By Dr. Arnold Mahesan
Fertility SpecialistBeverly Hills Babies
Dr. Arnold Mahesan is a board-certified fertility specialist with extensive experience in IVF, fertility treatment, and gestational surrogacy. He is committed to helping intended parents navigate their journey with personalized care and expert guidance
Embryo transfer success depends on the embryo, the uterus, preparation of the cycle and the transfer itself. A surrogate’s previous healthy pregnancies are valuable information, but they cannot make every embryo implant. Likewise, a promising embryo does not remove the need for careful medical preparation.
The aim is to create appropriate conditions for a healthy pregnancy while acknowledging that biology remains uncertain.
1. Understand what the embryo report can tell you
The age of the egg source at retrieval helps frame the likelihood of chromosome abnormalities. Embryo development and appearance provide additional information. If genetic testing was performed, the result needs to be interpreted in context.
PGT-A screens a small sample of embryo cells for chromosome-number abnormalities. It does not create a better embryo, test for every disease or guarantee implantation. Its value varies with the clinical situation, and routine use for every IVF patient has not been established.
2. Evaluate the uterus and current health
The surrogate’s uterine evaluation looks for relevant structural findings before transfer. Her current health and obstetric history are reviewed as well. A successful prior delivery does not make those steps unnecessary.
Sometimes the appropriate decision is to investigate a finding or postpone treatment. Moving ahead simply because an embryo and a calendar date are available is not a sound reason to transfer.
3. Synchronize the embryo and the uterine lining
The transfer plan must coordinate the embryo’s developmental stage with the uterine lining. Depending on the protocol, that may involve ovulation monitoring or prescribed estrogen and progesterone.
Medication timing matters, especially when progesterone determines the transfer schedule. Ultrasound and bloodwork are interpreted together with the protocol. One isolated measurement should not become a universal definition of readiness for every patient.
4. Keep the goal focused on a healthy birth
ASRM strongly recommends single-embryo transfer in gestational-carrier cycles. Transferring two embryos can lead to twins and exposes the surrogate and babies to additional risk. It is not a dependable way to compensate for uncertainty about one embryo.
Pregnancy outcomes also need clear definitions. A positive pregnancy test, an ultrasound-confirmed pregnancy and a live birth are different endpoints. When discussing estimates, ask which outcome is being described and whether the estimate applies to embryos like yours.
5. Review a failed transfer without jumping to conclusions
An unsuccessful transfer deserves a review of the embryo, treatment record and procedure. It does not automatically mean the surrogate has an implantation disorder or that an extensive panel of additional tests will help.
Some findings justify a change. Others represent uncertainty that cannot be eliminated with another intervention. I want each proposed test or treatment to answer a specific question and have a reason to influence the plan.
Contact BHB for an individualized review of your embryos and transfer preparation.
