my menstrual cycles to become normal again for two months. It is the word ‘normal’ that caught my attention. I didn’t like it. Not one bit. Not for reasons of politically correctness, with a reference to ‘normal’ being derogatory to all other cycle types, like some kind of cycle racist, but because my PCOS makes ‘normal’ cycles a struggle. I assume what the clinic are wanting are two periods. Proper periods. Not any weird postpartum bleeding that you may be tempted to count if you were being wily. If by ‘normal’ they mean the same as the terrible advice I received from my GP when I was first out of the gates of the infertility starting blocks and asking about my 7 week cycles, where I was told that “what ever is normal for you is completely normal” (reassuring, yet alarmingly inaccurate) then we are golden! Two ‘Amber specials’ coming up.

To wean or not to wean? That is the question

So is the reason I am advised to stop breastfeeding before a FET because:

  1. my cycles need to return, my hormones need to be ‘normal’ and breastfeeding hinders this? Or

  2. because the drugs used in the FET cycle can be transferred to the baby through the breastmilk?

The answer isn’t clear to me.

The Australian Breastfeeding Association says ‘It is important not to generalise about whether breastfeeding must cease before IVF begins. Some women having IVF may have resumed regular ovulation and menstruation while continuing to breastfeed. For these women, there may be little or no benefit of weaning before starting IVF in terms of the chances of falling pregnant.’ This implies that the reason to stop breastfeeding before a FET is in order for your prolactin to drop and your periods to return. It is still possible to have periods, ovulate and be fertile whilst breastfeeding. The Breastfeeding Support website says that ‘Fertility will automatically return once breastfeeding falls to a low enough level, but exactly how low is unique to a mother’s own body chemistry. ‘

If, like me, you are breastfeeding but are also eagerly awaiting the return of your period, then the Breastfeeding Support website suggests that some ‘ideas to kick start fertility include; increasing the time interval between breastfeeds, giving a baby who is ready for solids his food before a breastfeed and introducing solid food quite quickly. A six hour gap between breastfeeds on one or several nights may be enough to trigger the return of a mother’s periods (Mohrbacher, 2010).’

If my periods have returned and I am still breastfeeding, can I continue doing so through FET or do the fertility drugs pass through to the baby via the breastmilk? This would be a shame. My son is far too young to be growing a thick lining and having kids of his own. This interesting blog post from Baby Dust Diaries explores the evidence on this topic and seems to cover everything as thoroughly as the skin on a sausage.

The post also includes categories of women who will need to wean before FET and those who may not. As is typical with my luck (maybe I did use it all up on the timings point above) I fall firmly into the ‘need to wean’ group. I’m a conformist by nature and I also don’t want to risk going against the advice of my IVF clinic. Presumably they hold their opinion firmly and based on evidence. One assumes that it is not just something they say to pad out emails, the way that I stuff vaguely relevant and inconsequential tittle tattle in to relatives’ birthday cards to fill the oppressive white space. So for me personally on the breastfeeding front, the answer is to put away my baps before bringing out the needles.

What is the wait list for FET?

There is no waiting list for a FET cycle. As simple as that. That is what our clinic said. Although let’s unpick this a little as past experience warns me to be cautious….

Our NHS registrar who was ‘overseeing’ (in the loosest possible sense of that word) our infertility said that there was no waiting list for being referred for IVF on the NHS. She told us that we just have to meet the qualifying criteria, which includes trying unsuccessfully for a baby for 3 years, then BOOM, you’re transferred straight across for IVF without your name ever gracing the pages of a waiting list. I took a long deep breath at this one and eased out the ‘that comment deserved a punch’ fist that had unconsciously formed in my hand. I don’t want to get caught up in semantics as technically the 3 year wait to qualify for NHS IVF wasn’t a list, but it was definitely a wait. I mean, come on!

Next, the IVF clinic’s website suggested that their IVF treatments had a 6-8 week waiting list to begin. The registrar warned us that it was a popular clinic and was currently running a wait of 3 months to begin IVF. 5 months later we started our cycle, after I had begged the clinic for an earlier appointment (there is no place for pride on the IVF ride).

So technically there may not be a waiting list for FET but does that mean that the consultants will be available for an initial appointment as soon as we are ready to start? I can envisage a situation where there is no waiting list but, the first available appointment with the consultant would be in 8 weeks time. Technically, technically, technically not a waiting list…. I am a little apprehensive, but I suppose only time will tell.

How much does FET cost?

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Approximately £1400. Most clinics have a price list for their various procedures and online my clinic says that FET is £1,300 & HFEA fee. The clinic confirmed to me by email that it is approximately £1400 (pleasing consistent there, I’d be panicked if it wasn’t) although presumably the cost varies depending on your drugs protocol and any complications with your treatment/added extras. But it is always good to have a ball park figure in mind so that we know approximately how poor we are going to be in 2019.

FET is so much cheaper than a fresh round of IVF that I am counting my blessings at having frozen embryos from our first round, which was NHS funded. We are so lucky. Not lucky enough to have babies naturally for free like most people, obviously. But IVF lucky, all the same.

How long does FET take?

Treatment takes approximately 2 months from your period to pregnancy test. According to the online information leaflet the process looks like this:

Day 1 of your cycle telephone the clinic to organise Treatment Planning.

  1. Day 21 of cycle commence Buserelin injection or if prescribed Nafarelin nasal spray. 

  2. Baseline scan will be arranged 14 days later (approx).

  3. If the scan shows the lining of the womb to be less than 5mm you will commence Progynova 4mgs for 6 days.(1 tablet twice daily)

  4. Day 7 increase Progynova to 6mgs (1 tablet three times daily).

  5. Day 13 or later of Progynova an ultrasound vaginal scan will be performed to measure the lining of the womb.

Wow, that is a whole lot of drugs and stages of which I am worryingly unfamiliar. It is pleasing to read that my nose could take the brunt of this cycle. I feel that my nose didn’t play a prominent enough role in my first IVF cycle, with the pressure of performance resting solely on my tummy fat, like a one man show. Bringing my nose into the limelight mixes things up, providing a wonderful sense of variety to my next treatment cycle.

So just two months for FET. Down regulate then grow a thick lining. What could possibly go wrong?

What are the success rates of FET?

This is where it gets a little depressing. The success rates for my clinic show a that my chances of a pregnancy from FET are 29%, as opposed to 44% for a fresh cycle. That is a whooping 13% less. My hopes of a positive have fallen 13%, just like that. Crumpets. This forces me in to circular thinking that: I must lower my expectations to protect my heart, but what if negative thinking impacts my chances, better to think positively, but does that just make a negative result more painful when less than 1 in 3 have a successful FET, the result will be what it is, best to think positively in the meantime…. and round and round we go in a thought loop of ever decreasing circles of madness.

To make matters worse (and this is why I should stop Googling - put the computer down and step away, no good has ever come from an infertile searching her chances) there is evidence that indicates that women who are not pregnant after a fresh embryo transfer have higher rates of success in subsequent FETs using their frosties from that initial IVF cycle (clinical pregnancy rate of 43%). This is compared to those women who did fall pregnant with the fresh embryo (clinical pregnancy rate of 22%). I’m in the latter category. Of course I am. Damn. I have three thoughts on this. First - bugger. Second - why? Why? oh WHY? And third - Maybe this is life trying its hardest to finally bring a little fairness into the horror that is infertility. Those whose fresh IVF cycles were unsuccessful initially have a higher chance the next time round. There is something lovely, reassuring and equitable about that, even if I am watching the river from the wrong side of the bank.

So let’s end on a positive. Yes, the chances of me having a second baby using FET may be slimmer than a supermodel on a detox juicing weekend,and yes, I have less chance of success with FET than someone who had a BFN first time round, BUT in the extremely unlikely event of it working then FET apparently leads to healthier babies than a fresh embryo transfer. Although my actual reaction to this is “are you saying that my IVF baby isn’t in tip top health?”. There’s no pleasing some people.

And so we proceed, with cautious hope…

There is nothing to be done but to blithely continue down the yellow brick road toward FET, ignoring the damning statistics on the chances of success. We hope to start our FET cycle in August, we hope that our allocated good luck wasn’t used up entirely on timings, we hope that our FET will be successful, and we hope that my boss doesn’t think me a cheeky slacker. We have so many hopes. The question now is how many of them will come true?