1
|
Sfakianoudis K, Maziotis E, Trypidi A, Grigoriadis S, Vaxevanoglou T, Angeli I, Rapani A, Kotsifaki A, Pistola K, Pantou A, Dafopoulos K, Pantos K, Simopoulou M. Embryo Transfer Procedural Parameters Do Not Predict IVF Cycle Outcome. J Clin Med 2024; 13:1312. [PMID: 38592155 PMCID: PMC10931750 DOI: 10.3390/jcm13051312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/01/2024] [Accepted: 02/07/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND this study aims to assess the effect of embryo transfer (ET) performance parameters of a technical nature on IVF outcome. METHODS A total of 1417 ETs from a single IVF center were included in this prospective observational study. The parameters investigated were as follows: the presence of cervical mucus post catheter withdrawal, the presence of blood, catheter reload, the employment of a tenaculum and stylet, catheter resistance as experienced by the physician and patient discomfort. RESULTS When ET performance parameters were associated with clinical outcomes on a singular level, none of the ET parameters presented with any statistical significance. The evaluation of covariates indicated that the number and the quality of transferred embryos, as well as maternal age, exerted a statistically significant effect on clinical outcomes. In a multivariate analysis, only the presence of mucus along with significant catheter resistance presented with statistical significance; however, when adjusting for covariates, this combination showed no statistically significant effect on clinical outcomes. CONCLUSIONS the results indicate that the time-consuming process of recording and analyzing ET performance parameters fails to offer any additional value in predicting the cycle's outcome, while factors like embryo quality and number, as well as maternal age, seem to be the sole robust predictive factors of an IVF cycle.
Collapse
Affiliation(s)
| | - Evangelos Maziotis
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Anna Trypidi
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Sokratis Grigoriadis
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | - Irene Angeli
- Genesis Athens Clinic, Centre for Human Reproduction, Papanikoli, 15232 Athens, Greece
| | - Anna Rapani
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Amalia Kotsifaki
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Kalliopi Pistola
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Agni Pantou
- Genesis Athens Clinic, Centre for Human Reproduction, Papanikoli, 15232 Athens, Greece
| | - Konstantinos Dafopoulos
- Department of Obstetrics and Gynecology, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41500 Larisa, Greece;
| | - Konstantinos Pantos
- Genesis Athens Clinic, Centre for Human Reproduction, Papanikoli, 15232 Athens, Greece
| | - Mara Simopoulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| |
Collapse
|
2
|
Sallam HN, Gelbaya TA, Rosas IM, Anagnostopoulou C, Sallam N, Agarwal A. Clinical aspects of oocyte retrieval and embryo transfer. Tips and tricks for the novice and experts. Panminerva Med 2022; 64:185-199. [PMID: 35179015 DOI: 10.23736/s0031-0808.22.04679-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Oocyte retrieval (ovum pick-up) and embryo transfer (ET) are essential steps in IVF and ICSI and over the years, the two procedures were developed in order to improve the clinical outcome. Many suggestions were proposed and applied before, during and after oocyte retrieval such as timing of HCG trigger, pre-operative pelvic scan, vaginal cleansing, type of anesthesia, type and gauge of aspiration needles, aspiration pressure, follicle flushing, and the need for prophylactic antibiotics. Similarly, many steps were suggested and implemented before, during and after ET including patient's position, type of anesthesia/analgesia, dummy (mock) ET, ultrasound-guidance, HCG injection in the uterine cavity, use of relaxing agents, full bladder, removal of the cervical mucus, flushing the cervix with culture medium, type of ET catheter, embryo loading techniques, site of embryo deposition, the use of adherence compounds, as well as bed rest after ET. Complications were also reported with oocyte retrieval and ET. The aim of this review is to evaluate the current practice of these two procedures in the light of available evidence.
Collapse
Affiliation(s)
- Hassan N Sallam
- Department of Obsterics and Gynaecology, Alexandria University Faculty of Medicine, Alexandria, Egypt -
| | - Tarek A Gelbaya
- Department of Obstetrics and Gynaecology, University Hospitals of Leicester, Leicester, UK
| | - Israel M Rosas
- Citmer Reproductive Medicine, IVF LAB, Mexico City, Mexico
| | | | - Nooman Sallam
- Department of Obstetrics and Gynaecology, Guy's and St Thomas' NHS Trust, London, UK
| | - Ashok Agarwal
- Andrology Center and American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
3
|
Ou YC, Huang KH, Lan KC. Hysteroscopic cervical features associated with difficult embryo transfer in unselected patients undergoing in vitro fertilization. Biomed J 2021; 45:557-564. [PMID: 34237454 PMCID: PMC9421922 DOI: 10.1016/j.bj.2021.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 02/02/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022] Open
Abstract
Background The most appropriate diagnostic tests for the assessment of the uterine cavity in patients undergoing standard infertility evaluation in daily practice remain unclear. Routine hysteroscopic uterine cavity evaluation before an in vitro fertilization-embyo transfer (IVF-ET) cycle is not a uniformly accepted procedure. However, cervical findings associated with difficult ET have rarely been reported in previous hysteroscopic studies. The main objective of this study was to examine the relationship between cervical finding under flexible outpatient hysteroscopy (OH) and difficult ET. Methods A cohort clinical study was conducted with 650 patients undergoing their first in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) from January 2010 to December 2017. Of them, 605 women with available embryos underwent transfer cycles. Outpatient hysteroscopies were scheduled during the follicular phase of the menstrual cycle, 1–3 months before starting IVF/ICSI treatment. Results Among the 650 women who underwent transvaginal sonography (TVS) and OH, abnormal sonographic findings were observed in 51 women (7.8%) in which submucous myoma, endometrial polyp, and endometrial hyperplasia were the most common. Abnormal hysteroscopic intracavitary findings were observed in 158 cases (24.3%) in which endometrial polyp, submucous myoma, and intrauterine adhesions were the most common. These results showed that TVS was specific (100%) but not sensitive (32.3%) compared with OH. Embryo transfer (ET) was difficult in 25% of women with cervical stenosis (CS) or tortuous cervical canal (TC) and was significantly more difficult in women in the TC group (30.7%) than in the CS group (19.6%). Conclusion OH can identify cervical charactistics associated with a high incidence of difficult ET.
Collapse
Affiliation(s)
- Yu-Che Ou
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuan-Hui Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Chung Lan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan; Center for Menopause and Reproductive Medicine Research, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| |
Collapse
|
4
|
Arora P, Mani A. Live birth following transmyometrial embryo transfer. J Hum Reprod Sci 2020; 13:65-67. [PMID: 32577071 PMCID: PMC7295255 DOI: 10.4103/jhrs.jhrs_88_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/24/2019] [Accepted: 01/13/2020] [Indexed: 11/04/2022] Open
|
5
|
Ferreri J, Portillo EG, Peñarrubia J, Vidal E, Fábregues F. Transmyometrial embryo transfer as a useful method to overcome difficult embryo transfers - a single-center retrospective study. JBRA Assist Reprod 2018; 22:134-138. [PMID: 29757581 PMCID: PMC5982560 DOI: 10.5935/1518-0557.20180029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Pregnancy after an embryo transfer depends largely on embryo quality, endometrial receptivity, and the technique used in the embryo transfer. Embryo transfers have been reported as inevitably traumatic and difficult for 5-7% of patients in assisted reproduction treatment. In these cases, transmyometrial embryo transfer should be considered as a suitable method to overcome difficult embryo transfers. The aim of this study was to report our experience with this technique and analyze its causes, results and complications. METHODS Since 1993, 39 women (40 cycles of assisted reproductive technology treatment) were submitted to transmyometrial embryo transfers in our center. The procedures were carried out as described by the Towako group. RESULTS The enrolled female patients had a mean age of 34 years and a mean baseline FSH level of 6.89 IU/mL. The median number of retrieved oocytes was 7.50 and a mean of 2.63 embryos were transferred. Implantation rate was 9.5%. With respect to clinical results, pregnancy and miscarriage rates were 25% and 30%, respectively. Since there were two twin pregnancies, the live birth rate was 22.5% (9/40). No major complications were reported. CONCLUSION Transmyometrial embryo transfer can and should be an option in cases of difficult/impossible transcervical embryo transfer.
Collapse
Affiliation(s)
- Janisse Ferreri
- Institut Clinic de Ginecologia, Obstetricia y Neonatología (ICGON). Hospital Clinic de Barcelona. Institut de Investigacions Biomédiques August Pi i Sunyer (IDIBAPS)
| | - Emma Gabriela Portillo
- Institut Clinic de Ginecologia, Obstetricia y Neonatología (ICGON). Hospital Clinic de Barcelona. Institut de Investigacions Biomédiques August Pi i Sunyer (IDIBAPS)
| | - Joana Peñarrubia
- Institut Clinic de Ginecologia, Obstetricia y Neonatología (ICGON). Hospital Clinic de Barcelona. Institut de Investigacions Biomédiques August Pi i Sunyer (IDIBAPS)
| | - Ester Vidal
- Institut Clinic de Ginecologia, Obstetricia y Neonatología (ICGON). Hospital Clinic de Barcelona. Institut de Investigacions Biomédiques August Pi i Sunyer (IDIBAPS)
| | - Francisco Fábregues
- Institut Clinic de Ginecologia, Obstetricia y Neonatología (ICGON). Hospital Clinic de Barcelona. Institut de Investigacions Biomédiques August Pi i Sunyer (IDIBAPS)
| |
Collapse
|
6
|
Coats E, Carden H, Zujovic L, Maalouf W, Hopkisson J, Raine-Fenning N. Qualifying the difficulty of embryo transfer with a visual analogue scale and assessing its impact on IVF outcomes. HUM FERTIL 2018; 22:177-181. [PMID: 29457513 DOI: 10.1080/14647273.2018.1434903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of this study was to determine whether a continuous visual analogue scale (VAS) is a reliable tool to grade embryo transfer (ET) difficulty when assessing IVF outcomes. No standardized grading system exists for reporting ET 'difficulty' which is typically recorded in descriptive terms. Clinicians performing 188 fresh single ETs between November 2014 and May 2016 also recorded a VAS score (0-100). Embryo transfers were stratified into three levels of ET 'difficulty': (A) 'easy' - no resistance; (B) 'medium' - resistance overcome by advancing the catheter's outer sheath; and (C) 'difficult' - a malleable stylet was required to overcome resistance; and these compared to the VAS scores. Clinical pregnancy and live birth rates were the primary outcomes. VAS scores were categorized into four incremental groupings according to the 25th, 50th and 75th percentiles (Groups 1-4) for analysis. No significant relationship (p > 0.05) was seen in clinical pregnancy or live birth rates in either the standard difficulty or the VAS groupings. The median VAS scores in Groups A-C increased as difficulty increased, but the interquartile ranges overlap with wide clinician variation, suggesting the VAS is not itself a reliable enough tool to record ET difficulty in isolation.
Collapse
Affiliation(s)
- Edward Coats
- a Division of Nurture Fertility, The East Midlands Fertility Clinic , Nottingham , UK
| | - Hannah Carden
- a Division of Nurture Fertility, The East Midlands Fertility Clinic , Nottingham , UK
| | - Lyndsey Zujovic
- a Division of Nurture Fertility, The East Midlands Fertility Clinic , Nottingham , UK
| | - Walid Maalouf
- b Division of Child Health, Obstetrics & Gynaecology, Faculty of Medicine & Health Sciences, University of Nottingham , Nottingham , UK
| | - James Hopkisson
- a Division of Nurture Fertility, The East Midlands Fertility Clinic , Nottingham , UK
| | | |
Collapse
|
7
|
A meta-analysis of atosiban supplementation among patients undergoing assisted reproduction. Arch Gynecol Obstet 2017; 296:623-634. [PMID: 28695395 DOI: 10.1007/s00404-017-4455-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 07/03/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Evidence for the efficacy of atosiban in improving pregnancy outcomes among patients undergoing assisted reproductive technology (ART) remains inconsistent. METHODS The PubMed, EMBASE, and CNKI databases were searched using keywords such as 'atosiban', 'infertility', and 'ART'. Studies that explored the efficacy of atosiban in the field of ART for patients with embryo transfer (ET) were included if they evaluated pregnancy outcomes. Combing using subgroups and sensitivity analysis were conducted, and risk ratios (RRs), and 95% confidence intervals (CIs) were calculated. RESULTS Six studies were included. Atosiban treatment could improve pregnancy outcomes for all patients undergoing ET, especially for the subgroups of patients with repeated implantation failure (RIF) (implantation rate: RR = 1.806, 95% CI = 1.473-2.215; clinical pregnancy rate: RR = 1.725, 95% CI = 1.394-2.135; live birth rate: RR = 2.141, 95% CI = 1.494-3.068), as shown by the comparison with placebo or no-treatment groups. However, no statistical significance was detected in subgroups of patients undergoing their first or second ET cycle. In addition, no significant differences were observed in positive pregnancy tests, miscarriage rates, multiple pregnancy rates, or ectopic pregnancy rates. CONCLUSIONS Supplementation with atosiban has a positive effect on ART and embryo transfer procedure, especially for women undergoing their third or more ET cycle.
Collapse
|