Patients are often confused about whether the success rate with fresh embryo transfer is better or worse as compared to frozen embryo transfer . Let me put this in perspective .

There used to be a time when our ability to freeze embryos was poor , as a result of which many of them died during the  lab process of freezing and thawing them. This is why in the early days of IVF, the pregnancy rate with fresh embryos was better – and this is still true when the IVF lab is not good, and the embryologist doesn’t have the expertise and experience to freeze embryos properly.

However, with the technique of ultra-rapid freezing ( vitrification ), the survival rate of frozen embryos after thawing is nearly 100% in a good clinic .

 However, do remember that freezing the embryos doesn't increase their implantation rate, and this is why the pregnancy rate with a fresh embryo transfer cycle is as good as with a frozen embryo transfer cycle, provided the embryos are top quality , and the endometrium is receptive .

After all, don’t forget that before we transfer the frozen embryo ( which is at -196 C), we need to thaw it to 37 C – so it’s exactly like a fresh embryo when we transfer it.

However, if the endometrial lining is not ready , or the patient is at risk for ovarian hyperstimulation syndrome ( OHSS), it’s far better to freeze all the embryos . This is where the actual value of freezing comes in.

The other big advantage of freezing is that you only need to transfer a single embryo at a time, which means  the patient doesn't run the risk of a multiple pregnancy , with the consequent risk of prematurity and cerebral palsy in the babies .

However , do remember that freezing is a good option only when you are sure that the lab is technically competent , and does only blastocyst transfers .

Now, if the embryologist is not confident about his own skills , and cannot be sure they can grow embryos routinely to Day 5 in their lab , then why would you trust them to be able to freeze and thaw your embryos properly ?

If you freeze your embryos in a bad IVF lab, there is a very real risk that the embryos will die as a result of this, and the freezing and thawing will reduce your pregnancy rates .

Sadly, most patients are completely clueless about these risks . Not only do they refuse to take the time and trouble to understand the details, doctors are often very opaque , and will not share this information with the patient .

This is why patients aren’t able to can’t make well informed decisions , and they get suboptimal care.