The Effect of Embryo Transfer Process Duration on Implantation Success (original) (raw)
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Comparative Study between two Types of Embryo Transfer Catheters: A Randomized Controlled Trial
Evidence Based Women's Health Journal
Background: Embryo transfer is a crucial step in IVF-embryo transfer treatment cycles, but it is probably the most inefficient. Ovarian stimulation, oocytes retrieval, fertilization and embryo culture have been extensively studied and are performed under tight control, while improvements in embryo transfer are less often considered. There are many factors, in addition to the embryo quality, that have been shown to influence the success of embryo transfer such as the technique used, the experience of the operator and the difficulty of the procedure. Aim of the Work: To compare the efficacy of the embryo transfer catheters: Wallace® and Prince® in an IVF program of a tertiary referral university center. Patients and Methods: A randomized controlled research trial conducted at private IVF unit and the unit of Reproductive Medicine of Ain-Shams University. Study subjects have been recruited from an IVF management cycle. The research study has been conducted from January 2016 till September 2019. Results: The current research study investigated four types of embryonic catheters Wallace, Prince with and without mandrel and Labotech most of the research study findings did not reveal any statistical significant differences by statistical analysis in which basic features and ovarian stimulation features did not differ between research groups categorized according to the type of catheter implemented. Conclusion: Another issue that should be considered in future research is the integration of uterine volume, cervical position, uterine axis as factors affecting the choice of the type of catheter that could aid in proper performance of this meticulous art of embryonic transfer besides differences in experience and practice performed by the reproductive clinician should be put in consideration. Future research studies should consider multicentric fashion of research with great consideration of age, BMI, ethnicity, infections (causing cervical edema) as factors affecting the anatomic integrity and position therefore affecting the ease of the embryonic transfer process.
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...
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.
Minimizing embryo expulsion after embryo transfer: a randomized controlled study
Human Reproduction, 2004
BACKGROUND: The aim of this work was to modify the embryo transfer technique to prevent expulsion of the embryos by exerting gentle mechanical pressure on the cervix using the vaginal speculum. METHODS: A total of 639 infertile patients undergoing ICSI were prospectively randomized into two groups using sealed dark envelopes. In the study group (n 5 325) the screw of the vaginal speculum was loosened in order to exert a gentle pressure on the portiovaginalis of the cervix before ejecting the embryos, and was maintained for 7 min afterwards. In the control group (n 5 314) no pressure was applied on the cervix during embryo transfer and the vaginal speculum was removed after transferring the embryos. RESULTS: The clinical pregnancy rate was significantly higher in the study group than in the control group [207/325 (67%) versus 150/314 (47.8%); odds ratio (OR) 1.39; 95% confidence interval (CI) 1.11-1.74]. The implantation rate was also significantly higher in the study group [304/913 (33.3%) versus 198/920 (21.5%); OR 1.54; 95% CI 1.26 -1.89]. CONCLUSIONS: Applying gentle mechanical pressure on the portiovaginalis of the cervix using the vaginal speculum during and after transferring the embryos significantly improved clinical pregnancy and implantation rates.
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...
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.
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.
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.