window of implantation frozen embryo transfer

The degree of difficulty of embryo transfer is an independent factor for predicting pregnancy. ERA Testing to Determine the Implantation Window . Once IVF was developed it was confirmed that there is a limited time for implantation, and thus a specific window during which an embryo transfer should take place (5). Bed rest: Bed rest is advised while at the clinic after the embryo transfer is performed. Optimal endometrial preparation for frozen embryo transfer cycles: window of implantation and progesterone support. No. For implantation to happen, we need a good quality embryo, and a uterus lining that is prepared and receptive. infertility, IVF-ICSI outcome, frozen embryo transfer, window of implantation, endometrium, receptivity. Added expense to the patient – the process of freezing and thawing an embryo is an extra step that incurs additional expense, which has to be borne by the patient. When reproductive success or failure relies on collaboration between two partners, the functionality and synchronization of both are necessary. A healthy balanced diet and exercise can help woman reach the BMI fertile window and increase implantation rate. Acupuncture has significant effect on chances of success with Frozen Embryo Transfer IVF patients. To optimize implantation several methods for endometrium preparation have been proposed. Both donor and autologous frozen embryo transfer cycles were included. undergone frozen-thawed embryo transfer (FTE) cycles. Related Posts. Go to Top of Page Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria … Embryo implantation requires a cross talk between the embryo and the receptive endometrium. Primary outcomes were implantation and clinical pregnancy rates and secondary outcomes were chemical, ongoing and multiple pregnancy and miscarriage rates. Frozen embryo transfer (FET) is increasingly adopted in modern IVF. Implantation can’t happen if your endometrial lining is too thin. The timing of embryo implantation is critical, and implantation occurring outside the ‘window of implantation’ is associated with a higher likelihood of miscarriage. Contact US. 511 - 515. For a human pregnancy to occur, a normal embryo must implant in... P … At the end of endometrial preparation should be an overlapping between the ‘window of transfer’, during which a transfer is planned, and this ‘window of implantation’. Optimal endometrial preparation for frozen embryo transfer cycles: window of implantation and progesterone support. And lastly, consider Circle + Bloom’s Frozen Embryo Transfer Mind-Body Program. Spotting may occur during the first five days following embryo transfer. ReUnite Rx 2019-04-17T11:45:16-05:00. A healthy embryo is incredibly valuable; however, the uterus also needs to be as receptive as possible to maximize its potential to produce a pregnancy. Take that week off. For example, if a perfectly healthy embryo is growing a bit slowly, it may miss the window of implantation for the uterus. More efficient cryopreservation strategies (i.e. CAS Article Google Scholar 4. The embryo will sense and react to environmental cues. What Are the Steps of Frozen Embryo Transfer? Employing frozen thawed embryo transfer at the blastocyst stage are associated with an improvement in pregnancy rates. Therefore, frozen day 2 or day 3 embryos were transferred 72 or … 2316–2319, 2001. Optimal endometrial preparation for frozen embryo transfer cycles: window of implantation and progesterone support. Optimal endometrial preparation for frozen embryo transfer cycles: window of implantation and progesterone support. P<0.05 value between study groups was taken as statistically significant. If you can't have acupuncture the day of your transfer, the next best thing is to get a treatment within 24 hours before your transfer, then again during your implantation window. The primary outcomes were chemical and clinical pregnancy rates. Transfers are usually done in our clinic in the afternoon, so patients go home, relax, and get a good night’s sleep. Then, patients underwent either customized embryo transfer (cET, n = 157 patients) according to the Win-Test results or embryo transfer … An accurate prediction tool for endometrial receptivity (ER) is extraordinarily needed to precisely guide successful embryo implantation. All women were undergoing frozen embryo transfer after one or more unsuccessful in vitro fertilization and embryo transfer cycle(s). Trial registration number ChiCTR-TRC-14004448. If implantation is successful and you become pregnant, you may experience some of all of the following symptoms: Vaginal discharge. However, if an embryo was transferred outside the ideal window of implantation, the chance of pregnan- cy is reduced, though not to zero. The present study was conducted to determine whether there is any relationship between … Subjects in the experimental group underwent endometrial biopsy in the luteal phase of the cycle preceding the frozen embryo transfer cycle. Do’s and Don’ts After Embryo Transfer. Fertil Steril. Subsequently, the rates of embryo implantation, clinical pregnancy and live birth rates were all higher in the TEAS group than in the mock TEAS group (p=0.024, p=0.038 and p=0.033, respectively). To optimize implantation several methods for endometrium preparation have been proposed. Aim and objectives: Endometrial Window of Implantation (WOI) is open in the midsecretory phase wherein the markers of invasion and cell adhesion are manifested .The primary objective was to find out the predictive value of Endometrial thickness and profile as a prognostic factors for embryo transfers during ART. 20, 21 Several studies demonstrate higher pregnancy rates when day-6 embryos are cryopreserved and resynchronised with … Implantation after frozen embryo transfer. Optimal endometrial preparation for frozen embryo transfer cycles: window of implantation and progesterone support Window of implantation: potential for personalized ET. Frozen Embryo Transfer Problem 3 – Inappropriate timing for the embryo transfer. In order to optimize treatment outcome, FET should be carried out during a period of optimal endometrial receptivity. Frozen Embryo Transfer Implantation Timeline: Advancements in Freezing. Information Zygote, Volume 28, Issue 6, December 2020, pp. Another small study of euploid or donor-egg embryo transfers with or without ERA testing also found no benefit of the test on implantation or pregnancy rates . Standard morphologic evaluation has been the most widely adopted approach to embryo selection, and remains the most common strategy.The objective of the study to determine the association between the morphologic grading and implantation rate of euploid blastocysts in single frozen-thawed embryo transfer (SET) cycles. This test bases your receptivity on several factors that includes the evaluation the expression of 248 genes. in every 10 women have a displaced window of implantation. Introduction. Embryo transfer is usually performed on the third to fifth day of progesterone therapy. Optimal endometrial preparation and identification of the receptive window for ET in frozen ET cycles thus assumes utmost importance for insuring the best frozen ET outcomes. Frozen embryo transfer implantation is one of them. Synchronizing embryo growth with the endometrial hormonal environment is important for successful implantation. Tomás C, Tikkinen K, Tuomivaara L, Tapanainen JS, Martikainen H. (2002). Women in the experimental proceeding FET cycle. Permits the uterus environment to return to normal after IVF medication, providing natural embryo implantation conditions. Every woman is different but, on average, this window typically takes place around day 20-24 of a woman’s cycle, which is circa 6-8 days after ovulation. It lasts for 48 hours. In IVF, the window of implantation is effectively the timeframe when embryos need to be transferred into the uterus; it’s when the endometrium is at its most responsive. Objective: The aim of this study was to estimate the effect of sildenafil citrate on ultrasonographic endometrial thickness and pattern and to investigate the estrogen level on the day of progesterone administration, the implantation rate and chemical pregnancy rate in frozen embryo transfer cycles. They also studied the outcome of the frozen thaw cycles where day 5 blastocysts were transferred after 5 and 6 days of progesterone administration. While it’s difficult to accept that implantation is largely out of your control, it is important to acknowledge that any one action you take is very unlikely to affect whether or not an embryo implants. Coordinating the transfer of a frozen embryo is key given the ideal window of implantation (WOI) in the mid-secretory phase is short. [ 17] (mean±SD, number of previous failed attempts 4.58±2.15), after fresh and/or frozen-thawed embryo transfer. Frozen thawed embryo transfer (FET) is a cost- effective adjunct to IVF or IVF-ICSI treatment. The embryo development and implantation of the embryo in the uterus is a flexible process. Just over 5% of women who had IVF with frozen embryos and received hormone therapy before implantation developed rapid rises in blood pressure, a … doi: 10.1016/j.fertnstert.2015.05.036. Prior This timing window applies to all types of embryo transfer, however, the test is most commonly performed during donor egg or donor embryo treatments. This timing window applies to all types of embryo transfer, however, the test is most commonly performed during donor egg or donor embryo treatments. In our laboratory, approximately 60-70 percent of embryos survive cryopreservation and thawing. The so-called “window of implantation” (WOI) is a concept that has been proposed to define the period of receptivity of the endometrium for embryo implantation Blastocyst or embryo implantation is critical for the establishment of pregnancy and occurs only for a limited time, defined as the “window of implantation (WOI),” between days 6 and 12 postfertilization in humans and between embryonic days 3.5 and 4.5 postcoitus in mouse . Disadvantages of frozen embryo transfer. Ovarian stimulation may be associated with poor endometrial vascularization. Epub 2015 Jun 13. The implantation window is the time that the endometrium is receptive for an embryo for implantation. Abstract. 2) Some people take the day off after the transfer, but it’s not required. Slow-developing embryos, which become blastocysts on day 6, are associated with lower pregnancy rates in fresh cycles than are day-5 blastocysts. How Long After Frozen Embryo Transfer Is Implantation? The FET procedure is much less stressful for patients because the transfer date can be adjusted. Transfer of frozen–thawed embryos at the blastocyst stage was preferable in the high responder patients to increase implantation, pregnancy and live birth rates compared with cleavage stage embryo transfer. This step involves the administration of hormonal medications to favor embryo implantation.In other words, to increase the chances of getting pregnant. How safe is it to use frozen embryos in treatment? Our finding was consistent with the Ben-Meir et al. Robert F Casper Division of Reproductive Sciences, University of Toronto, and Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, and Toronto Center for Advanced Reproductive Technology (TCART) Fertility Partners, Toronto, Ontario, Canada. Since every patient’s window of implantation can vary, this test can pinpoint the best timing of not just any embryo transfer, but one that’s personalized to when your endometrial lining is most receptive. Frozen–thawed embryo transfer: influence of clinical factors on Human Reproduction Vol.16, No.11 pp. Methods We performed a single-center, retrospective, case-control study of patients who underwent in vitro fertilization between January 2014 and June 2019. During this phase, stromal cells undergo pseudo-decidualization and an epithelial cell-like appearance due to the accumulation of … We usually transfer 1 to 2 embryos during each FET cycle. 2016;105(4):867–72. Attempting a fresh transfer of this embryo would require placing the embryos in the uterus prior to the time when the embryo is ready or waiting so long for the embryo to get to its optimal stage that the uterus has now lost some of its receptivity. ART Blastocyst Cleavage embryo transfer Clinical outcome High responder Type Research Article. Reliable data are essential for defining the optimal endometrial preparation protocols with accurate determination of the implantation window in frozen ET cycles. Methods: Patients who underwent IVF/FET in Reproductive Medicine Center of Xiangya Hospital during April 1, 2015 to October 31, 2015 were chosen. At the time of a transfer, the embryo is already usually a five day old blastocyst who beat the odds in the lab. Most recent studies suggest that the optimal WOI is small, possible not more than two days. In general, the majority of women have implantation on day five after the progesterone levels start to be high, so after ovulation. The time of maximum uterine receptivity is from post-ovulatory days 6-10 (cycle days 22-24 of an idealized 28-day cycle). Benefits of delayed frozen embryo transfer (freeze all IVF cycle)Delayed frozen embryo transfer, also called the freeze all technique when a patient freezes all embryos during the first cycle of IVF, has several benefits, including:. More and more doctors are recommending a frozen embryo transfer over fresh cycles thanks to advancement in freezing technology known as vitrification. According to Dr. Carlos Simon, coordinating this period of time between the window of implantation and the development of an embryo can be key in a successful IVF outcome. Frozen-thawed (FT) embryo transfer is a procedure used for the storage and transfer of excess embryos obtained during in vitro fertilization– intracytoplasmic sperm injection cycles. During an embryo transfer, an embryo or embryos are released into the cavity of the womb with the use of a very thin tube, called embryo transfer catheter, that passes through the vagina and the cervix. In mammals, the opdmum time for embryo transfer greatly depends upon the species. Keep the uterus calm for implantation with the specific herbal blend UteriCalm. This is sometimes referred to as “late implantation”, or delayed implantation. Previously, doctors believed that the timing of the window of implantation was the same in all women. Endometrial pattern, but not endometrial thickness, affects implantation rates in euploid embryo transfers Fertil Steril. Frozen thawed embryo transfer (FET) is a cost- effective adjunct to IVF or IVF-ICSI treatment. What Is a Frozen Embryo Transfer? ADHESIORT - Personalizing Window of Implantation During Frozen Embryo Transfer: Actual Study Start Date : March 24, 2021: Estimated Primary Completion Date : December 31, 2023: Estimated Study Completion Date : December 31, 2024: Arms and Interventions. Frozen embryos can also be reused even though the first embryo implantation is successful, if both parents want a repeat pregnancy with IVF. The ratio between FET and fresh embryo transfer in ART cycles has increased both in Europe and USA: from 28% to 40.3% (2010–2015) and from 22.9% to 69.4% (2010–2017), respectively De Geyter et al., 2018; ART Success Rates | CDC, 2020). DOI: 10.1007/978-1-4613-0645-0_77 Corpus ID: 81760525. The aim is an open so-called ‘window of implantation’ with a highly receptive-appearing endometrium at the time of embryo transfer. A total of 271 patients aged 20–40 years undergoing … Missed period. 14. However, transfer of excess embryos in frozen cycles increases the cumulative pregnancy rates and decreases the costs. Studies have shown that for some women this “window of implantation” is shifted either earlier or later in the menstrual cycle, or it is very narrow. 20. of transfer being out of synchrony with the endometrial window of implantation.20,21 Several studies demonstrate higher pregnancy rates when day-6 embryos are cryopreserved and resynchronised with the endometrium in a subsequent FER cycle compared with fresh transfer on day 6.22,23 A fresh cycle in which all suitable embryos are frozen is Embryo implantation after frozen blastocyst transfers (FET) can be slightly delayed compared to that seen with fresh blastocyst transfer. At the time of a transfer, the embryo is already usually a five day old blastocyst who beat the odds in the lab. Among the many factors that have contributed to such change, the pursuit of an … Both fresh and frozen embryo transfer will need a good endometrium for implantation. Reproductive endocrinologists and fertility patients alike are constantly seeking ways to improve implantation, pregnancy and ultimately live birth rates following in vitro fertilization (IVF). Group B consisted of 100 patients (100 cycles) who started daily estradiol valerate 6 mg administration from the second day of the FET cycle and followed the same regimen but without prior treatment with triptorelin. Typically an at home pregnancy test is performed around ten to twelve days after the transfer to see if it has been successful. The period of implantation of the embryos in the female uterus consists of several phases: detachment of the zona pellucida, pre-contact and apposition, adhesion and invasion. In the following image we can see the stages of implementation, although we explain them in detail below. Both fresh and frozen embryo transfer will need a good endometrium for implantation. During the 1950’s it was suggested that an embryo had to implant during a specific time in the menstrual cycle (4). This may cause the uterus to prematurely prepare itself for embryo implantation, bringing forward the time frame in which the uterus is receptive. Frozen–thawed embryo transfer: influence of clinical factors on implantation rate and risk of multiple. A second biopsy will be needed in only 10% of cases. Before the placenta takes over the production of progesterone, the progesterone produced by the corpus luteum provides the necessary support for early pregnancy. Ovarian stimulation may be associated with poor endometrial vascularization. What is an Embryo Transfer? Fertil Steril 2016;105:867–72. The synchrony between embryo development and endometrium is the key to success in assisted reproductive technology (ART) [].In addition to embryo quality, endometrial receptivity is widely accepted as one of the main limiting factors for ART outcomes, especially in frozen–thawed embryo … Once it is transferred, it typically takes between one and five days to implant in the uterus and begin to develop. The "window of transfer" is a little different from the window of implantation. The main risk is having a multiple birth (twins or triplets), which can pose serious health risks to both mum and babies. The implantation of the embryo into the wall of the womb, once it has been placed inside the woman’s uterus, is not part of the assisted reproduction process; it is something that occurs naturally in exactly the same way as in normal sexual conception. In order to optimize treatment outcome, FET should be carried out during a period of optimal endometrial receptivity. A recent study, however, did find an effect of personalized embryo transfer following ERA testing . After the embryo has been transferred, it takes a few days for the embryo to hatch out of its shell and implant into the uterus. This is rapid freezing in liquid nitrogen prevents the formation of ice crystals which can be damaging to the embryo. Monitoring for the timing of an embryo’s transfer during a FET cycle is more flexible than in a fresh IVF cycle. These endometrial criteria will be assessed with transvaginal ultrasound and serum estradiol levels. Get your lining in shape. Current research based on the results of ERA tests states that around 25% of all donor egg or donor embryo patients have problems with implantation. Personalized embryo transfer (PET) Window of implantation (WOI) Introduction. The problem with this is that by the time a fresh embryo is grown and ready for transfer, the window of uterine receptivity may have passed. Listing a study does not mean it has been evaluated by the U.S. Federal Government. ˜˚˛˝˙ˆˇˆ˘ ˜˚˜˛˝˙ˆˇ Optimal endometrial preparation for frozen embryo transfer cycles: window of implantation and progesterone support With significant improvements in cryopreservation technology (vitrification) the number of frozen ET IVF cycles is increasing and may soon surpass in numbers and success rates those of fresh stimulated IVF cycles. Pregnancy rates following cryopreserved embryo transfer cycles are usually lower than fresh embryo transfer cycles. We included a total of 192 … The mean age of patients in the groups in this study were 38.4 ± 4.7 in the RIF group and 39.1 ± 5.1 in the control group. The reasons for that can be numerous – from embryo quality to immunological causes. So, we can say there are 5 aspects that affect implantation after embryo transfer: Egg, Sperm and Embryo … Implantation efficiency is becoming critically important in combination with new technologies like Comprehensive Chromosome Screening (CCS), which allows us to screen embryos for health, and transfer only healthy embryos, one at a time. In natural cycle FET (NC-FET), the endometrium develops under endogenous hormonal … Tomás C, Tikkinen K, Tuomivaara L, Tapanainen JS, Martikainen H. (2002). With frozen embryos, the transfer has to be timed to coincide with "implantation window," on average about 20 to 23 days after the last period, during the luteal phase of the menstrual cycle, which is the part of the cycle after ovulation. This state is induced through an interplay of hor-mones including estrogen and progesterone [6]. Fertil Steril, 105(4):867-872, 25 Jan 2016 Cited by: 26 articles | PMID: 26820769. Review Timing the window of implantation by nucleolar channel system prevalence matches the accuracy of the endometrial receptivity array. Optimal endometrial preparation and identification of the receptive window for ET in frozen ET cycles thus assumes utmost importance for insuring the best frozen ET outcomes. Programmed FET cycles are especially useful for patients with irregular menses, but are used in all patient types given the ease of scheduling of transfers … Increasing numbers of elective single ETs are also resulting in more frozen embryos (blastocysts) available for subsequent frozen ET cycles. The lining of the womb undergoes changes to receive the embryo(s). We aimed to establish an RNA-Seq-based endometrial receptivity test (rsERT) tool … In frozen embryo transfer (FET) cycles, estrogen and progesterone are sequentially administered to synchronize the embryo transfer with the endometrial window of implantation. Embryo implantation after frozen blastocyst transfers (FET) can be slightly delayed compared to that seen with fresh blastocyst transfer. Embryo transfer timing is essential for setting the window of implantation (WOI), the time through which the endometrium becomes prepared for embryo implantation (Kim and Matevossian, 2020) [15]. The process of embryo implantation is carried out during the receptive stage of the endometrium in the midluteal phase of the menstrual cycle, known as window of implantation (WOI). In other species, such as pigs 5, mares 6 and monkeys 7, an asynchrony up to one or even two days is possible. If you're using frozen embryos, then use the age of the embryos to determine the implantation window. Materials and Methods: Endometrial thickness assessment was performed with … In 25% of patients the window of implantation was shifted, and once their embryo transfer time was changed based on personal data gathered from the ERA, the rates of implantation climbed to the rates of those with receptive endometrium with normal WOI. When an IVF embryo transfer fails, it is very disheartening and frustrating to patients and providers alike. The objective of embryo transfer is to facilitate conception following fertilization from the in vitro fertilization procedure. Purpose: To detect the expression level of imprinted gene H19 in the endometrium of patients with repeated implantation failure (RIF) who were undergoing in vitro fertilization and embryo transfer (IVF-ET) or frozen embryo transfer (FET). We aimed to establish an RNA-Seq-based endometrial receptivity test (rsERT) tool using … In some situations, all the embryos from a cycle may be frozen so that the woman’s body can recover from the demanding IVF process before undergoing a frozen embryo transfer (FET) in a month or so. In natural cycle FET (NC-FET), the endometrium develops under endogenous … outcome of frozen-thawed embryo transfer cycles. Current research based on the results of ERA tests states that around 25% of all donor egg or donor embryo patients have problems with implantation. Article Download PDF View Record in Scopus Google Scholar. This information is crucial, as it may lead to the development of a tool to help prognose outcome. 7. pp: 465-470, July 2016 467 Fisher exact test, independent t-test multiple comparison procedure to calculate the significance. Your window of implantation is so incredibly unique that your reproductive endocrinologist can schedule your frozen embryo transfer (FET) around when your endometrial lining will be at its most optimal for implantation. Symptoms of pregnancy Some women may experience tenderness around the breasts, cramps, spotting, bleeding or leg pain after frozen embryo transfer but these may … How To Improve Your Uterine Lining To Prepare For IVF. For any embryos permitted to implant, that usually happens around four to five days after the transfer. The main function of the endometrium is to provide the most suitable conditions for an embryo to implant. Embryo Cryopreservation. Frozen embryo transfers are performed 3 to 5 days post-ovulation during the natural menstrual cycle (deemed a natural transfer), or with a programmed menstrual cycle using exogenous estradiol and progesterone supplementation. By the fifth day, implantation should be complete, and your body will begin producing the pregnancy hormone (hCG) from cells in the developing placenta. Initially, our patient underwent multiple unsuccessful endometrium-matched blastocyst transfers after five days of … Using an embryo transfer medium with a high dose of hyaluronan can improve implantation and pregnancy rates in both fresh and frozen transfer cycles. Employing frozen thawed embryo transfer at the blastocyst stage are associated with an improvement in pregnancy rates. (2)Research Department, Nadezhda Women's Health Hospital, 3 "Blaga Vest" Street, … Age, lifestyle and weight can also affect the implantation process. This is sometimes referred to as “late implantation”, or delayed implantation. It’s vital to … The Endometrial Receptivity Analysis (ERA) examines gene expression in the endometrium to evaluate whether the endometrium is receptive and predicts a woman’s personal window of implantation. Advancements in the optimization of embryo culture conditions and the establishment of vitrification as a standard cryopreservation technique have allowed researchers to perform fresh and frozen-thawed embryo transfer (ET) at the blastocyst stage [1,2,3].Several studies involving fresh blastocyst transfer revealed that higher clinical pregnancy rates (CPRs) occurred when blastocysts … FIRST EMBRYO TRANSFER CUMULATIVE RATE 13.8 pp [email protected] - (305) 501-4948 - w 15.8pp w w. i ge n o mi x. co m ERA® is a diagnostic test indicated for all patients starting assisted reproductive treatments that allows a personalized embryo transfer by sinchronizing the patient's window of implantation. It is caused by elevated hormone levels. Hence many clinicians prefer frozen embryo transfer. Hum Reprod; 17:2632–5. In patients undergoing IVF treatment, the day of embryo transfer is usually considered to be in the middle of implantation window. This period lasts a maximum of 48 h Psychoyos, 1986). You can reduce your risk of having a multiple birth by transferring only one embryo to the womb, a process known as elective single embryo transfer or eSET. 2015 Sep;104(3):620-8.e5. Stamenov GS(1), Parvanov DA(2), Chaushev TA(2). Dr. Hamamah concluded that microRNAomes in endometrial tissues during implantation windows during a cycle preceding fresh or frozen embryo transfer cycle have been shown to predict outcome. Furthermore, by moving the planned embryo transfer to the appropriate time, chances of successful implantation can be improved. Blastocyst implantation in an FET cycle. Similar to our study, they did not use a GnRH agonist for down-regulation, and thus endogenous basal LH secretion was not … Watch the video and find out how to prepare for embryo transfer and learn how important the implantation window is for embryo implantation. Hence many clinicians prefer frozen embryo transfer. Keywords. Therefore, from all of the above information, the inferred window of implantation may extend from days 18-19 to 23-24 of the "idealized cycle". In this case, with the ERA computational predictor, we will estimate your window of implantation indicating when your personalized embryo transfer is optimal in 90% of the cases. Personalizing Window of Implantation During Frozen Embryo Transfer (AdhesioRT) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Answered by Dr. Robert Kwok: Time will tell: Patience is a valuable virtue. Women will then begin intramuscular progesterone injection and if assigned to the study arm, a single euploid embryo will be transferred at … When we talk about embryo transfer and embryo transfer of frozen embryos we don't refer to the transfer of frozen embryos but to the process of embryo transfer after being frozen and thawn.

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