Frozen vs. Fresh Embryo Transfer: Which Is Better?

Having a baby through fertility treatment involves many important choices, and one of them is deciding whether to use a fresh or frozen embryo during the transfer stage. This step can feel a bit confusing, especially when you're already trying to understand all the medical terms and options. If you're feeling unsure, you're not alone. Many couples find it challenging to choose between the two. In this blog, we’ll explain the difference between fresh and frozen embryo transfers, how each one works, and what the pros and cons are, all in simple, easy-to-follow language to help you feel more confident and informed in your fertility journey.

What Is Embryo Transfer in IVF?

Embryo transfer is one of the final steps of the IVF process. Once the egg is fertilized with sperm in the lab, it begins to divide and grow into an embryo. This embryo is then transferred into the woman’s uterus in hopes that it will implant and lead to a successful pregnancy.

There are two main ways to do this:

• Fresh Embryo Transfer: The embryo is transferred into the uterus just a few days after egg retrieval (usually on day 3 or day 5).

• Frozen Embryo Transfer (FET): The embryo is frozen and stored for later use. It is thawed and transferred in a later cycle.

Let’s now take a closer look at each method.

What Is a Fresh Embryo Transfer?

In a fresh embryo transfer, the embryo is placed into the uterus during the same IVF cycle in which the eggs were collected. The timeline is quick, eggs are retrieved, fertilized, and a healthy embryo is selected for transfer within 3 to 5 days.

Read more: How Stress Affects Fertility: What Science Says

Pros of Fresh Embryo Transfer

1. Faster process: Since everything happens in one cycle, you don’t need to wait for the next period to begin.

2. Less delay in trying for pregnancy: It may reduce the emotional and mental stress of waiting.

3. No need to thaw embryos: Some worry that the freezing and thawing process might affect embryo quality (though modern freezing techniques are very advanced).

Cons of Fresh Embryo Transfer

1. High hormone levels may affect the uterus: During IVF, hormone medications stimulate the ovaries to produce multiple eggs. This may lead to an environment in the uterus that is not ideal for implantation.

2. Risk of ovarian hyperstimulation syndrome (OHSS): If a woman shows signs of OHSS, doctors often avoid fresh transfers to prevent health risks.

3. Lower success in some cases: For some women, especially those with certain conditions, success rates may be lower with fresh transfers.

What Is a Frozen Embryo Transfer (FET)?

In a frozen embryo transfer, embryos are frozen using a process called vitrification. These frozen embryos can be stored for months or even years. When the time is right, one or more embryos are thawed and placed into the uterus during a future cycle.

Pros of Frozen Embryo Transfer

1. More time for the body to recover: After egg retrieval and hormonal stimulation, the body can rest and return to a more natural state before pregnancy is attempted.

2. Higher success rates in some cases: Studies show that FET can sometimes lead to higher pregnancy rates and healthier babies, especially in women with high hormone levels.

3. Lower risk of OHSS: Since transfer is delayed, it gives the body time to recover and reduces the chance of complications.

4. More flexibility and control: FET allows you to better plan the timing of your pregnancy.

5. Useful for genetic testing: If embryos are tested for genetic abnormalities (PGT-A or PGT-M), they must be frozen while waiting for results.   

Cons of Frozen Embryo Transfer

1. Longer wait time: You need to wait for a new cycle to prepare the uterus, which can feel emotionally tough.

2. Cost: The freezing, storage, and later thawing of embryos may increase the overall cost of treatment.

3. Not always necessary: In some cases, a fresh transfer may be just as effective, especially for younger women with good embryo quality.                                                                                                                      

Success Rates: What Does the Research Say?

Success in IVF depends on many things: the woman’s age, the quality of embryos, the clinic’s expertise, and individual medical conditions. However, some studies and fertility experts suggest that:

• Frozen transfers may lead to higher pregnancy rates in certain groups of women, especially those with high estrogen levels or polycystic ovary syndrome (PCOS).

• Birth weights of babies from frozen embryos tend to be slightly higher and risks of preterm birth slightly lower.

• However, not all women benefit more from frozen transfers. For women with normal hormone levels and regular cycles, a fresh transfer may be equally effective.

When Do Doctors Recommend Fresh vs. Frozen?

Every fertility journey is different. Doctors look at several factors before deciding which type of transfer is best:

Fresh Transfer is Usually Recommended When:

• The woman is young (under 35) and has healthy eggs.

• Hormone levels are stable during IVF.

• There’s no sign of OHSS or other complications.

• There’s a good-quality embryo available.

Frozen Transfer is Preferred When:

• Hormone levels are too high or the uterus isn’t ready.

• The woman is at risk of OHSS.

• Embryos are being genetically tested.

• Previous fresh transfer attempts have failed.

• More time is needed for emotional or physical recovery.

Is One Safer Than the Other?

Both fresh and frozen embryo transfers are safe and widely used around the world. However, some data shows that:

• Frozen transfers might reduce the risk of low birth weight and premature birth.

• Fresh transfers may carry a slightly higher risk of pregnancy complications like OHSS if the body is overstimulated.

Again, these risks are very small, and your fertility expert will take steps to minimize them.

What About Emotional and Mental Health?

The IVF journey can be emotionally draining. Choosing between fresh and frozen transfers also depends on what feels right for you and your partner.

• Some people prefer fresh transfers because they’re eager to move forward quickly.

• Others prefer frozen transfers because they want their bodies to be in the best shape possible and reduce risks.

It's important to speak openly with your doctor and your support system about your feelings and preferences.

Cost Difference Between Fresh and Frozen Transfers

In India, a fresh IVF cycle (including medication and embryo transfer) can cost between ₹1.5 to ₹2.5 lakhs or more, depending on the clinic.

Frozen embryo transfer may add additional costs:

• Freezing and storage: ₹20,000–₹40,000 per year

• Thawing and transfer: ₹40,000–₹60,000

While FET may increase the total cost, it may also improve chances of success, especially if multiple embryos are stored and used later without needing another IVF cycle.

Read more: Common Lifestyle Habits That Can Lead to Infertility

Which One Is Better? Final Thoughts

There is no “one-size-fits-all” answer. Both fresh and frozen embryo transfers have their advantages and disadvantages. What matters most is your individual health, medical history, emotional state, and how your body responds to treatment.

Fresh embryo transfer may be better if:

• Your hormone levels are normal.

• You want to avoid extra costs.

• You want to move quickly toward pregnancy.

Frozen embryo transfer may be better if:

• Your hormone levels are too high.

• You’re at risk of OHSS.

• You want to prepare your body and mind fully.

• You're doing genetic testing.

Talk to Your IVF Specialist

Only a fertility specialist who understands your full medical history can recommend the best approach for you. Don't hesitate to ask questions like:

• What are my hormone levels?

• Is my uterus ready for a fresh transfer?

• How many embryos do I have?

• What are my chances of success with fresh vs. frozen?

Making informed decisions with the help of your doctor will increase your chances of success and give you more peace of mind during your IVF journey.

Conclusion

Choosing between fresh and frozen embryo transfer is an important step in the IVF process. Both methods have helped millions of couples achieve parenthood. Understanding the pros, cons, and differences can help you feel more confident and prepared for this life-changing journey.

Remember, the goal is not just to get pregnant, but to have a healthy pregnancy and a healthy baby. Take your time, gather information, and trust the guidance of your fertility expert.