Ultrasound guidance during embryo transfer: a prospective, single-operator, randomized, controlled trial (original) (raw)
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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...
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.
Optimising the Outcome of Embryo Transfer
EMJ Reproductive Health
In vitro fertilisation (IVF) is a complex procedure, the success of which is dependent on several factors at every step of the process. Despite major advances, successful implantation rates in IVF remain low. Aside from the status of the embryo and endometrium, embryo transfer (ET) plays a major role in implantation. There are numerous variables in ET that are causative factors for IVF success. In this article, the authors discuss whether the stage at which (cleavage versus blastocyst) ET occurs; a fresh or frozen ET; and the technique of ET affects the results of an assisted reproductive technology cycle. Blastocysts had higher implantation potential than cleavage-stage embryos and it was also observed that extended embryo culture was not related to increased adverse obstetric and perinatal outcome. Though freezing has several advantages over fresh cycles, one must remember that evidence is still lacking for its use in all patients. Elective cryopreservation of all embryos with tra...
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.
Influence of embryo transfer depth on in vitro fertilization and embryo transfer outcomes
Fertility and sterility, 2004
Objective: To investigate the influence of transfer distance from the fundus (TDF) on clinical pregnancy rate (PR) and ectopic pregnancy rate. Design: Retrospective cohort. Between January 2000 and December 2001, 699 ultrasound (US)-guided embryo transfers were conducted. Mock transfer was performed to measure uterine cavity depth 1 month before treatment. Cavity depth was measured by abdominal US before the transfer, from the vaginal stripe to the fundus. Transfers were performed with a Wallace embryo transfer catheter (Cooper Surgical, Shelton, CT) using US and physician's judgment of cavity depth. Transfer distance from the fundus was calculated by subtracting the depth of catheter insertion from the cavity depth, as determined by US or by mock transfer. Statistical analyses were performed by building a multivariable logistic regression model to calculate odds ratios and 95% confidence intervals (CI). Setting: Women aged 23 to 43 years who are in a university-affiliated, community-based IVF program in Springfield, Massachusetts. Patient(s): All patients enrolled in IVF program undergoing embryo transfer. Intervention(s): No patient received any additional procedure or intervention. All of the measurements obtained with the embryo catheter and the transvaginal ultrasound were part of the program's protocol for the embryo transfer. Main Outcome Measure(s): Odds ratio examining relationship between embryo transfer depth and PR. Result(s): Clinical, implantation, and ectopic PR were 37%, 20%, and 2.1%. Cavity depth by US differed from cavity depth by mock by at least 10 mm in Ͼ30% of cases. The TDF by US was highly predictive of PR; TDF by mock was not predictive of PR. Increasing the TDF by US resulted in significantly increased PR as well as lower ectopic rates. Using regression analysis, the odds ratio for TDF by US was 1.11 (95% CI: 1.07-1.14). This suggests that for every additional millimeter embryos are deposited away from the fundus, the odds of clinical pregnancy increased by 11%. Conclusion(s): After controlling for potential confounders, the clinical PR is significantly influenced by the transfer distance from the fundus. Cavity depth by US is clinically useful to determine the depth beyond which catheter insertion should not occur.
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.
Effect of embryo transfer depth on IVF/ICSI outcomes: A randomized clinical trial
International Journal of Reproductive BioMedicine (IJRM)
Background: Although there has been remarkable advancement in the field of assisted reproductive technology, implantation failure remains a significant issue in most infertile couples receiving these treatments. Embryo transfer is important in assisted reproductive technology and directly affects the implantation rates and pregnancy outcomes. Objective: To assess the effect of two different distance embryo transfer sites from fundal endometrial surface on the outcomes of in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles. Materials and Methods: A total of 180 women who were candidate for IVF/ ICSI/ embryo transfer in Yazd Research and Clinical Center for Infertility were equally assigned to two groups based on the distance between the fundal endometrial surface and catheter tip to investigate implantation, chemical and clinical pregnancy (group A: 15 ± 5 mm and group B: 25 ± 5 mm, respectively). Results: The subjects in the group B showed significantly highe...
Human Reproduction, 2002
BACKGROUND: Recent reports have suggested that ultrasound (US) guidance during embryo transfer might improve pregnancy rates. METHODS: A prospective randomized (computer-generated random table) trial was performed to compare embryo transfer under abdominal US guidance (n ⍧ 255 women) with clinical touch embryo transfer (n ⍧ 260). RESULTS: The clinical pregnancy rate was 26.3% (67/255) in the US-guided transfer group compared with 18.1% (47/260) in the clinical touch transfer group (P < 0.05). The implantation rate was 11.1% (100/903) in the US group compared with 7.5% (66/884) in the clinical touch group (P < 0.05). US-guided transfer was associated with a decrease in the difficulty of the transfers: 97% of transfers were easy in the US-guided group compared with 81% in the clinical touch group (P < 0.05). CONCLUSIONS: US-guided embryo transfer increased pregnancy and implantation rates in IVF cycles, as well as the frequency of easy transfers. It is suggested that the decrease in cervical and uterine trauma can play a role in the increase in pregnancy rates associated with USguided transfer. It is recommended that embryo transfer should be performed under US guidance.