Transfer day: what happens, and the one decision you make beforehand

After the intensity of stimulation and the drama of retrieval, transfer day tends to surprise people by how ordinary it is. It usually takes a few minutes, requires no anaesthetic, and you walk out afterwards.

The part worth preparing for happens before you get there.

The decision: how many embryos

This is a genuine conversation, not a formality, and it is worth having properly rather than being asked in the moment.

ESHRE published a guideline on the number of embryos to transfer during IVF/ICSI in 2024, with 35 recommendations and good-practice points. Notably, it was built with substantial patient-survey input and includes practical clinical scenarios and material on informed consent — which tells you something about the nature of the decision: it is clinical, but patient preference is explicitly part of it.

The core tension is straightforward. Transferring more than one embryo raises the chance that one implants, and it also raises the chance of a twin pregnancy, which carries higher risks for both the pregnant person and the babies. Most modern practice leans toward transferring one at a time, with the remainder frozen for later attempts, precisely because that separates the goal — a healthy baby — from the instinct to maximise the odds of this particular transfer.

What varies is the individual case: your age, embryo quality, how many previous transfers there have been and what happened. Ask your clinic what they recommend for you and, specifically, what is driving that recommendation. A clinic that can explain the reasoning in your case is doing the thing the guideline asks for.

What happens on the day

No sedation, usually. A transfer is normally done awake and without anaesthetic, which is one reason it feels so unlike retrieval.

You may be asked to arrive with a full bladder. This is not arbitrary — it improves the ultrasound view used to guide the catheter. It is also the detail patients complain about most, so plan the timing.

Identity checks again. Your details and the embryo’s are confirmed, repeatedly, as part of the same chain-of-custody discipline that runs through the laboratory.

The transfer itself. A fine, soft catheter passes through the cervix, guided by ultrasound, and the embryo is placed in the uterus. Most people describe it as similar to a cervical smear: brief, occasionally uncomfortable, not painful.

Then you get up. Extended bed rest afterwards is not standard practice. Most clinics will have you rest briefly and then send you home to a normal, unstrenuous day.

Before you leave, confirm three things: which medication to continue and for how long, the date of your pregnancy test, and who to contact with questions. Write them down, because this is a day when people do not absorb information well.

What you will be told about your embryo

You will normally be told what was transferred and what happened to the rest — how many were suitable for freezing. If the grading language is unfamiliar, what the letters and numbers actually mean covers how to read it, and the short version is that it is an ordering tool rather than a prediction.

If this is a frozen transfer

Increasingly it is, because freeze-all has become common practice. A frozen transfer happens in a separate cycle from the retrieval, with its own preparation — medication to get the endometrium ready, and scans to check it is responding.

This matters most if you are travelling: it is a second trip, on its own schedule, and the preparation phase has appointments in it. That structure is the subject of freeze-all and the two-trip treatment, and it is worth planning around rather than discovering.

Questions worth asking beforehand

• How many embryos are you recommending we transfer, and why that number for me?
• What are the risks you are weighing on each side?
• Fresh or frozen, and what makes that the right choice here?
• What medication will I be on, and for how long?
• When is the test, and how do I get the result?

Afterwards

The wait begins, and it is its own experience — long, information-free, and harder than the procedure. Resist the urge to test early; clinics set the test date for a reason, and early results are unreliable in both directions.

This article is general information, not medical advice. How many embryos to transfer is a decision for you and your clinician together, based on your specific case.

For how transfer fits into the rest of treatment, read the patient journey.