1
|
Nguyen E, Strug M, Gardner A, Burney R, Campbell S, Aghajanova L. Initial fertility evaluation with saline sonography vs. hysterosalpingography: it is debate-tubal. Fertil Steril 2024; 121:922-930. [PMID: 38703168 DOI: 10.1016/j.fertnstert.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Edward Nguyen
- Division Reproductive Endocrinology and Infertility, Stanford University School of Medicine, Sunnyvale, California
| | - Michael Strug
- Division Reproductive Endocrinology and Infertility, Stanford University School of Medicine, Sunnyvale, California
| | - Austin Gardner
- Division Reproductive Endocrinology and Infertility, University of Alabama at Birmingham, Birmingham, Alabama
| | - Richard Burney
- Division Reproductive Endocrinology and Infertility, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sukhkamal Campbell
- Division Reproductive Endocrinology and Infertility, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lusine Aghajanova
- Division Reproductive Endocrinology and Infertility, Stanford University School of Medicine, Sunnyvale, California
| |
Collapse
|
2
|
D’Angelo A, Panayotidis C, Alteri A, Mcheik S, Veleva Z. Evidence and consensus on technical aspects of embryo transfer. Hum Reprod Open 2022; 2022:hoac038. [PMID: 36196080 PMCID: PMC9522404 DOI: 10.1093/hropen/hoac038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Ultrasound-guided embryo transfer (US-GET) is a widely performed procedure, but standards for the best practice are not available.
OBJECTIVE AND RATIONALE
This document aims to provide an overview of technical aspects of US-GET after considering the published data and including the preparation for the embryo transfer (ET) procedure, the actual procedure, the post-procedure care, associated pathologies, complications and risks, quality assurance and practitioners’ performance.
SEARCH METHODS
A literature search for evidence on key aspects of the ET procedure was carried out from database inception to November 2021. Selected papers (n = 359) relevant to the topic were analysed by the authors. The following key points were considered in the papers: whether ultrasound (US) practice standards were explained, to what extent the ET technique was described and whether complications or incidents and how to prevent such events were reported. In the end, 89 papers could be used to support the recommendations in this document, which focused on transabdominal US-GET.
OUTCOMES
The relevant papers found in the literature search were included in the current document and described according to the topic in three main sections: requirements and preparations prior to ET, the ET procedure, and training and competence for ET. Recommendations are provided on preparations prior to ET, equipment and materials, ET technique, possible risks and complications, training and competence. Specific aspects of the laboratory procedures are covered, in particular the different loading techniques and their potential impact on the final outcomes. Potential future developments and research priorities regarding the ET technique are also outlined.
LIMITATIONS, REASONS FOR CAUTION
Many topics were not covered in the literature review and some recommendations were based on expert opinions and are not necessarily evidence based.
WIDER IMPLICATIONS
ET is the last procedural step in an ART treatment and is a crucial step toward achieving a pregnancy and live birth. The current paper set out to bring together the recent developments considering all aspects of ET, especially emphasizing US quality imaging. There are still many questions needing answers, and these can be subject of future research.
STUDY FUNDING/COMPETING INTEREST(S)
No funding. ADA has received royalties from CRC Press and personal honorarium from Cook, Ferring and Cooper Surgical. The other co-authors have no conflicts of interest to declare that are relevant to the content of this article.
Collapse
Affiliation(s)
- Arianna D’Angelo
- Wales Fertility Institute, Swansea Bay Health Board, University Hospital of Wales, Cardiff University , Cardiff, UK
| | - Costas Panayotidis
- Attiki Iatriki advanced gynaecological ultrasound and hysteroscopic centre private practice , Pallini, Athens, Greece
| | | | - Saria Mcheik
- European society of human reproduction and embryology (ESHRE) Central Office , Strombeek-Bever, Belgium
| | - Zdravka Veleva
- Helsinki University Central Hospital , Helsinki, Finland
| |
Collapse
|
3
|
Tyler B, Walford H, Tamblyn J, Keay SD, Mavrelos D, Yasmin E, Al Wattar BH. Interventions to optimize embryo transfer in women undergoing assisted conception: a comprehensive systematic review and meta-analyses. Hum Reprod Update 2022; 28:480-500. [PMID: 35325124 PMCID: PMC9631462 DOI: 10.1093/humupd/dmac009] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/02/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Several interventions and techniques are suggested to improve the outcome of embryo transfer (ET) in assisted conception. However, there remains no consensus on the optimal practice, with high variations among fertility specialists. OBJECTIVE AND RATIONALE We conducted a comprehensive systematic review and meta-analyses of randomized controlled trials (RCTs) aiming to identify effective interventions that could be introduced around the time of ET to improve reproductive outcomes. SEARCH METHODS We searched the electronic databases (MEDLINE, EMBASE and Cochrane CENTRAL) from inception until March 2021 using a multi-stage search strategy of MeSH terms and keywords, and included all RCTs that evaluated an intervention in the 24-h period before/after ET in women undergoing IVF/ICSI. Our primary outcome was clinical pregnancy rate post-ET confirmed as viable pregnancy on ultrasound scan. We assessed the risk of bias in included trials and extracted data in duplicate. We pooled data using a random-effect meta-analysis and reported using risk ratio (RR) with 95% CI. We explored publication bias and effect modifiers using subgroup analyses. OUTCOMES Our search yielded 3685 citations of which we included 188 RCTs (38 interventions, 59 530 participants) with a median sample size of 200 (range 26-1761). The quality of included RCTs was moderate with most showing a low risk of bias for randomization (118/188, 62.8%) and attrition (105/188, 55.8%) but there was a significant risk of publication bias (Egger's test P = 0.001). Performing ET with ultrasound guidance versus clinical touch (n = 24, RR 1.265, 95% CI 1.151-1.391, I2 = 38.53%), hyaluronic acid versus routine care (n = 9, RR 1.457, 95% CI 1.197-1.261, I2 = 46.48%) and the use of a soft versus hard catheter (n = 27, RR 1.122, 95% CI 1.028-1.224, I2 = 57.66%) led to higher clinical pregnancy rates. Other pharmacological add-ons also showed a beneficial effect including granulocyte colony-stimulating factor (G-CSF: n = 4, RR 1.774, 95% CI 1.252-2.512, I2 = 0), Atosiban (n = 7, RR 1.493, 95% CI 1.184-1.882, I2 = 68.27%) and hCG (n = 17, RR 1.232, 95% CI 1.099-1.382, I2 = 57.76%). Bed rest following ET was associated with a reduction in clinical pregnancy (n = 6, RR 0.857, 95% CI 0.741-0.991, I2 = 0.01%). Other commonly used interventions, such as non-steroidal anti-inflammatory drugs, prophylactic antibiotics, acupuncture and cervical mucus removal, did not show a significant benefit on reproductive outcomes. Our effect estimates for other important outcomes, including miscarriage and live birth, were limited by the varied reporting across included RCTs. WIDER IMPLICATIONS Using ultrasound guidance, soft catheters and hyaluronic acid at the time of ET appears to increase clinical pregnancy rates. The use of Atosiban, G-CSF and hCG showed a trend towards increased clinical pregnancy rate, but larger trials are required before adopting these interventions in clinical practice. Bed rest post-ET was associated with a reduction in clinical pregnancy and should not be recommended.
Collapse
Affiliation(s)
- Bede Tyler
- UCL Institute for Women's Health, University College London, London, UK
| | - Hugo Walford
- UCL Institute for Women's Health, University College London, London, UK
| | - Jennifer Tamblyn
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham, UK
| | - Stephen D Keay
- Centre for Reproductive Medicine, University Hospital of Coventry & Warwickshire, Coventry, UK
| | - Dimitrios Mavrelos
- UCL Institute for Women's Health, University College London, London, UK,Reproductive Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals, London, UK
| | - Ephia Yasmin
- UCL Institute for Women's Health, University College London, London, UK,Reproductive Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals, London, UK
| | - Bassel H Al Wattar
- Correspondence address. Reproductive Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals, London, UK, WC1E 6DB. E-mail:
| |
Collapse
|
4
|
Chae H. Administration of oxytocin antagonist at the same time as using a Foley catheter with cotton swab before embryo transfer for cervical stenosis. BMC WOMENS HEALTH 2021; 21:265. [PMID: 34217262 PMCID: PMC8254982 DOI: 10.1186/s12905-021-01409-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022]
Abstract
Background Embryo transfer without difficulty in a patient with cervical stenosis can be a great challenge for in vitro fertilization (IVF). We report a successful pregnancy following a frozen thawed embryo transfer after administration of an oxytocin antagonist at the same time as using a Foley catheter with cotton swab in a patient with refractory cervical stenosis. Case presentation A 40-year-old woman undergoing IVF. The patient’s previous embryo transfers were difficult. For every transfer, uterine manipulation was needed, force was required, and dilatation was necessary. A Foley catheter with a cotton swab was inserted into the cervical canal, atosiban was administered at the same time, and the Foley catheter was removed immediately before embryo transfer. A smooth transfer was performed without bleeding, force, uterine manipulation, or cervical dilator. The patient became pregnant and delivered by cesarean section at term. Conclusion This method is effective in performing atraumatic embryo transfer in patients with cervical stenosis.
Collapse
Affiliation(s)
- Heesuk Chae
- Department of Obstetrics and Gynecology, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University, 20, Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do, 561-712, South Korea.
| |
Collapse
|
5
|
Dakhly DMR, Bassiouny YA. Ultrasound-guided intrauterine device insertion: a step closer to painless insertion: a randomized control trial. EUR J CONTRACEP REPR 2017; 22:349-353. [PMID: 28978240 DOI: 10.1080/13625187.2017.1381234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM OF STUDY To reduce the pain and duration of the intrauterine device (IUD) insertion procedure through minimizing instrumentation and using trans-abdominal sonography (TAS). METHODS This randomized control trial was conducted in a university hospital and included 102 eligible females, fulfilling the inclusion criteria. They were randomly assigned into two groups via 1:1 computer-based randomization program; the trans-abdominal guided IUD insertion group (n = 51), and the traditional IUD insertion group (n = 51). The main outcomes were the pain experienced during the procedure as scored by the visual analogue score and the duration of the procedure. RESULTS The trans-abdominal guided IUD insertion was found to be statistically superior to the traditional technique for IUD insertion regarding the pain scores (according to the Visual Analogue Scale, from 0 to 10) recorded by the candidates (2.4 ± 2.1 vs. 5.0 ± 1.7, p < .001) as well as the time (in seconds) taken for IUD insertion procedure (32.2 ± 14.8 vs. 77.7 ± 30.6, p < .001). CONCLUSIONS Due to the decrease in pain and time taken for IUD insertion, the trans-abdominal guided technique can be used as a modified technique for IUD insertion. ClinicalTrials.gov Identifier: NCT02582268.
Collapse
|
6
|
Karavani G, Ben-Meir A, Shufaro Y, Hyman JH, Revel A. Transvaginal ultrasound to guide embryo transfer: a randomized controlled trial. Fertil Steril 2017; 107:1159-1165. [DOI: 10.1016/j.fertnstert.2017.01.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 01/07/2017] [Accepted: 01/26/2017] [Indexed: 11/30/2022]
|
7
|
Plowden TC, Hill MJ, Miles SM, Hoyt B, Yauger B, Segars JH, Csokmay JM, Chason RJ. Does the Presence of Blood in the Catheter or the Degree of Difficulty of Embryo Transfer Affect Live Birth? Reprod Sci 2016; 24:726-730. [PMID: 27655772 DOI: 10.1177/1933719116667607] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The technique used for embryo transfer (ET) can affect implantation. Prior research that evaluated the effect of postprocedural blood of the transfer catheter tip have yielded mixed results, and it is unclear whether this is actually a marker of difficulty of the transfer. Our objective was to estimate the effect of blood at the time of ET and the difficulty of ET on live birth rates (LBR). This retrospective cohort study utilized generalized estimating equations (GEEs) with nesting for repeated cycles for all analyses. Univariate modeling was performed and a final multivariate (adjusted) GEE model accounted for all significant confounders. Embryo transfers were subjectively graded (easy, medium, or hard) by a physician at the time of transfer. The presence of blood at ET was associated with more difficult ETs, retained embryos, and presence of mucous in the catheter. In the univariate analysis, ET with blood was not associated with live birth, while the degree of difficulty for ET had a negative impact on LBR. In the final multivariate GEE model, which accounts for repeated cycles from a patient, the only factors associated with an increased LBR were the degree of difficulty of the ET, female age, and blastocyst transfer. After controlling for confounding variables, the presence of blood in the transfer catheter was not associated with the likelihood of pregnancy and thus was not an independent predictor of cycle outcome. This indicates that the difficulty of the transfer itself was a strong negative predictor of pregnancy.
Collapse
Affiliation(s)
- Torie C Plowden
- 1 Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver NICHD, National Institutes of Health, Bethesda, MD, USA
- 2 Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Micah J Hill
- 1 Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver NICHD, National Institutes of Health, Bethesda, MD, USA
- 2 Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Shana M Miles
- 2 Walter Reed National Military Medical Center, Bethesda, MD, USA
| | | | - Belinda Yauger
- 2 Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - James H Segars
- 4 Johns Hopkins Department of Gynecology and Obstetrics, Baltimore, MD, USA
| | - John M Csokmay
- 2 Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Rebecca J Chason
- 2 Walter Reed National Military Medical Center, Bethesda, MD, USA
| |
Collapse
|
8
|
Fouda UM, Elshaer HS, Elsetohy KA, Youssef MA. Misoprostol versus uterine straightening by bladder distension for pain relief in postmenopausal patients undergoing diagnostic office hysteroscopy: a randomised controlled non-inferiority trial. Eur J Obstet Gynecol Reprod Biol 2016; 203:326-30. [DOI: 10.1016/j.ejogrb.2016.06.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/03/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
|
9
|
Abstract
BACKGROUND Meta-analysis revealed that embryo placement 20 mm from the fundal endometrial surface resulted in higher pregnancy rate, ongoing pregnancy rate, and live birth rate compared with placement 10 mm from the fundal endometrial surface. Pregnancy and implantation rates according to relative position were higher when the catheter tip was positioned close to the middle of the endometrial cavity. The aim of the current study is to evaluate differences in implantation and pregnancy rates if the site of embryo transfer is 2 cm distance from the fundal endometrium (DFE) compared to the midpoint of the endometrial cavity length (ECL). METHODS Patients were randomized to one of two groups: in group A (n = 98, 98 IVF-ET cycles), the embryo transfer catheter tip was positioned 2 cm DFE, while that in group B (n = 97, 97 IVF-ET cycles) was positioned at the midpoint of the ECL. We compared pregnancy outcomes of implantation rate, chemical pregnancy rate, clinical pregnancy rate, ongoing pregnancy rate, ectopic pregnancy rate, and miscarriage rate in the two groups. RESULTS Analysis of implantation rate (19.5 ± 27.7 vs. 21.7 ± 32.6; p = 0.6), chemical pregnancy rate (51 % vs. 50.5 %; p = 0.94), clinical pregnancy rate (35.7 % vs. 38.1 %; p = 0.73), ongoing pregnancy rate (31.6 % vs. 30.9 %; p = 0.92), ectopic pregnancy rate (8.6 % vs. 2.7 %; p = 0.35), and miscarriage rate (11.4 % vs. 16.2 %; 0.74) revealed comparable results for both groups. CONCLUSIONS Implantation and pregnancy rates were not influenced by the site of the ET catheter tip being 2 cm DFE compared to at the midpoint of the ECL. ISRCTN ISRCTN15972342.
Collapse
Affiliation(s)
- Hwang Kwon
- Department of Obstetrics and Gynecology, CHA Fertility Center of Bundang CHA General Hospital, CHA University, Seongnam, Korea.
- College of Medicine, CHA University and CHA Fertility Center of Bundang CHA General Hospital, 351 Yatap-dong, Bundang-gu, Seongnam, Gyeonggi-do, 463-712, Korea.
| | - Dong-Hee Choi
- Department of Obstetrics and Gynecology, CHA Fertility Center of Bundang CHA General Hospital, CHA University, Seongnam, Korea.
| | - Eun-Kyung Kim
- CHA Fertility Center of Bundang CHA General Hospital, CHA University, Seongnam, Korea.
| |
Collapse
|
10
|
Bhat VV, Chandel NP, Bhat BS, Geetha MD. Outcome Analysis of Transabdominal Ultrasound Guided versus Classical Blind Artificial Insemination in Indian Scenario: A Randomized Retrospective Multicenter Comparative Study. JOURNAL OF MEDICAL SCIENCES AND HEALTH 2015. [DOI: 10.46347/jmsh.2015.v01i02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
11
|
Abstract
Assisted reproductive technologies (ART) encompass fertility treatments, which involve manipulations of both oocyte and sperm in vitro. This chapter provides a brief overview of ART, including indications for treatment, ovarian reserve testing, selection of controlled ovarian hyperstimulation (COH) protocols, laboratory techniques of ART including in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI), embryo transfer techniques, and luteal phase support. This chapter also discusses potential complications of ART, namely ovarian hyperstimulation syndrome (OHSS) and multiple gestations, and the perinatal outcomes of ART.
Collapse
|
12
|
Cameron ST, Glasier A, Cooper A, Johnstone A. Does a full bladder assist insertion of intrauterine contraception? A randomised trial. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2013; 39:207-10. [DOI: 10.1136/jfprhc-2012-100422] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
13
|
Mains L, Van Voorhis BJ. Optimizing the technique of embryo transfer. Fertil Steril 2010; 94:785-90. [DOI: 10.1016/j.fertnstert.2010.03.030] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 03/09/2010] [Indexed: 11/17/2022]
|
14
|
Derks RS, Farquhar C, Mol BWJ, Buckingham K, Heineman MJ. Techniques for preparation prior to embryo transfer. Cochrane Database Syst Rev 2009:CD007682. [PMID: 19821435 DOI: 10.1002/14651858.cd007682.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Embryo transfer (ET) is the final and most vulnerable step in in vitro fertilisation (IVF) treatment. Pregnancy rates after ET may be influenced by several factors including cervical preparation, the performance of a dummy or mock transfer, the choice of catheter, the use of ultrasound guidance, removing the mucus or blood on the catheter, and straightening of the utero-cervical angle. Recent research has focused on improving the embryo transfer technique in the hope of increasing the success rates of IVF. This review focused on preparation techniques as it is unclear whether these simple interventions will make ET an easier procedure with higher success rates and lower complication rates. OBJECTIVES To determine whether different preparation techniques prior to ET result in improved IVF outcomes. SEARCH STRATEGY The Cochrane Menstrual Disorders and Subfertility Group Specialised Register, CENTRAL (The Cochrane Library), MEDLINE, EMBASE, CINAHL, and PsycINFO were searched (November 2008). The citation lists of relevant publications, reviews, and included studies were handsearched. Experts in the field were contacted to identify any unpublished trials. SELECTION CRITERIA Only truly randomised controlled trials of the interventions straightening the utero-cervical angle, dummy transfer prior to ET, cervical and endometrial preparation, and embryo afterloading were included. The primary outcomes were live birth rate and pregnancy rate per woman randomised. Participants were women with any type of subfertility undergoing IVF treatment and reaching the ET stage. DATA COLLECTION AND ANALYSIS Two review authors critically appraised potentially eligible studies. Ten studies were included in this review and data were independently extracted by two review authors. Disagreements were resolved by discussion and involvement of a third author. Risk of bias was also independently assessed by two authors. Dichotomous outcome data were expressed as Peto odds ratios. Subgroup analysis and the investigation of heterogeneity were planned. MAIN RESULTS At the time of ET, there was no evidence of benefit with the following interventions: full bladder, removal of cervical mucus, flushing the endocervical canal or the endometrial cavity. We did not identify any eligible studies for dummy transfer, changing patient position, the use of a tenaculum, or embryo afterloading. AUTHORS' CONCLUSIONS On the basis of the evidence in this review, no specific implications for practice are made. It is recommended, in general, that more, larger studies are done on ET preparation techniques. The studies need to be of a higher quality with better explained methods, more specified inclusion and exclusion criteria, and more participants.
Collapse
Affiliation(s)
- Roos S Derks
- Amsterdam Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands, 1100 DD
| | | | | | | | | |
Collapse
|
15
|
Derks RS, Farquhar C, Mol BWJ, Buckingham K, Heineman MJ. Techniques for preparation prior to embryo transfer. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2009. [DOI: 10.1002/14651858.cd007682] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
16
|
Allahbadia GN, Gandhi G, Kadam K, Arora S, Awasthi A, Nagwekar A, Allahbadia S, Wolman I. Antibubble trajectory during embryo transfers in donor egg IVF does not predict success. Reprod Biomed Online 2008; 16:881-5. [DOI: 10.1016/s1472-6483(10)60156-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
17
|
Yang WJ, Lee RKK, Su JT, Lin MH, Hwu YM. Uterine Position Change Between Mock and Real Embryo Transfers. Taiwan J Obstet Gynecol 2007; 46:162-5. [PMID: 17638625 DOI: 10.1016/s1028-4559(07)60011-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE This study was designed to assess the change in uterine position between mock and real embryo transfers. MATERIALS AND METHODS A total of 386 embryo transfer cycles were reviewed, and the uterine position was recorded at the time of mock embryo transfer and then again at the time of real embryo transfer. RESULTS Of 254 patients with an anteverted uterus at mock transfer, only 3 (1.2%) were found to have a retroverted uterus at actual embryo transfer. Of 132 patients with a retroverted uterus at mock transfer, 24 (18%) had an anteverted uterus at actual embryo transfer (p < 0.0001). CONCLUSION Routine ultrasound-guided embryo transfer is suggested when a retroverted uterus is found at mock embryo transfer, as there is a significant chance that the uterine position will change.
Collapse
Affiliation(s)
- Wen-Jui Yang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | | | | | | | | |
Collapse
|
18
|
Flisser E, Grifo JA. Is what we clearly see really so obvious? Ultrasonography and transcervical embryo transfer—a review. Fertil Steril 2007; 87:1-5. [PMID: 17094986 DOI: 10.1016/j.fertnstert.2006.06.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Revised: 05/08/2006] [Accepted: 05/08/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To critically review the role of ultrasound-guided embryo transfer (ET) and its influence on the outcome of in vitro fertilization (IVF). DESIGN Medline review of published manuscripts. RESULT(S) Studies evaluating the role of ultrasound-assisted ET have had mixed results, and although meta-analysis of prospective trials suggests an improvement in outcome, limitations in study design may overstate the effect of ultrasonography. Other ET techniques may eliminate the advantages provided by ultrasonography, limiting its benefit to specific clinical scenarios. However, because no trial has demonstrated an adverse effect and because cases that may benefit from its use often cannot be predicted reliably, the routine application of ultrasonography can be justified.
Collapse
Affiliation(s)
- Eric Flisser
- New York University Fertility Center, New York University School of Medicine, New York, New York 10016, USA.
| | | |
Collapse
|
19
|
Buckett WM. A review and meta-analysis of prospective trials comparing different catheters used for embryo transfer. Fertil Steril 2006; 85:728-34. [PMID: 16500345 DOI: 10.1016/j.fertnstert.2005.08.031] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2005] [Revised: 08/14/2005] [Accepted: 08/14/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the relative efficacy of different types of embryo transfer (ET) catheters. DESIGN Systematic review and meta-analysis of prospective randomized, controlled trials comparing at least two different ET catheters. SETTING Infertility centers providing treatment with in vitro fertilization/embryo transfer (IVF-ET). PATIENT(S) Women undergoing ET. INTERVENTION(S) Embryo transfer with soft or hard catheters. MAIN OUTCOME MEASURE(S) Clinical pregnancy rate. RESULT(S) A total of seven prospective trials were identified that compared soft (Cook or Wallace) catheters with hard (TDT, Frydman, Tomcat, Rocket) catheters. The meta-analysis demonstrated an increased chance of clinical pregnancy when soft ET catheters were used. The TDT catheter was compared against both soft catheters and other hard catheters, showing decreased chance of clinical pregnancy when the TDT catheter was used. Six more prospective trials were identified comparing the Cook and Wallace soft catheters, and the meta-analysis of these data showed no demonstrable difference in clinical pregnancy rates. CONCLUSION(S) An increased chance of clinical pregnancy is achieved when soft ET catheters are used. There appears to be little difference between the Cook and Wallace soft catheters.
Collapse
Affiliation(s)
- William M Buckett
- Department of Obstetrics and Gynecology, McGill University, Royal Victoria Hospital, Montreal, Quebec, Canada.
| |
Collapse
|
20
|
Abstract
PURPOSE OF REVIEW Embryo transfer is arguably the most critical step in assisted reproduction. The purpose of this article is to review the different aspects of the procedure in the light of recent evidence. RECENT FINDINGS Randomized trials have shown that significantly higher pregnancy rates are obtained when embryo transfer is performed under ultrasound guidance, the embryos are deposited in the middle part of the uterine cavity, an atraumatic technique is used and when low-dose aspirin is routinely administered following the procedure. Blood in the catheter and leaving the embryos inside it for more than 120 s diminish the pregnancy rate significantly. Air in the catheter, immediate removal of the catheter, performing two transfers in the same cycle, prolonged bed rest, sexual intercourse after embryo transfer or the use of sildenafil do not affect the results. Based on currently available evidence, Cochrane reviews have concluded that the live birth rate is not increased by delaying embryo transfer from day two to three or to the blastocyst stage, and that single embryo transfer leads to lower live birth rates than the transfer of two embryos. The value of a mock transfer a few days before the actual procedure has been challenged as the position of the uterus may change. The effect of holding the cervix with a volsellum, routinely administering antibiotics and the superiority of one catheter over the others is still to be determined. SUMMARY Recent studies confirm the importance of the various aspects of embryo transfer. More randomized studies are needed to further evaluate them.
Collapse
Affiliation(s)
- Hassan N Sallam
- Department of Obstetrics and Gynaecology, University of Alexandria and Alexandria Fertility Center, Alexandria, Egypt.
| |
Collapse
|
21
|
Lorusso F, Depalo R, Bettocchi S, Vacca M, Vimercati A, Selvaggi L. Outcome of in vitro fertilization after transabdominal ultrasound–assisted embryo transfer with a full or empty bladder. Fertil Steril 2005; 84:1046-8. [PMID: 16213872 DOI: 10.1016/j.fertnstert.2005.04.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2004] [Revised: 04/25/2005] [Accepted: 04/25/2005] [Indexed: 11/29/2022]
Abstract
The use of ultrasound guidance has proven to be a key factor in performing embryo transfer in a gentle and atraumatic manner. However, despite the lower incidence of brusque maneuvers, bladder distension has not shown any positive impact on the IVF success rate.
Collapse
|
22
|
Shamonki MI, Schattman GL, Spandorfer SD, Chung PH, Rosenwaks Z. Ultrasound-guided trial transfer may be beneficial in preparation for an IVF cycle. Hum Reprod 2005; 20:2844-9. [PMID: 16006476 DOI: 10.1093/humrep/dei139] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The objective of this study is to determine if ultrasound-guided trial transfer (UTT) in the office in preparation for an IVF cycle can be utilized as an alternative and/or adjunct to ultrasound-guided embryo transfer (UGET). METHODS Patients planning to undergo an IVF cycle at an academic centre were included. Each patient underwent an UTT in the office by the same practitioner. The difference in length (DL), if any, was measured from the perceived top of the uterine cavity (catheter tip) to the actual cavity apex as visualized by ultrasound. RESULTS Of the 64 patients enrolled, 19 patients (29.7%) had a measurable DL, of which 14 (21.9%) had a DL exists 0.5 cm, and nine (14.1%) had a DL exists 1.0 cm. Significant differences were noted between patients when comparing DL to previous pregnancy status and the total cavity depth (sounding depth + DL) (P < 0.05). CONCLUSION UTT in the office setting appears to be beneficial in preparation for an IVF cycle with embryo transfer.
Collapse
Affiliation(s)
- Mousa I Shamonki
- The Center for Reproductive Medicine and Infertility, Weill Medical College of Cornell University and The New York Presbyterian Hospital, New York 10021, USA
| | | | | | | | | |
Collapse
|
23
|
Shamonki MI, Spandorfer SD, Rosenwaks Z. Ultrasound-guided embryo transfer and the accuracy of trial embryo transfer. Hum Reprod 2005; 20:709-16. [PMID: 15689350 DOI: 10.1093/humrep/deh546] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies have suggested that ultrasound-guided embryo transfer (UG-ET) may improve the outcome in IVF; however, several factors may account for the improvement in pregnancy rate. This study examines the use of ultrasound to determine the accuracy of trial transfer (TT) in preparation for ET. METHODS Sixty-seven consecutive patients prospectively underwent UG-ET over a 2 month period. Total cavity length by US was compared with the length noted by TT. A difference of > or = 1 cm was considered significant. All embryos were placed within 1-2 cm of the fundus by US. RESULTS Twenty patients (29.9%) had a difference of > or = 1 cm and 13 patients (19.4%) had a difference of < or = 1.5 cm. Patients with a difference of > or = 1 or > or = 1.5 cm had a significantly greater depth at transfer (P < 0.001) and uterine cavity length (P < 0.001) when compared with patients without a difference. Clinical pregnancy, implantation, delivery and overall miscarriage rates did not differ between patients with a difference of > or = 1 or > or = 1.5 cm versus no difference. There were no ectopic pregnancies. CONCLUSIONS Nineteen percent of patients had a discrepancy of > or = 1.5 cm and approximately 30% had a difference of > or = 1 cm from TT at UG-ET, suggesting a benefit to UG-ET. A large prospective randomized trial comparing UG-ET with blind transfer is required to assess further if UG-ET should be used in all cases of ET.
Collapse
Affiliation(s)
- Mousa I Shamonki
- Cornell Center for Reproductive Medicine, 505 East 70th Street, 3rd floor, New York, NY 10021, USA
| | | | | |
Collapse
|
24
|
Sallam HN. Should embryo transfer always be performed under ultrasound guidance? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 24:383-386. [PMID: 15343590 DOI: 10.1002/uog.1722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
|
25
|
Embryo transfer—a critique of the factors involved in optimizing pregnancy success. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.ics.2004.01.093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
26
|
Mirkin S, Jones EL, Mayer JF, Stadtmauer L, Gibbons WE, Oehninger S. Impact of transabdominal ultrasound guidance on performance and outcome of transcervical uterine embryo transfer. J Assist Reprod Genet 2003; 20:318-22. [PMID: 12948094 PMCID: PMC3455275 DOI: 10.1023/a:1024809607966] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To determine the impact of transabdominal ultrasound guidance on embryo transfer during IVF therapy. METHODS Retrospective analysis of 823 consecutive embryo transfers. Three hundred and sixty-seven procedures performed with transabdominal ultrasound guidance were compared to 456 cases performed with the "clinical touch" method. RESULTS Ultrasound-guided embryo transfer yielded higher, but not statistically significant, clinical pregnancy (48% vs. 44%) and implantation rates (22% vs. 20%). The incidence of multiple pregnancies, ectopic and multiple pregnancy rates were similar. The frequency of negative factors typically associated with difficult transfers, such as requirement of use of tenaculum, and presence of blood or mucus in the catheter tip, were significantly lower in the ultrasound-guided group in comparison with the clinical touch group. Ultrasound-guided embryo transfer was associated with a significantly increased easiness of transfer performance; 95% of the transfers were rated as very easy in the ultrasound-guidance group compared to 87% in the clinical touch group. The use of a soft pass catheter was the only variable independently and significantly associated with pregnancy success (odds ratio = 2.74). CONCLUSION(S) Ultrasound-guidance facilitates embryo transfer and in combination with the use of a soft catheter should be implemented to optimize embryo transfer results.
Collapse
Affiliation(s)
- Sebastian Mirkin
- Department of Obstetrics and Gynecology, The Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, 601 Colley Avenue, Norfolk, Virginia 23507
| | - Estella L. Jones
- Department of Obstetrics and Gynecology, The Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, 601 Colley Avenue, Norfolk, Virginia 23507
| | - Jacob F. Mayer
- Department of Obstetrics and Gynecology, The Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, 601 Colley Avenue, Norfolk, Virginia 23507
| | - Laurel Stadtmauer
- Department of Obstetrics and Gynecology, The Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, 601 Colley Avenue, Norfolk, Virginia 23507
| | - William E. Gibbons
- Department of Obstetrics and Gynecology, The Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, 601 Colley Avenue, Norfolk, Virginia 23507
| | - Sergio Oehninger
- Department of Obstetrics and Gynecology, The Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, 601 Colley Avenue, Norfolk, Virginia 23507
| |
Collapse
|
27
|
Fasouliotis SJ, Schenker JG. Failures in assisted reproductive technology: an overview. Eur J Obstet Gynecol Reprod Biol 2003; 107:4-18. [PMID: 12593887 DOI: 10.1016/s0301-2115(02)00309-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Sozos J Fasouliotis
- Department of Obstetrics and Gynecology, Hadassah Medical Organization, Hebrew University, PO Box 12000, Jerusalem 91120, Israel
| | | |
Collapse
|
28
|
Sallam HN, Agameya AF, Rahman AF, Ezzeldin F, Sallam AN. Ultrasound measurement of the uterocervical angle before embryo transfer: a prospective controlled study. Hum Reprod 2002; 17:1767-72. [PMID: 12093837 DOI: 10.1093/humrep/17.7.1767] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The study aim was to determine whether moulding the embryo transfer catheter according to the uterocervical angle measured by ultrasound could improve pregnancy and implantation rates. METHODS Patients were alternately allocated to one of two groups. In the ultrasound-guided group (n = 320), the catheter was moulded according to the uterocervical angle measured by abdominal ultrasound. In controls (n = 320), embryo transfer was performed using the "clinical feel" method. RESULTS Moulding the embryo transfer catheter according to the uterocervical angle significantly increased clinical pregnancy [(OR = 1.57, 95% CI (1.08-2.27)] and implantation rates [(OR = 1.47, 95% CI (1.10-1.96)] compared with the "clinical feel" method. It also significantly reduced difficult transfers [(OR = 0.25, 95% CI (0.16-0.40)] and blood during transfers [OR = 0.71, 95% CI (0.50-0.99)]. Patients with large angles (>60 degrees ) had significantly lower pregnancy rates compared with those with no angle [OR = 0.36, 95% CI (0.16-0.52)]. CONCLUSIONS Moulding the embryo transfer catheter according to the uterocervical angle measured by ultrasound increases clinical pregnancy and implantation rates and diminishes the incidence of difficult and bloody transfers.
Collapse
Affiliation(s)
- H N Sallam
- Department of Obstetrics and Gynaecology, Alexandria Fertility Center, University of Alexandria, 22 Victor Emanuel Square, Smouha, Alexandria, Egypt 21615
| | | | | | | | | |
Collapse
|
29
|
Abstract
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.
Collapse
Affiliation(s)
- W B Schoolcraft
- Colorado Center for Reproductive Medicine, Englewood, Colorado 80110, USA
| | | | | |
Collapse
|
30
|
Egbase PE, Al-Sharhan M, Grudzinskas JG. Influence of position and length of uterus on implantation and clinical pregnancy rates in IVF and embryo transfer treatment cycles. Hum Reprod 2000; 15:1943-6. [PMID: 10966991 DOI: 10.1093/humrep/15.9.1943] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In a prospective study of 807 consecutive women shown to have an apparently normal uterus after hysterosalpingography, hysteroscopy or pelvic ultrasonography prior to IVF or intracytoplasmic sperm injection (ICSI) and embryo transfer, the position and length of the uterine cavity was measured routinely at a pre-treatment mock transfer procedure. The apparent length of the uterine cavity was <7 cm in 128 women (group 1), 7-9 cm in 594 women (group 2) and >9 cm in 85 women (group 3). The uterus was noted to be retroverted in 38. 2% (308) women. The embryo transfer catheter was advanced to 5 mm from the uterine fundus based on the previously determined cavity length in all the embryo transfer procedures at 48 h after oocyte collection. Implantation and clinical pregnancy rates were not significantly different with respect to position of the uterus, difficulties encountered in passage of the catheter, mean age of the women, aetiology or duration of infertility or embryology events. An apparently greater cavity length was seen in older and/or parous women, but the difference was not statistically significant. Although the highest implantation and clinical pregnancy rates were seen in women with a cavity length of 7-9 cm (group 2) the differences were not statistically significant: group 1, 18.9 and 36. 7%; group 2, 21.0 and 46.5%; and group 3, 17.3 and 32.9% respectively. The incidence of ectopic pregnancy per reported clinical pregnancy was highest in group 1 women, being 14.9% (7/47) in comparison with group 2 (1.8%, 5/276) and group 3 (0%, 0/27) (P: < 0.0005), suggesting that the size of the uterus is a critical factor in the aetiology of ectopic pregnancy in IVF/ICSI-embryo transfer.
Collapse
Affiliation(s)
- P E Egbase
- IVF Centre, Maternity Hospital, Kuwait and Department of Obstetrics & Gynaecology, St Bartholomew's & The Royal London School of Medicine & Dentistry, Royal London Hospital, London E1 1BB, UK
| | | | | |
Collapse
|
31
|
Hearns-Stokes RM, Miller BT, Scott L, Creuss D, Chakraborty PK, Segars JH. Pregnancy rates after embryo transfer depend on the provider at embryo transfer. Fertil Steril 2000; 74:80-6. [PMID: 10899501 DOI: 10.1016/s0015-0282(00)00582-3] [Citation(s) in RCA: 109] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the effect of individual providers on pregnancy outcome after embryo transfer. DESIGN Retrospective data analysis. SETTING University-based tertiary-care assisted reproductive technology program with 10 physician-providers. PATIENT(S) Six hundred and seventeen women who underwent 854 fresh embryo transfers between January 1996 and January 1999. INTERVENTION(S) Pregnancies after embryo transfer were recorded for each provider. MAIN OUTCOME MEASURE(S) Establishment of a clinical pregnancy. RESULT(S) Three hundred ninety-three clinical pregnancies resulted from 854 embryo transfers, for an overall clinical pregnancy rate of 46.0% per embryo transfer. Three hundred forty-seven (40.6%) pregnancies were ongoing. The clinical pregnancy rate varied significantly between providers: for example, 17.0% (47 transfers) vs. 54.3% (57 transfers) (P<.05). Similarly, the ratio of high-grade embryos required to produce a gestational sac differed between providers. The number or quality of embryos transferred did not differ significantly. CONCLUSION(S) Significant differences were observed in pregnancy rates after embryo transfer done by different providers, suggesting that embryo transfer technique may influence pregnancy outcome in assisted reproductive technology.
Collapse
Affiliation(s)
- R M Hearns-Stokes
- Walter Reed Army Medical Center and National Institute of Child Health and Human Development, National Institutes of Health, Washington, DC, USA
| | | | | | | | | | | |
Collapse
|
32
|
Karande VC, Morris R, Chapman C, Rinehart J, Gleicher N. Impact of the "physician factor" on pregnancy rates in a large assisted reproductive technology program: do too many cooks spoil the broth? Fertil Steril 1999; 71:1001-9. [PMID: 10360901 DOI: 10.1016/s0015-0282(99)00139-9] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether in one program with unified treatment protocols, patients can expect varying treatment outcomes with different physicians. DESIGN Retrospective data analysis. SETTING University-affiliated infertility center with 14 physicians. PATIENT(S) One thousand eight hundred fifty IVF cycles performed consecutively between August 1995 and June 1997. INTERVENTION(S) The pregnancy rate and implantation rate per ET were evaluated for individual physicians between August 1995 and June 1996 (phase I). Physicians with lower success rates underwent strict supervision from July 1996 to June 1997 (phase II). MAIN OUTCOME MEASURE(S) Variations in success rates between physicians. RESULT(S) The pregnancy rate varied among the physicians from 13.2%-37.4%, and the implantation rate varied from 4.4%-14%. Some physicians' outcomes improved between phase I and phase II of the study, whereas others' did not. The pregnancy and implantation rates varied significantly for some physicians, depending on whether they were responsible for the choice of stimulation protocol, supervision of cycle monitoring, or ET in their own or other physicians' patients. CONCLUSION(S) Outcomes of IVF vary depending on the treating physician. Lower than expected pregnancy and implantation rates usually are not caused by poor ET techniques alone, but appear to be disproportionately the consequences of poor cycle stimulation.
Collapse
Affiliation(s)
- V C Karande
- Center for Human Reproduction-Illinois, Hoffman Estates 60194, USA.
| | | | | | | | | |
Collapse
|