Minimizing embryo expulsion after embryo transfer: a randomized controlled study (original) (raw)
Related papers
Fertility and sterility, 2017
To establish the relationship between the degree of difficulty of ET and pregnancy rate (PR), with a view to proposing an algorithm for the objective assessment of ET. Retrospective, observational study. In vitro fertilization unit. Women undergoing assisted reproductive technology (ART) with ET after IVF/intracytoplasmic sperm injection, in whom fresh embryo transfer or frozen-thawed embryo transfer was performed. None. Clinical pregnancy rate (CPR). A total of 7,714 ETs were analyzed. The CPR was significantly higher in the cases of easy ET compared with difficult ET (38.2% vs. 27.1%). Each instrumentation needed to successfully deposit the embryos in the fundus involves a progressive reduction in the CPR: use of outer catheter sheath (odds ratio [OR] 0.89; 95% confidence interval [CI] 0.79-1.01), use of Wallace stylet (OR 0.71; 95% CI 0.62-0.81), use of tenaculum (OR 0.54; 95% CI 0.36-0.79). Poor ultrasound visualization significantly diminish the CPR. The CPR decreases progressi...
The influence of the depth of embryo transfer into the uterine cavity on implantation rate
Middle East Fertility Society Journal, 2010
To assess the effect of the depth of embryo transfer replacement on implantation and clinical pregnancy rates in intracytoplasmic sperm injection cycles.This study was conducted on 90 consecutive patients. All patients underwent a standard down regulation protocol for ovarian stimulation. Oocytes retrieval was performed at 36 h after HCG administration. Embryo transfer took place 2–4 days after oocyte retrieval. The patients were grouped according to the distance between the tip of the catheter and the uterine fundus at transfer (group I <0.75 cm, group II 0.75–<1.5 cm, group III 1.5–2 cm).Implantation and clinical pregnancy rates varied significantly between group I and other groups: 10.3% and 13.3%, respectively, in group I; 26.7% and 53.3%, respectively, in group II; 27.8% and 53.3%, respectively, in group III.The depth of embryo replacement inside the uterine cavity may influence implantation rates and should be considered as an important factor to improve the success of implantation and pregnancy rates.
The degree of difficulty of embryo transfer is an independent factor for predicting pregnancy
Human Reproduction, 2002
BACKGROUND: The role of embryo transfer as regards the success of IVF/ICSI treatments is recognized but has not been comprehensively evaluated. In order to determine its importance, the degree of difficulty of 4807 embryo transfers after IVF/ICSI was analysed retrospectively. METHODS: Logistic regression analysis identified the age of the subject, type of treatment (IVF versus ICSI), number of embryos transferred and degree of difficulty of embryo transfer as independent factors predicting pregnancy. The main focus of the study was to evaluate the importance of the difficulty of embryo transfer after taking into account the other confounding variables. RESULTS: Embryo transfer was classified as easy (2821), intermediate (1644) or difficult (342). The transfer was considered difficult if it was time consuming, the catheter met great resistance, there was a need to change the catheter, if sounding or cervical dilatation was needed or if blood was found in any part of the catheter. Easy or intermediate transfers resulted in a 1.7-fold higher pregnancy rate than difficult transfers (P < 0.0001; 95% confidence interval: 1.3-2.2). CONCLUSIONS: This study demonstrates that the degree of difficulty of embryo transfer is an independent factor as regards achieving pregnancy after IVF/ICSI. All efforts should be made to avoid difficult embryo transfers. Physicians should be alert to the factors associated with embryo transfer and should be instructed to use a stepwise approach in difficult transfers.
Fertility and Sterility, 1999
To assess the impact of ET difficulty on IVF outcome and to optimize the ET procedure. Design: Retrospective analysis of IVF outcome by ET catheter type and ET difficulty. Prospective treatment and follow-up of patients with a history of extremely difficult cervical passage. Setting: Large university-based IVF program. Patient(s): All patients Ͻ40 years of age undergoing IVF-ET from September 1995 to May 1998. Intervention(s): Surgical correction of cervical stenosis. Main Outcome Measure(s): Pregnancy and embryo implantation rates. Result(s): Only 0.6% of ETs were "extremely difficult." Pregnancy rates were not statistically significantly different among ETs graded easy, moderate, and difficult. In contrast, no pregnancies occurred in the rare "extremely difficult" ET group. Eight patients with a history of extremely difficult cervical passage underwent surgical correction of their cervical stenosis. Twelve postoperative IVF-ET in these women resulted in eight clinical pregnancies, six of which were multiple gestations. The embryo implantation rate of these cycles was 42.2%.
Human Reproduction, 1998
In order to assist the medical team in the decision-making process and in adequate counselling of patients when encountering technical difficulties at the time of embryo transfer, we investigated the effect of difficult embryo transfer, with or without the need for cervical dilatation or repeated sequential attempts because of retained embryos in the catheter system, on in-vitro fertilization (IVF) pregnancy rates and outcome. A total of 854 consecutive embryo transfer procedures were prospectively categorized as (i) easy (smooth, unforced), (ii) difficult (requiring uterine manipulation or increased force or cervical grasping and/or accompanied by trauma), (iii) requiring cervical dilatation, or (iv) multiple (two or three) sequential attempts because of embryos retained in the catheter system. Embryo transfer was easy in 734 cases (85.9%). It was difficult in 72 (8.4%), cervical dilatation was required in 21 (2.5%), and one or two repeated attempts were needed in 27 cases (3.2%). Pregnancy rates for the different categories of embryo transfer were 23.3, 23.6, 23.8 and 29.6% respectively. There were no significant differences in the percentage of the ongoing/delivered pregnancies for the different categories of embryo transfer (69, 64.6, 60 and 62.5% respectively). There were no significant differences in the distribution of embryo transfer types among the six infertility specialists who performed the procedures. To conclude, embryo transfers that are difficult to perform or that require cervical dilatation or repeated attempts do not adversely affect pregnancy rates and outcome following IVF. Cervical dilatation, if needed for patients with cervical stenosis, should be performed at the time of the embryo transfer and not earlier. Surgical transmyometrial embryo transfer or rescheduling patients for delayed embryo transfer could be avoided in most patients. This information is important for patient management and counselling in cases of embryo transfer that are not easy to perform.
Fertility and Sterility, 2010
In this randomized trial study, two groups of infertile women (n ¼ 55) aged %40 years underwent in vitro fertilization or intracytoplasmic sperm injection treatment cycles with or without 0.2 mL of air pushed into the catheter after embryo transfer. The implantation and clinical pregnancy rates were statistically significantly higher in the study group than in the controls. This improvement on standard ET technique may advance clinical pregnancy rates.
Importance of embryo transfer duration in human assisted reproduction techniques
2017
The most important step in in vitro fertilization (IVF) is the transfer of the embryos (ET) in the uterine cavity. Stimulation of the cervix or uterus during the procedure causes uterine contractions and possibly expulsion of the embryos. The catheter for embryo transfer can also be an element of local distress. The aim of the present pilot study was to assess the influence of the time the catheter remains inside in the uterine cavity on the final outcome of the IVF procedure. The prospective two-center study excluded patients with difficult ET procedure. The pregnancy was confirmed by ultrasound (embryonic cardiac activity present) 6 weeks after the procedure. Patients were divided into two groups (catheterization < 120 seconds or > 120 seconds). Data were processed and statistically analyzed applying Fisher's exact test. 122 cycles of IVF were analyzed. Average ages of patients included in the study was 34.6 years, the average number of transferred embryos was 2.18 and 3...
Embryo transfer: techniques and variables affecting success
Fertility and Sterility, 2001
Objective: To review the literature on the variables affecting embryo transfer success or failure and to define technical factors associated with optimal outcome. Design: Literature review. Results: Avoidance of blood, mucus, bacterial contamination, excessive uterine contractions, and trauma to the endometrium is associated with optimal pregnancy and implantation rates after transcervical embryo transfer. A trial transfer, ultrasonographic guidance, and use of "soft" catheters appear to facilitate successful embryo transfer. Conclusion: An understanding of the variables associated with embryo transfer success together with adherence to techniques shown to facilitate atraumatic embryo transfer will enhance the efficiency of IVF by maximizing embryo implantation.
Optimizing the embryo transfer technique
Human Reproduction, 2002
Background: Part of the success of ultrasound-guided embryo transfer has been associated with the beneficial effect of uterine straightening by passive bladder distention. Even so, this has not been properly analysed in the literature. Methods: This is a systematic review and meta-analysis of prospective, randomised, controlled trials, comparing embryo transfer with a full versus empty bladder. Electronic (e.g. PubMed, EMBASE, Cochrane Library) and hand searches were performed to locate trials. Primary outcomes were live-birth, ongoing and clinical pregnancy rates. Secondary outcomes were rates of implantation, miscarriage, multiple and ectopic pregnancies, and retained embryos. Also, the ease of transfer, need for instrumental assistance, and presence of blood on the catheter tip were evaluated. Four studies were identified, of which 1 study was excluded. Meta-analysis was conducted with the Mantel-Haenszel method, utilising the fixed-effect model. Results: For the primary outcome measures, no data was available for the LBR rate. There was a significantly higher chance of an ongoing pregnancy [OR = 1.44 (95% CI = 1.04 -2.04)] and clinical pregnancy [OR = 1.55 (95% CI = 1.16 -2.08)] with a full bladder. For the secondary outcomes, there was a significantly greater incidence of difficulty, or need for instrumental assistance, with an empty bladder. Other outcome measures were not significantly different. Conclusion: There is evidence in the literature advising to fill the bladder prior to embryo transfer.