Embryo Transfer Guidelines for Patients with Adenomyosis or Repeated Implantation Failures

Introduction to Embryo Transfer Strategies

The European Society of Human Reproduction and Embryology (ESHRE) strongly states that the number of previous failed treatment attempts should not influence the decision to transfer one embryo instead of two 1, 2
Transferring two embryos increases the risk of multiple pregnancy 30-fold (OR 30.54, 95% CI 7.46-124.95) without improving the cumulative live birth rate 1
Endometrial characteristics should not determine the decision to transfer one or two embryos in FET cycles 1

The American Society for Reproductive Medicine recommends continuing progesterone supplementation at a dose of 800 mg vaginally per day without interruption to maintain endometrial support necessary for implantation 3
Progesterone supplementation should be continued throughout early pregnancy 3
Hormonal support should not be discontinued based on symptoms or their absence 3

The American Society of Clinical Oncology (ASCO) states that ovarian suppression with GnRH agonists should not be used as a method of fertility preservation due to insufficient evidence 4, 5
In patients with adenomyosis, GnRH agonists may improve implantation and pregnancy rates, but the evidence is not strong enough to support routine use 5
In patients with repeated implantation failures, GnRH agonists may show a trend towards improvement, but the evidence is weak and not statistically significant 5

Patients should wait for the scheduled beta-HCG blood test (usually 9-12 days after blastocyst transfer) instead of using early home pregnancy tests 3
A single beta-HCG level >3000 mIU/mL should prompt early ultrasound to assess multiple pregnancy, even after single embryo transfer 3
Early transvaginal ultrasound at 5-6 weeks confirms the location and number of gestational sacs 3
All prescribed hormonal support should be continued until further instructions are received from the doctor 3

Do not increase the number of embryos transferred based on previous failures – this is strongly advised against by ESHRE 1, 2
Do not discontinue progesterone supplementation based on symptoms – hormone levels must remain stable regardless of subjective feelings 3
Do not rely on GnRH agonists as a method of fertility preservation or routine preparation for FET 4, 5
Do not introduce drastic lifestyle changes that create stress or anxiety 3