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Koch J, Redden R, Homan G, Roberts B, Pacella-Ince L. Sonographer-guided frozen embryo transfer vs ultrasound-assisted frozen embryo transfer - A randomised controlled study. Aust N Z J Obstet Gynaecol 2024; 64:154-159. [PMID: 37882228 DOI: 10.1111/ajo.13764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 10/09/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND The use of ultrasound to guide placement of the embryo during in vitro fertilisation (IVF) is important, but there are times where a good image cannot be obtained. Having a trained sonographer perform the ultrasound may therefore improve the success of embryo transfer. AIM To determine whether the routine use of a sonographer to guide embryo transfer is superior to standard care. MATERIALS AND METHODS Randomised, controlled, prospective clinical study in a private infertility clinic. There were 113 women aged <38 years undergoing frozen embryo transfer (donor egg/embryo excluded) who were randomised to sonographer-guided embryo transfer or standard care (the doctor performs an ultrasound prior to embryo transfer and the patient holds the ultrasound probe). The primary outcome was visualisation of the air bubble, and secondary outcomes were distance of the air bubble from the fundal endometrium, pregnancy rate (gestational sac on ultrasound at seven weeks) and live birth rate. RESULTS The bubble was visualised in 100% of embryo transfers with a sonographer compared to 83% in the ultrasound-assisted group, and this was statistically significant (P < 0.01). No statistically significant differences were found in terms of distance from the fundal endometrium or in pregnancy rate and live birth rate. CONCLUSION Sonographer-guided embryo transfer leads to statistically higher rates of visualisation of the air bubble compared to ultrasound-assisted transfer.
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Affiliation(s)
- Juliette Koch
- Repromed, Monash IVF, Adelaide, South Australia, Australia
| | - Rebecca Redden
- Repromed, Monash IVF, Adelaide, South Australia, Australia
| | - Gillian Homan
- Repromed, Monash IVF, Adelaide, South Australia, Australia
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Sun X, Cai J, Liu L, Chen H, Jiang X, Ren J. Uterine factors modify the association between embryo transfer depth and clinical pregnancy. Sci Rep 2022; 12:14269. [PMID: 35995967 PMCID: PMC9395418 DOI: 10.1038/s41598-022-18636-4] [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: 11/30/2021] [Accepted: 08/16/2022] [Indexed: 11/09/2022] Open
Abstract
The embryo transfer depth may affect the chance of pregnancy. However, embryo dislodging caused by uterine contraction may occur after the transfer. The aim of the retrospective study was to investigate whether the factors associated with uterine contractilities, such as endometrial thickness and progesterone elevation, affect the association between transfer depth and implantation. A total of 7849 fresh transfer cycles on conventional stimulation in a single in vitro fertilization (IVF) center during the period 2013–2015 was reviewed. Patients were categorized according to quartiles of embryo transfer depth (≤ 9 mm, n = 1735, 9.1–11 mm, n = 2557, 11.1–14 mm, n = 1933, ≥ 1.4 mm, n = 1624, respectively). Adjusted for confounding factors, the adjusted odds ratio (aOR) (95% confidence interval, CI) for clinical pregnancy was 0.90 (0.79–1.02), 0.86 (0.74–0.99), and 0.70 (0.60–0.82) respectively in quartiles 2 through 4, comparing with quartile 1. However, the aORs were significantly increased when the endometrial thickness was < 8 mm. In comparison with that in the cycles with a normal endometrial thickness (8–11 mm), the aORs comparing quartiles 2 through 4 with quartile 1 in the cycles with an endometrial thickness < 8 mm increased from 0.78 (95% CI 0.65–0.93), 0.79 (95% CI 0.65–0.97), and 0.64 (95% CI 0.51–0.81) to 1.73 (95% CI 1.21–2.47), 1.04 (95% CI 0.69–1.56), and 1.45 (95% CI 0.91–2.31), respectively. In the cycles with elevated progesterone and blastocyst stage transfer, the aORs comparing quartiles 4 with quartile 1 decreased from 0.73 (95% CI 0.62–0.87) and 0.74 (95% CI 0.63–0.87) to 0.58 (95% CI 0.40–0.84) and 0.42 (95% CI 0.25–0.73) than those in the cycles without. However, only blastocyst transfer showed a significant interaction with transfer depth (p = 0.043). Our data suggested that endometrial thickness and blastocyst transfer significantly affect the association between embryo transfer depth and clinical pregnancy.
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Affiliation(s)
- Xiaohua Sun
- The Affiliated Chenggong Hospital of Xiamen University, Xiamen, 361002, Fujian, China
| | - Jiali Cai
- The Affiliated Chenggong Hospital of Xiamen University, Xiamen, 361002, Fujian, China
| | - Lanlan Liu
- The Affiliated Chenggong Hospital of Xiamen University, Xiamen, 361002, Fujian, China
| | - Haixiao Chen
- The Affiliated Chenggong Hospital of Xiamen University, Xiamen, 361002, Fujian, China
| | - Xiaoming Jiang
- The Affiliated Chenggong Hospital of Xiamen University, Xiamen, 361002, Fujian, China
| | - Jianzhi Ren
- The Affiliated Chenggong Hospital of Xiamen University, Xiamen, 361002, Fujian, China.
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Huang Y, Huang Q, Liu J, Guo M, Liu Y, Lai D. Concurrent Ovarian and Tubal Ectopic Pregnancy After IVF-ET: Case Report and Literature Review. Front Physiol 2022; 13:850180. [PMID: 35444560 PMCID: PMC9013932 DOI: 10.3389/fphys.2022.850180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
Ovarian pregnancy (OP) coupled with tubal ectopic pregnancy is rare. We present a case of coexistent ovarian and tubal ectopic pregnancies in the same adnexa resulting from in vitro fertilization and embryo transfer (IVF-ET) for tubal occlusion. The patient presented with mild vaginal bleeding without abdominal pain. OP was diagnosed via sonographic findings of an ectopic gestational sac (GS) and yolk sac that seemed to be inside her left ovary. Laparoscopic exploration confirmed this diagnosis, and ipsilateral tubal ectopic pregnancy was suspected during surgery. The patient underwent left salpingectomy and resection of the ovarian lesion. A subsequent histopathological examination verified the diagnosis of coexistent ovarian and tubal ectopic pregnancy. Though the mechanism underlying concurrent OP and tubal ectopic pregnancy is still unclear, clinicians should be cautious of potential combined ectopic pregnancy when dealing with patients who have received more than one embryo transfer.
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Affiliation(s)
- Yating Huang
- School of Medicine, The International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Qin Huang
- School of Medicine, The International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jinglan Liu
- School of Medicine, The International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Mengxi Guo
- School of Medicine, The International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yuan Liu
- School of Medicine, The International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Dongmei Lai
- School of Medicine, The International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- *Correspondence: Dongmei Lai,
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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.
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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
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Evaluation of embryo transfer through a scoring system: ETSS (Embryo transfer scoring system). J Gynecol Obstet Hum Reprod 2021; 51:102237. [PMID: 34614436 DOI: 10.1016/j.jogoh.2021.102237] [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: 06/04/2021] [Revised: 09/06/2021] [Accepted: 09/26/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION To create a scoring system by including all of the factors that are recommended for an ideal ET and to investigate its correlation with the Β-HCG results. MATERIALS AND METHODS This study was conducted as a retrospective trial between January 2009 and December 2018. Women who had a single ET between the specified dates were included in the study. The embryo grade, ET day, distance between the fundus to embryo transfer site measured via ultrasonography, endometrial thickness on ET day, and presence of mucus and blood in the catheter after transfer were the variables evaluated. Each one of the five variables that constituted the scoring system were rated separately. RESULTS Overall, 1652 patients participated in this research. Antral follicle count (13,3 ± 8 vs. 14,6 ± 8,2, p: 0,001), endometrial thickness on the ET day (9.9 ± 2 vs.10.3 ± 2, p = 0.006) and number of mature oocytes (8.6 ± 6 vs. 9 ± 5.1, p: 0.003) were significantly higher in patients with positive Β-HCG values. The total score in the Β-HCG positive group was 9.8 ± 1.4 versus 8.9 ± 1.4 in the Β-HCG negative group (p < 0.001). The best ETSS cut-off value for predicting Β-HCG positivity was 9.5, with 82% sensitivity and 67% specificity (AUC:0.808). CONCLUSION Our scoring system is an important step toward standardization, as it offers a new, practical, cost-free, and applicable scoring system based on pre- and post-ET measurements and laboratory data.
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Bayram A, De Munck N, Elkhatib I, Arnanz A, El-Damen A, Abdala A, Coughlan C, Garrido N, Vidales LM, Lawrenz B, Fatemi HM. The position of the euploid blastocyst in the uterine cavity influences implantation. Reprod Biomed Online 2021; 43:880-889. [PMID: 34474972 DOI: 10.1016/j.rbmo.2021.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/03/2021] [Accepted: 02/14/2021] [Indexed: 01/10/2023]
Abstract
RESEARCH QUESTION Does the position of the euploid blastocyst in the uterine cavity upon transfer, measured as distance in millimetres (mm) from the fundus (DFF) to the air bubble, influence implantation potential? DESIGN A total of 507 single/double euploid frozen embryo transfer (FET) cycles at blastocyst stage were included retrospectively between March 2017 and November 2018 at a single centre. The patients were on average 33.3 years old. The FET were performed in natural cycles (n = 151) or hormone replacement therapy cycles (n = 356). RESULTS Of the 507 transfers, 370 (73.0%) resulted in a pregnancy, defined as human chorionic gonadotrophin concentration over 15 mIU/ml, and 341 (67.3%) in a clinical pregnancy, with an implantation rate of 62.0% and ongoing pregnancy rate of 59.6% (302/507). When comparing the number of embryos transferred, the pregnancy rate, clinical pregnancy rate and ongoing pregnancy rate were significantly higher after double-embryo transfer (DET) (P = 0.002: P < 0.001 and P = 0.002). The quality of the blastocyst in the single-embryo transfer group had a positive effect on the pregnancy rate (A versus B, P = 0.016; A versus C, P = 0.003) and clinical pregnancy rate (A versus C, P = 0.013). After performing a multivariate logistic regression analysis to consider the effect of all explanatory variables, a negative effect between DFF and pregnancy (P = 0.001), clinical pregnancy (P = 0.001) and ongoing pregnancy (P = 0.030) was found. When all variables remained constant, an increase of 1 mm of DFF changed the odds of pregnancy by 0.882, of clinical pregnancy by 0.891 and of ongoing pregnancy by 0.925. No significant effect of DFF was found on the miscarriage outcome (P = 0.089). CONCLUSIONS The depth of blastocyst replacement inside the uterine cavity may influence the pregnancy, clinical pregnancy and ongoing pregnancy rates and should be considered as an important factor to improve the success of IVF cycles.
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Affiliation(s)
- Aşina Bayram
- ART Fertility Clinics, Abu Dhabi, United Arab Emirates.
| | | | | | - Ana Arnanz
- ART Fertility Clinics, Abu Dhabi, United Arab Emirates
| | | | - Andrea Abdala
- ART Fertility Clinics, Abu Dhabi, United Arab Emirates
| | | | - Nicolas Garrido
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | | | - Barbara Lawrenz
- ART Fertility Clinics, Abu Dhabi, United Arab Emirates; Obstetrical Department, Women's University Hospital Tuebingen, Tuebingen, Germany
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National Survey Highlights the Urgent Need for Standardisation of Embryo Transfer Techniques in the UK. J Clin Med 2021; 10:jcm10132839. [PMID: 34198995 PMCID: PMC8267796 DOI: 10.3390/jcm10132839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/31/2021] [Accepted: 06/18/2021] [Indexed: 11/23/2022] Open
Abstract
Embryo transfer (ET) is one of the vital steps in the in vitro fertilisation (IVF) process, yet there is wide variation in ET technique throughout the UK, without a nationally approved standardised approach. The aim of this study was to gain contemporaneous information regarding the current clinical ET practice in the UK. Method: A 38-question electronic survey was distributed to the 79 UK Human Fertilisation and Embryology Authority (HFEA) registered clinics performing ETs. Results: In total, 59% (47/79) of units responded, 83% (39/47) performing ultrasound-guided transfers, with 42% (20/47) of units using a tenaculum; 22% (10/45) would proceed with transfer regardless of fluid in the endometrial cavity. In 91% (43/47) of units, embryos were deposited in the upper/middle portion of the uterine cavity, but interpretation of this area ranged from 0.5 to >2 cm from the fundus, with 68% (32/47) allowing patients to mobilise immediately after transfer. In 60% (27/45) of clinics, success rates were based on clinical pregnancy rates (CPR). Conclusion: Within the UK there is a wide range of variability in ET techniques, with >70% of discordance in survey-responses between clinics. Whilst there are areas of good practice, some disadvantageous techniques continue to persist. This survey emphasises the importance of developing a standardised, evidence-based approach to improve ET success rates.
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8
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Davar R, Poormoosavi SM, Mohseni F, Janati S. Effect of embryo transfer depth on IVF/ICSI outcomes: A randomized clinical trial. Int J Reprod Biomed 2020; 18:723-732. [PMID: 33062918 PMCID: PMC7521168 DOI: 10.18502/ijrm.v13i9.7667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 01/04/2020] [Accepted: 03/01/2020] [Indexed: 11/26/2022] Open
Abstract
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 higher implantation rate, chemical and clinical pregnancy rate compared to the group A (p = 0.03, 0.01, 0.04, respectively). The rate of ongoing pregnancy and miscarriage indicated no significant differences between groups (p = 0.21, 0.27, respectively). Conclusion In conclusion, our study showed that the depth of embryo replacement inside the uterine cavity at a distance of 25 ± 5 mm beneath fundal endometrial surface have better effects on the pregnancy outcomes of IVF/ICSI cycles and can be considered as an important factor to improve the success of IVF cycles.
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Affiliation(s)
- Robab Davar
- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Fereshteh Mohseni
- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sima Janati
- Department of Obstetrics and Gynecology, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran
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Hayashi N, Enatsu N, Iwasaki T, Otsuki J, Matsumoto Y, Kokeguchi S, Shiotani M. Predictive factors influencing pregnancy rate in frozen embryo transfer. Reprod Med Biol 2020; 19:182-188. [PMID: 32273825 PMCID: PMC7138944 DOI: 10.1002/rmb2.12322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/18/2019] [Accepted: 02/15/2020] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To evaluate the outcomes of embryo transfer (ET) and to identify the parameters influencing pregnancy outcomes. METHODS This study included 938 ET cycles involving single frozen and thawed good-quality blastocyst (Gardner grade ≥3BB) between August 2017 and January 2018. The significance of several parameters including endometrial thickness, position of the transferred air bubble, self-evaluation score by physicians, and uterus direction at ET as predictors of clinical pregnancy was evaluated using univariate and multivariate analyses. RESULTS Among 938 ET cycles, 462 (49.3%) resulted in a clinical pregnancy. Endometrial thickness was positively associated with clinical pregnancy in a linear trend. Between the variable position of the transferred air bubble and clinical pregnancy rate showed a curvilinear relationship. Clinical pregnancy rate was higher in cases with good self-evaluation score, whereas there was no difference between groups with different uterus directions. Univariate analysis of predictive parameters identified endometrial thickness, self-evaluation score by physicians, and position of air bubbles as significant predictors of clinical pregnancy, of which endometrial thickness and position of air bubbles appeared to be independently related to clinical pregnancy. CONCLUSION Endometrial thickness and the position of transferred air bubbles influenced clinical pregnancy in ET cycles.
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Affiliation(s)
| | | | | | - Junko Otsuki
- Hanabusa Women's ClinicKobe CityJapan
- Okayama University Assisted Reproduction Technology CenterOkayama CityJapan
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Santos MMD, Silva AA, Barbosa ACP, Brum G, Nakagawa HM, Cabral I, Iglesias JR, Barbosa MWP. Embryo placement in IVF and reproductive outcomes: a cohort analysis and review. JBRA Assist Reprod 2019; 23:210-214. [PMID: 30875171 PMCID: PMC6724395 DOI: 10.5935/1518-0557.20190003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: The objective of the present study was to determine the influence of the
embryo placement depth on the endometrial cavity in relation to the
reproductive outcomes, after frozen-thawed embryo transfer performed under
transabdominal ultrasound guidance. Methods: Retrospective cohort study that evaluated the influence of the embryo
placement depth in the endometrial cavity in relation to the reproductive
outcomes of patients submitted to cryotransfer cycles at a private assisted
reproduction clinic, from 2012 to 2017. The patients were classified
according to three variables: <10mm, 10 to 15mm and >15mm. The primary
outcome was clinical pregnancy, and the secondary outcomes were miscarriage,
ongoing pregnancy and live birth. The data was summarized as relative risk,
with a 95%CI. Results: Clinical and ongoing pregnancy rates were higher in the 10-15mm and >15mm
Groups, when compared to the <10mm Group; there was no statistical
difference between the groups in terms of miscarriage and live birth rates.
We performed a subsequent analysis, using the same sample of patients,
comparing only the <10mm and ≥10mm variables. The ≥10mm
Group had better reproductive outcomes, with higher clinical and ongoing
pregnancy rates. Conclusion: Pregnancy rates are influenced by embryo transfer site, and better results
can be achieved when the tip of the catheter is placed in the central area
of the endometrial cavity, especially when the distance from the endometrial
fundus is >10mm.
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Affiliation(s)
| | | | | | - Guilherme Brum
- GENESIS - Center for Assistance in Human Reproduction, Brasília, DF, Brazil
| | | | - Iris Cabral
- GENESIS - Center for Assistance in Human Reproduction, Brasília, DF, Brazil
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Mubarak S, Yusoff NH, Adnan TH. Ultrasound guidance versus the blind method for intrauterine catheter insemination: A randomized controlled trial. Clin Exp Reprod Med 2019; 46:87-94. [PMID: 31181876 PMCID: PMC6572662 DOI: 10.5653/cerm.2019.46.2.87] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/04/2019] [Indexed: 11/13/2022] Open
Abstract
Objective The primary objective of this study was to compare clinical pregnancy rates in intrauterine insemination (IUI) treatment cycles with transabdominal ultrasound guidance during intrauterine catheter insemination (US-IUI) versus the “blind method” IUI without ultrasound guidance (BM-IUI). The secondary objective was to compare whether US-IUI had better patient tolerability and whether US-IUI made the insemination procedure easier for the clinician to perform compared to BM-IUI. Methods This was a randomized controlled trial done at the Reproductive Medicine Unit of General Hospital Kuala Lumpur, Malaysia. We included women aged between 25 and 40 years who underwent an IUI treatment cycle with follicle-stimulating hormone injections for controlled ovarian stimulation. Results A total of 130 patients were recruited for our study. The US-IUI group had 70 patients and the BM-IUI group had 60 patients. The clinical pregnancy rate was 10% in both groups (p> 0.995) and there were no significant difference between the groups for patient tolerability assessed by scores on a pain visual analog scale (p= 0.175) or level of difficulty for the clinician (p> 0.995). The multivariate analysis further showed no significant increase in the clinical pregnancy rate (adjusted odds ratio, 1.07; 95% confidence interval, 0.85–1.34; p= 0.558) in the US-IUI group compared to the BM-IUI group even after adjusting for potential covariates. Conclusion The conventional blind method for intrauterine catheter insemination is recommended for patients undergoing IUI treatment. The use of ultrasound during the insemination procedure increased the need for trained personnel to perform ultrasonography and increased the cost, but added no extra benefits for patients or clinicians.
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Affiliation(s)
- Sarah Mubarak
- Reproductive Medicine Unit, Department of Obstetrics and Gynaecology, General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Noor Haliza Yusoff
- Reproductive Medicine Unit, Department of Obstetrics and Gynaecology, General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Tassha Hilda Adnan
- National Clinical Research Centre, General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
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Bakas P, Simopoulou M, Giner M, Tzanakaki D, Deligeoroglou E. Accuracy and efficacy of embryo transfer based on the previous measurement of cervical length and total uterine length. Arch Gynecol Obstet 2018; 299:565-570. [PMID: 30460614 DOI: 10.1007/s00404-018-4971-6] [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: 11/14/2017] [Accepted: 11/14/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Aim of the study was to examine the accuracy of embryo transfer based on the previous measurement of cervical length and total uterine length. METHODS The study has taken place in an academic-assisted reproduction clinic. 248 patients with infertility requiring IVF/ICSI treatment have been included. All patients underwent IVF/ICSI cycles with antagonist protocol and were treated with controlled ovarian stimulation using recombinant FSH (100-400 IU/day). On the day of oocyte retrieval, all patients were given vaginally natural micronized progesterone in a dose of 200 mg/tds. All patients had transvaginal ultrasound measurement of cervical length and endometrial cavity length prior to embryo transfer and measurement of embryo distance (intrauterine air bubbles) from fundal surface of uterine cavity and internal cervical os immediately after embryo transfer. Embryo transfer was performed on days 2-3. Primary outcome was to estimate the accuracy of embryo transfer based on the measurement of the embryo distance from middle of uterine cavity after embryo transfer and secondary outcome was to assess the effect of embryo distance from uterine fundus and internal cervical os to clinical pregnancy rate. RESULTS The clinical pregnancy rate was 42.7%. The mean embryo distance from the middle of endometrial cavity was 0.48 ± 0.02 cm, the mean embryo distance from the uterine fundus was 0.88 ± 0.32 cm, and from the internal cervical os was 1.67 ± 0.45 cm. Multiple regression analysis showed that the embryo distance from middle of cavity was related to endometrial cavity length and to the embryo distance from the fundus and it was not related to Cx length, total uterine length, embryo distance from internal Cx os, and embryo transfer length. CONCLUSIONS Embryo transfer with the previous measurement of total uterine length and estimation of embryo transfer length can be performed with very good accuracy by a single operator.
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Affiliation(s)
- Panagiotis Bakas
- 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, University of Athens, Vas. Sofias Avenue 124A, 11526, Athens, Greece.
| | - Mara Simopoulou
- 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, University of Athens, Vas. Sofias Avenue 124A, 11526, Athens, Greece
| | - Maria Giner
- 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, University of Athens, Vas. Sofias Avenue 124A, 11526, Athens, Greece
| | - Despina Tzanakaki
- 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, University of Athens, Vas. Sofias Avenue 124A, 11526, Athens, Greece
| | - Eythimios Deligeoroglou
- 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, University of Athens, Vas. Sofias Avenue 124A, 11526, Athens, Greece
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Yayla Abide C, Ozkaya E, Sanverdi I, Bostancı Ergen E, Kurek Eken M, Devranoglu B, Bilgiç BE, Kilicci C, Kayatas Eser S. Prospective Randomized Trial Comparing Embryo Transfers of Cases with and without Catheter Rotation during Its Withdrawal. Gynecol Obstet Invest 2018; 83:397-403. [PMID: 29758560 DOI: 10.1159/000489493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 04/21/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare embryo transfer (ET) technique based on catheter rotation during its withdrawal in cases with unexplained infertility in a prospective, randomized trial (NCT03097042). METHODS Two hundred intracytoplasmic sperm injection (ICSI) patients undergoing ET with cleaving or blastocyst-stage fresh embryos were randomized into 2 groups: cases with (n = 100), and without (n = 100) catheter rotation during its withdrawal. Groups were matched for age and some clinical parameters. A soft catheter was used to transfer a single embryo with catheter rotation during its withdrawal in the study group and without rotation in the control. The use of a stiff catheter or tenaculum was not needed in any case. Groups were compared in terms of cycle characteristics and clinical pregnancy rates. RESULTS Pregnancy rate was significantly higher in the study group (41 vs. 26%, p = 0.04). Clinical pregnancy rate was also significantly higher in the study group (39 vs. 25%, OR 1.9 [1.1-3.5], p = 0.05). On the other hand, the ongoing pregnancy rate was similar between the 2 groups (33 vs. 23%, p = 0.2). CONCLUSION Catheter rotation during its withdrawal may be associated with increased pregnancy and clinical pregnancy rates; however, the difference in ongoing pregnancy rates did not reach statistical significance.
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Fıçıcıoğlu C, Özcan P, Koçer MG, Yeşiladalı M, Alagöz O, Özkara G, Tayyar AT, Altunok Ç. Effect of air bubbles localization and migration after embryo transfer on assisted reproductive technology outcome. Fertil Steril 2018; 109:310-314.e1. [PMID: 29306491 DOI: 10.1016/j.fertnstert.2017.10.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/21/2017] [Accepted: 10/23/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the effect of embryo flash position and movement of the air bubbles at 1 and 60 minutes after ET on clinical pregnancy rates (PRs). DESIGN Prospective clinical trial. SETTING University fertility clinic. PATIENT(S) A total of 230 fresh ultrasound-guided ETs performed by a single physician (C.F.) at the IVF center of Yeditepe University Hospital between September 2016 and February 2017 were included. INTERVENTION(S) Transabdominal ultrasonographic guidance at ET. MAIN OUTCOME MEASURE(S) Clinical PRs. RESULT(S) There was no significant difference in terms of clinical PRs between women with embryo flash located >15 mm and <15 mm from the fundus at 1 or 60 minutes (P=.6 and P=.7, respectively). The PRs in women with embryo flash located <15 mm and >15 mm from the fundus were 47% and 60%, respectively (P=.6). The clinical intrauterine PRs were 69.5%, 38.5%, and 19.1% in fundal, static, and cervical, respectively. The highest PR was in fundal when compared with others (P<.01). The clinical PR appears to be associated with the embryo flash movement/migration and the PR was dramatically reduced when the embryo migrated from its original position toward the cervix at 60 minutes. CONCLUSION(S) We concluded that clinical PR appears to be associated with the embryo flash movement/migration at 60 minutes after ET and embryo flash movement toward the fundus is associated with higher clinical PRs. Further well-designed randomized controlled trials are required to optimize ET technique in the future.
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Affiliation(s)
- Cem Fıçıcıoğlu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yeditepe University, İstanbul, Turkey
| | - Pınar Özcan
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Acıbadem University Faculty of Medicine, İstanbul, Turkey.
| | - Melis G Koçer
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yeditepe University, İstanbul, Turkey
| | - Mert Yeşiladalı
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yeditepe University, İstanbul, Turkey
| | - Oya Alagöz
- Department of Embryology, Faculty of Medicine, Yeditepe University, İstanbul, Turkey
| | - Gülçin Özkara
- Department of Embryology, Faculty of Medicine, Yeditepe University, İstanbul, Turkey
| | - Ahter T Tayyar
- Department of Obstetrics and Gynecology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, İstanbul, Turkey
| | - Çiğdem Altunok
- Department of Medical Informatics, Faculty of Medicine, Yeditepe University, İstanbul, Turkey
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Singh N, Lata K, Malhotra N, Vanamail P. Correlation of Site of Embryo Transfer with IVF Outcome: Analysis of 743 Cycles from a Single Center. J Hum Reprod Sci 2017; 10:102-107. [PMID: 28904498 PMCID: PMC5586082 DOI: 10.4103/jhrs.jhrs_54_15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate the influence of site of embryo transfer (ET) on reproductive outcome. MATERIALS AND METHODS A retrospective analysis of 743 ultrasound-guided ET in fresh in vitro fertilization (IVF) cycles from a single center over a period of 4 years was conducted. The distance between the fundal endometrial surface and the air bubble was measured, and accordingly, patients were divided into four groups (≤10 mm; >10 and ≤15 mm; >15 and 20 mm; >20 and <25 mm). SETTING Tertiary Assisted Reproductive Technology (ART) center. PATIENTS All patients enrolled in the IVF program undergoing ET. INTERVENTIONS Controlled ovarian hyperstimulation (OS), IVF, and ET. MAIN OUTCOME MEASURES Cleavage rate and clinical pregnancy rate. RESULTS Clinical pregnancy rate was significantly more in groups 2 and 3 compared to the other groups. Logistic regression analysis showed that one unit increase in embryos transfer will enhance the pregnancy outcome about 3.7 (adjusted odds ratio) times with 95% confidence limits 2.6 to 5.4. Similarly, pregnancy outcome will be 3.1 (95% confidence limits: 1.5-6.4) times higher for distance group >15 and <20 mm compared to less than 10-mm distance group. Ectopic pregnancy rates were similar in all the four groups. CONCLUSION The present study demonstrates that site of ET has significant difference on reproductive outcome.
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Affiliation(s)
- Neeta Singh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Kusum Lata
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neena Malhotra
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - P Vanamail
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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Irani M, Robles A, Gunnala V, Spandorfer SD. Unilateral Salpingectomy and Methotrexate Are Associated With a Similar Recurrence Rate of Ectopic Pregnancy in Patients Undergoing In Vitro Fertilization. J Minim Invasive Gynecol 2017; 24:777-782. [PMID: 28285056 DOI: 10.1016/j.jmig.2017.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 01/19/2023]
Abstract
STUDY OBJECTIVE To determine whether different treatment approaches of ectopic pregnancy (EP), particularly unilateral salpingectomy and methotrexate, affect its recurrence rate in patients undergoing in vitro fertilization (IVF). DESIGN A retrospective cohort study (Canadian Task Force classification II-2). SETTING An academic medical center. PATIENTS Patients with a history of a previous EP who achieved pregnancy after IVF cycles between January 2004 and August 2015 were included. The recurrence rate of EP was compared between patients who underwent different treatment approaches for a previous EP. INTERVENTIONS IVF. MEASUREMENTS AND MAIN RESULTS A total of 594 patients were included. Seventeen patients had a recurrence of EP (2.9%). Patients with a history of ≥2 EPs were associated with a significantly higher recurrence rate of EP than those with 1 previous EP (8.5% vs. 1.8%; p = .01; odds ratio [OR] = 2.2; 95% confidence interval [CI], 1.2-4.4). Patients who underwent unilateral salpingectomy (n = 245) had a comparable recurrence rate of EP after IVF with those who received methotrexate (n = 283) (3.6% vs. 2.8%; p = .5; OR = 1.3; 95% CI, 0.4-3.4). This OR remained unchanged after adjusting for patient's age, number of previous EPs, number of transferred embryos, and peak estradiol level during stimulation (adjusted OR = 1.4; 95% CI, 0.5-3.8). None of the patients who underwent bilateral salpingectomy (n = 45) or salpingostomy (n = 21) had a recurrence of EP after IVF. CONCLUSION The recurrence rate of EP significantly correlates with the number of previous EPs. Treatment of EP with methotrexate has a comparable recurrence rate of EP after IVF with unilateral salpingectomy. Therefore, the risk of recurrence should not be a reason to favor salpingectomy over methotrexate in this population.
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Affiliation(s)
- Mohamad Irani
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York
| | - Alex Robles
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York
| | - Vinay Gunnala
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York
| | - Steven D Spandorfer
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York.
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Kava-Braverman A, Martínez F, Rodríguez I, Álvarez M, Barri PN, Coroleu B. What is a difficult transfer? Analysis of 7,714 embryo transfers: the impact of maneuvers during embryo transfers on pregnancy rate and a proposal of objective assessment. Fertil Steril 2017; 107:657-663.e1. [DOI: 10.1016/j.fertnstert.2016.11.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/28/2016] [Accepted: 11/21/2016] [Indexed: 12/01/2022]
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19
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Revelli A, Rovei V, Dalmasso P, Gennarelli G, Racca C, Evangelista F, Benedetto C. Large randomized trial comparing transabdominal ultrasound-guided embryo transfer with a technique based on uterine length measurement before embryo transfer. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:289-95. [PMID: 26924732 DOI: 10.1002/uog.15899] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 02/19/2016] [Accepted: 02/22/2016] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To compare in a randomized, non-inferiority trial the embryo transfer (ET) technique based on uterine length measurement before transfer (ULMbET) with transabdominal ultrasound-guided embryo transfer (TA-UGET) in a large population of patients undergoing in-vitro fertilization (IVF). METHODS Patients undergoing IVF with ET with cleaving fresh embryos were randomized to receive ULMbET or TA-UGET. The transfer of one to three embryos on day 2-3 of culture was performed using a soft catheter either under transabdominal ultrasound guidance (TA-UGET group) or after measurement of the uterine cavity by transvaginal ultrasound and calculation of the discharge site (ULMbET group). The primary outcome measures were clinical pregnancy rate, ongoing pregnancy rate and implantation rate, and secondary outcomes included patient discomfort during ET. RESULTS A total of 1648 patients undergoing IVF were randomized to receive ULMbET (n = 828) or TA-UGET (n = 820) and were included in the analysis. Comparable clinical pregnancy rate (38.2% vs 38.9%), implantation rate (24.8% vs 25.2%) and ongoing pregnancy rate (33.1% vs 34.8%) were observed in ULMbET and TA-UGET groups. The discomfort intensity score and the proportion of patients with moderate-to-severe discomfort during ET were significantly higher in the TA-UGET group (2.6 vs 1.5 visual analog scale points and 19.8% vs 1.2%; P = 0.045 and P = 0.003, respectively). CONCLUSION The ULMbET technique leads to IVF results comparable to those obtained with UGET, but is better tolerated than is TA-UGET and is technically easier to perform for a single operator. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Revelli
- Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Sant'Anna Hospital, University of Turin, Turin, Italy.
| | - V Rovei
- Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Sant'Anna Hospital, University of Turin, Turin, Italy
| | - P Dalmasso
- Medical Statistics Unit, Department of Public Health and Microbiology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - G Gennarelli
- Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Sant'Anna Hospital, University of Turin, Turin, Italy
| | - C Racca
- Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Sant'Anna Hospital, University of Turin, Turin, Italy
| | - F Evangelista
- Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Sant'Anna Hospital, University of Turin, Turin, Italy
| | - C Benedetto
- Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Sant'Anna Hospital, University of Turin, Turin, Italy
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Caanen MR, van der Houwen LE, Schats R, Vergouw CG, de Leeuw B, Lambers MJ, Groeneveld E, Lambalk CB, Hompes PG. Embryo Transfer with Controlled Injection Speed to Increase Pregnancy Rates: A Randomized Controlled Trial. Gynecol Obstet Invest 2016; 81:394-404. [DOI: 10.1159/000443954] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 01/11/2016] [Indexed: 11/19/2022]
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21
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Schoolcraft WB. Importance of embryo transfer technique in maximizing assisted reproductive outcomes. Fertil Steril 2016; 105:855-60. [DOI: 10.1016/j.fertnstert.2016.02.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 02/08/2016] [Accepted: 02/12/2016] [Indexed: 11/26/2022]
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Weiss A, Beck-Fruchter R, Golan J, Lavee M, Geslevich Y, Shalev E. Ectopic pregnancy risk factors for ART patients undergoing the GnRH antagonist protocol: a retrospective study. Reprod Biol Endocrinol 2016; 14:12. [PMID: 27005813 PMCID: PMC4804527 DOI: 10.1186/s12958-016-0146-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/02/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND In-vitro fertilization is a known risk factor for ectopic pregnancies. We sought to establish the risk factors for ectopic pregnancy in GnRH antagonist cycles examining patient and stimulation parameters with an emphasis on ovulation trigger. METHODS We conducted a retrospective, cohort study of 343 patients undergoing 380 assisted reproductive technology (ART) cycles with the GnRH antagonist protocol and achieving a clinical pregnancy from November 2010 through December 2015. RESULTS Significant risk factors for ectopic pregnancy in the univariate analysis included prior Cesarean section (CS), endometriosis, mechanical factor infertility, longer stimulation, elevated estradiol and progesterone levels, GnRH agonist trigger, higher number of oocytes aspirated, and insemination technique. Independent risk factors for ectopic pregnancy in the multivariate analysis included GnRH agonist trigger, higher number of oocytes aspirated, insemination technique, and prior Cesarean section. CONCLUSION Excessive ovarian response, IVF (as opposed to ICSI), prior Cesarean section and GnRH agonist trigger were found to be independent risk factors for ectopic pregnancy. Caution should be exercised before incorporating the GnRH agonist trigger for indications other than preventing OHSS. When excessive ovarian response leads to utilization of GnRH agonist trigger, strategies for preventing ectopic pregnancy, such as a freeze all policy or blastocyst transfer, should be considered. Further studies should elucidate whether adjusting the luteal support can reduce the ectopic pregnancy risk.
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Affiliation(s)
- A. Weiss
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - R. Beck-Fruchter
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - J. Golan
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - M. Lavee
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - Y. Geslevich
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - E. Shalev
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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23
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Ectopic pregnancy following in vitro fertilization with embryo transfer: A single-center experience during 15 years. Taiwan J Obstet Gynecol 2015; 54:541-5. [DOI: 10.1016/j.tjog.2015.08.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 03/18/2015] [Indexed: 01/19/2023] Open
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Rombauts L, McMaster R, Motteram C, Fernando S. Risk of ectopic pregnancy is linked to endometrial thickness in a retrospective cohort study of 8120 assisted reproduction technology cycles. Hum Reprod 2015; 30:2846-52. [PMID: 26428211 DOI: 10.1093/humrep/dev249] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/11/2015] [Indexed: 12/27/2022] Open
Abstract
STUDY QUESTION Is endometrial combined thickness (ECT) measured prior to embryo transfer (ET) associated with ectopic pregnancy (EP)? SUMMARY ANSWER Following IVF, the risk of EP is 4-fold increased in women with an ECT of <9 mm compared with women with an ECT of >12 mm. WHAT IS KNOWN ALREADY Known risk factors for EP include tubal damage, maternal cigarette smoking and endometriosis. EP is also more common following IVF but the underlying causes for this remain unclear. STUDY DESIGN, SIZE, DURATION Retrospective cohort study restricted to all IVF cycles leading to a pregnancy (βhCG > 50 IU/l) between January 2006 and December 2014. A total of 6465 patients achieved a pregnancy in 8120 cycles. Cycles using preimplantation genetic screening or donor oocytes were excluded. PARTICIPANTS/MATERIALS, SETTING, METHODS This cohort consists of 6465 patients achieving a pregnancy in 6920 stimulated cycles with fresh embryo transfers (STIM ET) and 1200 hormone replacement therapy frozen embryo transfers (HRT-FET) cycles at a private IVF unit (Monash IVF, Melbourne, Australia). ECT was the primary independent variable of interest; the primary outcome was a diagnosis of EP. The dataset was analysed using binary logistic general estimating equations (SPSS v22.0) to calculate odds ratio (OR) for EP adjusted for known confounders (aOR). There was no loss to follow-up in the dataset. MAIN RESULTS AND THE ROLE OF CHANCE The study groups did not differ significantly prior to IVF treatment. After adjusting for confounders, ECT remained statistically significant as an independent risk factor for EP. Compared with women with an ECT of <9 mm, women with an ECT of 9-12 mm had an aOR of 0.44 (95% CI 0.29-0.69, P < 0.01) and women with an ECT > 12 mm had an aOR of 0.27 (95% CI 0.10-0.77, P = 0.01). These differences remained statistically significant after performing a sensitivity analysis excluding HRT-FET, smokers and patients with tubal infertility. LIMITATIONS, REASONS FOR CAUTION The study design is retrospective, and it is possible that not all confounders have been accounted for. Measurement of ECT was performed by highly trained sonographers, but some inconsistency between individuals may be present. WIDER IMPLICATIONS OF THE FINDINGS Our group has previously demonstrated an increased risk of placenta praevia with increased ECT. These new findings suggest that the directionality of the uterine peristalsis waves matters more than their frequency or amplitude. Combining the data from both studies we now hypothesize that increased ECT is a marker for increased fundus-to-cervix uterine peristalsis, explaining both the increased placenta praevia risk and the lower EP risk. Further prospective studies are required to confirm these observations.
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Affiliation(s)
- L Rombauts
- Monash IVF, Epworth Hospital, 89 Bridge Rd, Richmond, Victoria 3121, Australia Hudson Institute of Medical Research, 246 Clayton Rd, Clayton, Victoria 3168, Australia Department of Obstetrics and Gynaecology, Monash University, 246 Clayton Rd, Clayton, Victoria 3168, Australia
| | - R McMaster
- Department of Obstetrics and Gynaecology, Monash University, 246 Clayton Rd, Clayton, Victoria 3168, Australia
| | - C Motteram
- Monash IVF, Epworth Hospital, 89 Bridge Rd, Richmond, Victoria 3121, Australia
| | - S Fernando
- Hudson Institute of Medical Research, 246 Clayton Rd, Clayton, Victoria 3168, Australia Department of Obstetrics and Gynaecology, Monash University, 246 Clayton Rd, Clayton, Victoria 3168, Australia
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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.
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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.
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26
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Fang C, Huang R, Wei LN, Jia L. Frozen-thawed day 5 blastocyst transfer is associated with a lower risk of ectopic pregnancy than day 3 transfer and fresh transfer. Fertil Steril 2015; 103:655-61.e3. [DOI: 10.1016/j.fertnstert.2014.11.023] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 11/18/2014] [Accepted: 11/18/2014] [Indexed: 10/24/2022]
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27
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Cenksoy PO, Fıcıcıoglu C, Yesiladali M, Akcin OA, Kaspar C. The importance of the length of uterine cavity, the position of the tip of the inner catheter and the distance between the fundal endometrial surface and the air bubbles as determinants of the pregnancy rate in IVF cycles. Eur J Obstet Gynecol Reprod Biol 2014; 172:46-50. [DOI: 10.1016/j.ejogrb.2013.09.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 07/27/2013] [Accepted: 09/18/2013] [Indexed: 11/30/2022]
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28
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Rovei V, Dalmasso P, Gennarelli G, Lantieri T, Basso G, Benedetto C, Revelli A. IVF outcome is optimized when embryos are replaced between 5 and 15 mm from the fundal endometrial surface: a prospective analysis on 1184 IVF cycles. Reprod Biol Endocrinol 2013; 11:114. [PMID: 24341917 PMCID: PMC3867220 DOI: 10.1186/1477-7827-11-114] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 12/02/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Some data suggest that the results of human in vitro fertilization (IVF) may be affected by the site of the uterine cavity where embryos are released. It is not yet clear if there is an optimal range of embryo-fundus distance (EFD) within which embryos should be transferred to optimize IVF outcome. METHODS The present study included 1184 patients undergoing a blind, clinical-touch ET of 1-2 fresh embryos loaded in a soft catheter with a low amount of culture medium. We measured the EFD using transvaginal US performed immediately after ET, with the aim to assess (a) if EFD affects pregnancy and implantation rates, and (b) if an optimal EFD range can be identified. RESULTS Despite comparable patients' clinical characteristics, embryo morphological quality, and endometrial thickness, an EFD between 5 and 15 mm allowed to obtain significantly higher pregnancy and implantation rates than an EFD above 15 mm. The abortion rate was much higher (although not significantly) when EFD was below 5 mm than when it was between 5 and 15 mm. Combined together, these results produced an overall higher ongoing pregnancy rate in the group of patients whose embryos were released between 5 and 15 mm from the fundal endometrial surface. CONCLUSIONS The site at which embryos are released affects IVF outcome and an optimal EFD range exists; this observations suggest that US-guided ET could be advantageous vs. clinical-touch ET, as it allows to be more accurate in releasing embryos within the optimal EFD range.
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Affiliation(s)
- Valentina Rovei
- Physiopatology of Reproduction and IVF Unit, Department of Surgical Sciences, University of Torino, Sant’Anna Hospital, Torino, Italy
| | - Paola Dalmasso
- Medical Statistics Unit, Department of Public Health and Paediatrics, University of Torino, Torino, Italy
| | - Gianluca Gennarelli
- Physiopatology of Reproduction and IVF Unit, Department of Surgical Sciences, University of Torino, Sant’Anna Hospital, Torino, Italy
| | - Teresa Lantieri
- Physiopatology of Reproduction and IVF Unit, Department of Surgical Sciences, University of Torino, Sant’Anna Hospital, Torino, Italy
| | - Gemma Basso
- Physiopatology of Reproduction and IVF Unit, Department of Surgical Sciences, University of Torino, Sant’Anna Hospital, Torino, Italy
| | - Chiara Benedetto
- Physiopatology of Reproduction and IVF Unit, Department of Surgical Sciences, University of Torino, Sant’Anna Hospital, Torino, Italy
| | - Alberto Revelli
- Physiopatology of Reproduction and IVF Unit, Department of Surgical Sciences, University of Torino, Sant’Anna Hospital, Torino, Italy
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Ivanovski M, Popovska S. The Impact of the Depth of Embryo Replacement into the Uterine Cavity under Transabdominal Ultrasound Guidance on In Vitro Fertilization and Embryo Transfer Outcome. Open Access Maced J Med Sci 2013. [DOI: 10.3889/oamjms.2013.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: The aim of the present study was to determine the importance of the depth of embryo replacement into the uterine cavity (upper or lower half endometrial cavity) on the implantation clinical pregnancy rates.Material and Methods: In this prospective observational were included 160 patients underwent controlled ovarian hyperstimulation followed by IVF/ICSI and embryo transfer. On the day of embryo transfer under direct transabdominal ultrasound guidance, the transfer catheter was advanced to a defined distance from the uterine fundus, up to the point estimated for transfer: 10 ± 2.5 mm (Group A) and 15 ± 2.5 mm (Group B).Results: In total, 160 patients, aged 24-42 years were included in the study. Overall clinical pregnancy rate were 41.2%. Analysis of our results demonstrated that pregnancy rate is significantly influenced by transfer distance from the fundus where the pregnancy rate decreases from 48.7% in group B to 34.5% in group A (p<0.05). There was not significantly difference in abortion rate between the two groups.Conclusion: In conclusion, our results suggest that depth of embryo replacement inside the uterine cavity may influence the pregnancy rates and should be considered as an important factor to improve the success of IVF cycles.
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Smith LP, Oskowitz SP, Dodge LE, Hacker MR. Risk of ectopic pregnancy following day-5 embryo transfer compared with day-3 transfer. Reprod Biomed Online 2013; 27:407-13. [PMID: 23953586 DOI: 10.1016/j.rbmo.2013.06.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 06/25/2013] [Indexed: 10/26/2022]
Abstract
The incidence of ectopic pregnancy after IVF is increased approximately 2.5-5-fold compared with natural conceptions; however, the aetiology for this increased risk remains unclear. One proposed practice change to decrease the incidence of ectopic pregnancy is blastocyst embryo transfer on day 5 rather than cleavage-stage embryo transfer on day 3. A retrospective cohort study was conducted to compare the risk of ectopic pregnancy following fresh day-5 embryo transfer with day-3 embryo transfer among women who underwent IVF and achieved pregnancy from 1998 to 2011. There were 13,654 eligible pregnancies; 277 were ectopic. The incidence of ectopic pregnancy was 2.1% among day-3 pregnancies and 1.6% among day-5 pregnancies. The adjusted risk ratio for ectopic pregnancy from day-5 compared with day-3 transfer was 0.71 (95% confidence interval 0.46-1.10). Although this analysis included 13,654 cycles, with a two-sided significance level of 0.05, it had only 21.9% power to detect a difference between the low incidence of ectopic pregnancy among both day-3 and day-5 transfers. In conclusion, this study was not able to demonstrate a difference in the risk of ectopic pregnancy among day-3 compared with day-5 transfers.
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Affiliation(s)
- Laura P Smith
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Kirstein 3, Boston, MA 02215, USA; Boston IVF, 130 Second Avenue, Waltham, MA 02451, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Reproductive Medicine and Surgery Center of Virginia, 595 Martha Jefferson Drive, Suite 390, Charlottesville, VA 22911, USA
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Szmyga MJ, Rybak EA, Nejat EJ, Banks EH, Whitney KD, Polotsky AJ, Heller DS, Meier UT. Quantification of nucleolar channel systems: uniform presence throughout the upper endometrial cavity. Fertil Steril 2013; 99:558-64. [PMID: 23137760 PMCID: PMC4074880 DOI: 10.1016/j.fertnstert.2012.10.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 10/03/2012] [Accepted: 10/12/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine the prevalence of nucleolar channel systems (NCSs) by uterine region, applying continuous quantification. DESIGN Prospective clinical study. SETTING Tertiary care academic medical center. PATIENT(S) Forty-two naturally cycling women who underwent hysterectomy for benign indications. INTERVENTION(S) NCS presence was quantified by a novel method in six uterine regions-fundus, left cornu, right cornu, anterior body, posterior body, and lower uterine segment (LUS)-with the use of indirect immunofluorescence. MAIN OUTCOME MEASURE(S) Percentage of endometrial epithelial cells (EECs) with NCSs per uterine region. RESULT(S) NCS quantification was observer independent (intraclass correlation coefficient 0.96) and its intrasample variability low (coefficient of variation 0.06). Eleven of 42 hysterectomy specimens were midluteal, ten of which were analyzable with nine containing >5% EECs with NCSs in at least one region. The percentage of EECs with NCSs varied significantly between the LUS (6.1%; interquartile range [IQR] 3.0-9.9) and the upper five regions (16.9%; IQR 12.7-23.4), with fewer NCSs in the basal layer of the endometrium (17 ± 6%) versus the middle (46 ± 9%) and luminal layers (38 ± 9%) of all six regions. CONCLUSION(S) NCS quantification during the midluteal phase demonstrates uniform presence throughout the endometrial cavity, excluding the LUS, with a preference for the functional luminal layers. Our quantitative NCS evaluation provides a benchmark for future studies and further supports NCS presence as a potential marker for the window of implantation.
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Affiliation(s)
- Michael J. Szmyga
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY
| | - Eli A. Rybak
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY
- Department of Obstetrics & Gynecology and Women's Health, and Albert Einstein College of Medicine, Bronx, NY
| | - Edward J. Nejat
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY
- Department of Obstetrics & Gynecology and Women's Health, and Albert Einstein College of Medicine, Bronx, NY
| | - Erika H. Banks
- Department of Obstetrics & Gynecology and Women's Health, and Albert Einstein College of Medicine, Bronx, NY
| | | | - Alex J. Polotsky
- Department of Obstetrics & Gynecology and Women's Health, and Albert Einstein College of Medicine, Bronx, NY
| | - Debra S. Heller
- Department of Pathology, UMDNJ – New Jersey Medical School, Newark, NJ
| | - U. Thomas Meier
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY
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Ovarian Pregnancy following Intracytoplasmic Sperm Injection and Embryo Transfer: A Case Report. Case Rep Obstet Gynecol 2012; 2012:389107. [PMID: 22762004 PMCID: PMC3384898 DOI: 10.1155/2012/389107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Accepted: 05/15/2012] [Indexed: 11/24/2022] Open
Abstract
Ovarian pregnancy is a rare form of ectopic pregnancy following ICSI-ET, and the diagnosis depends on the physicians suspicion and experience. Preservation of ovarian tissue during surgery is of utmost importance to preserve fertility. We present a case of ovarian pregnancy who had a successful treatment preserving the ovary.
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Tiras B, Korucuoglu U, Polat M, Saltik A, Zeyneloglu HB, Yarali H. Effect of air bubble localization after transfer on embryo transfer outcomes. Eur J Obstet Gynecol Reprod Biol 2012; 164:52-4. [PMID: 22682963 DOI: 10.1016/j.ejogrb.2012.05.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Revised: 04/21/2012] [Accepted: 05/12/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Our study aimed to provide information about the effects of air bubble localization after transfer on embryo transfer outcomes. STUDY DESIGN Retrospective analysis of 7489 ultrasound-guided embryo transfers. Group 1 included 6631 embryo transfers in which no movement of the air bubbles was observed after transfer. Group 2 consisted of 407 embryo transfers in which the air bubbles moved towards the uterine fundus spontaneously, a little time after transfer. Group 3 included 370 embryo transfers in which the air bubbles moved towards the uterine fundus with ejection, immediately after transfer. Group 4 consisted of 81 embryo transfers in which the air bubbles moved towards the cervical canal. RESULTS The four patient groups were different from one another with respect to positive pregnancy tests. Post hoc test revealed that this difference was between group 4 and other groups. CONCLUSIONS An initial finding of our study was significantly decreased positive pregnancy test rates and clinical pregnancy rates with air bubbles moving towards the cervical canal after transfer. Although air bubbles moving towards the uterine fundus with ejection were associated with higher pregnancy rates, higher miscarriage rates and similar live birth rates were observed compared to air bubbles remaining stable after transfer.
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Affiliation(s)
- Bulent Tiras
- Gazi University Faculty of Medicine, Ankara, Turkey
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Kovacs P, Sajgo A, Rarosi F, Kaali SG. Does it really matter how far from the fundus embryos are transferred? Eur J Obstet Gynecol Reprod Biol 2012; 162:62-6. [DOI: 10.1016/j.ejogrb.2012.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Revised: 01/18/2012] [Accepted: 02/20/2012] [Indexed: 10/28/2022]
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Standardization of catheter load speed during embryo transfer: comparison of manual and pump-regulated embryo transfer. Reprod Biomed Online 2011; 24:163-9. [PMID: 22197134 DOI: 10.1016/j.rbmo.2011.10.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 09/20/2011] [Accepted: 10/31/2011] [Indexed: 11/21/2022]
Abstract
The position of transfer air bubbles after embryo transfer is related to the pregnancy rate. With the conventional manual embryo-transfer technique it is not possible to predict the final position of the air bubbles. This position mainly depends on the catheter load speed at transfer (injection speed), a parameter that remains uncontrollable with the conventional technique even after standardization of the protocol. Therefore, the development of an automated device that generates a standardized injection speed is desirable. This study aimed to examine the variation in injection speeds in manual embryo transfer and pump-regulated embryo transfer (PRET). Seven laboratory technicians were asked to perform simulated transfers using the conventional embryo-transfer technique. Their injection speeds were compared with that of a PRET device. The results indicate that in manually performed transfers, even after standardization of the protocol, there is still a large variation in injection speed, while a PRET device generates a reliable and reproducible injection speed and therefore brings new possibilities for further standardization of the embryo-transfer procedure. Future research should reveal whether these experiments mimic real clinical circumstances and if a standardized injection speed results in more exact positioning of the transferred embryos and therefore higher pregnancy rates.
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Choi HJ, Im KS, Jung HJ, Lim KT, Mok JE, Kwon YS. Clinical analysis of ovarian pregnancy: a report of 49 cases. Eur J Obstet Gynecol Reprod Biol 2011; 158:87-9. [PMID: 21601978 DOI: 10.1016/j.ejogrb.2011.04.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 03/08/2011] [Accepted: 04/25/2011] [Indexed: 11/17/2022]
Affiliation(s)
- Hong-Jun Choi
- Department of Obstetrics and Gynecology, College of Medicine, University of Kwandong, Cheil General Hospital and Women's Healthcare Center, 1-19 Mukjeong-dong, Jung-gu, Seoul 100380, Republic of Korea
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Okamura Y, Arakane F, Nagayoshi-Taura Y, Honda R, Ohba T, Katabuchi H. Heterotopic triplet pregnancy: report of a patient with remnant tubal ectopic and intrauterine twin pregnancy after frozen-thawed embryo transfer. Reprod Med Biol 2011; 10:283-286. [PMID: 29699100 DOI: 10.1007/s12522-011-0098-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 06/15/2011] [Indexed: 10/18/2022] Open
Abstract
A case of heterotopic triplet pregnancy after frozen-thawed embryo transfer is presented. The patient conceived after transfer of three frozen-thawed embryos at a fertility clinic where she had previously undergone laparoscopic left salpingectomy due to pyosalpinx. Approximately 4 weeks after the embryo transfer, she presented with a complaint of abnormal genital bleeding and was diagnosed by ultrasound as having a dichorionic twin pregnancy. One week later, she was referred to our hospital because of lower abdominal pain. Hematoperitoneum was suspected based on findings of low blood pressure and tachycardia. Diagnostic emergent laparoscopy demonstrated an ectopic pregnancy in the remnant isthmic portion of the left tube. Laparoscopic excision of the remnant fallopian tube was performed, but the procedure resulted in early-pregnancy loss of one of the twins. The risk of heterotopic pregnancy is not small under assisted reproductive technology. Attention should be paid to the risk of tubal pregnancy after transferring more than two embryos or controlled ovarian hyperstimulation, even after salpingectomy has been performed.
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Affiliation(s)
- Yoshinori Okamura
- Department of Obstetrics and Gynecology, Faculty of Life Sciences Kumamoto University Honjo 1-1-1 860-8556 Kumamoto Kumamoto Japan
| | - Futoshi Arakane
- Department of Obstetrics and Gynecology, Faculty of Life Sciences Kumamoto University Honjo 1-1-1 860-8556 Kumamoto Kumamoto Japan
| | - Yumiko Nagayoshi-Taura
- Department of Obstetrics and Gynecology, Faculty of Life Sciences Kumamoto University Honjo 1-1-1 860-8556 Kumamoto Kumamoto Japan
| | - Ritsuo Honda
- Department of Obstetrics and Gynecology, Faculty of Life Sciences Kumamoto University Honjo 1-1-1 860-8556 Kumamoto Kumamoto Japan
| | - Takashi Ohba
- Department of Obstetrics and Gynecology, Faculty of Life Sciences Kumamoto University Honjo 1-1-1 860-8556 Kumamoto Kumamoto Japan
| | - Hidetaka Katabuchi
- Department of Obstetrics and Gynecology, Faculty of Life Sciences Kumamoto University Honjo 1-1-1 860-8556 Kumamoto Kumamoto Japan
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38
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The effect of air bubble position after blastocyst transfer on pregnancy rates in IVF cycles. Fertil Steril 2011; 95:944-7. [DOI: 10.1016/j.fertnstert.2010.07.1063] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2010] [Revised: 07/06/2010] [Accepted: 07/11/2010] [Indexed: 11/22/2022]
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Bharath M, Shetty N, Shashikala T, Kaur H. Ovarian Ectopic Pregnancy Following Assisted Reproductive Techniques: A Rare Entity. ACTA ACUST UNITED AC 2011. [DOI: 10.5005/jp-journals-10016-1015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
ABSTRACT
Ovarian ectopic pregnancy should be kept in mind as a rare possibility following assisted reproductive techniques. Although early use of quantitative serum â-hCG and pelvic ultrasonography has increased our diagnostic capability for ectopic pregnancy, ovarian pregnancy still represents a diagnostic problem. Laparoscopy is the gold standard for diagnosis and treatment for ovarian ectopic pregnancy.
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Tiras B, Polat M, Korucuoglu U, Zeyneloglu HB, Yarali H. Impact of embryo replacement depth on in vitro fertilization and embryo transfer outcomes. Fertil Steril 2010; 94:1341-1345. [PMID: 20044085 DOI: 10.1016/j.fertnstert.2009.07.1666] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2008] [Revised: 07/08/2009] [Accepted: 07/30/2009] [Indexed: 11/16/2022]
Affiliation(s)
- Bulent Tiras
- Anatolia IVF Center, Ankara, Turkey; Gazi University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
| | | | - Umit Korucuoglu
- Gazi University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | | | - Hakan Yarali
- Hacettepe University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
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41
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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]
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Mohamed MAS. The influence of the depth of embryo transfer into the uterine cavity on implantation rate. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2010. [DOI: 10.1016/j.mefs.2010.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Gelbaya TA. Short and long-term risks to women who conceive through in vitro fertilization. HUM FERTIL 2010; 13:19-27. [PMID: 19929571 DOI: 10.3109/14647270903437923] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
There are a number of potential risks to women who conceive through in vitro fertilisation (IVF). Among these, ovarian hyperstimulation syndrome and multiple pregnancies are the most serious. Other potential risks include increased levels of anxiety and depression, ovarian torsion, ectopic pregnancy, pre-eclampsia, placenta praevia, placental separation and increased risk of cesarean section. The association between assisted conception and long-term risk of cancer is debatable. The objective of this review is to critically evaluate the current evidence for potential risks to women who conceive through IVF. To assess the relative risk for any condition, a number of factors need to be taken into account including the method used in identifying the study and control group, the women's characteristics and the number of women included in the study. Many conditions such as ectopic pregnancy and pre-eclampsia appear to be commoner in assisted conception than in spontaneous pregnancy. Nevertheless, the increased risk of these conditions is probably related to the woman's subfertility status and/or increased incidence of multiple pregnancy. Currently, all efforts should concentrate on reduction of multiple births from IVF by restricting the number of transferred embryos.
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Affiliation(s)
- Tarek A Gelbaya
- Assisted Conception Unit, Kensington Building, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK.
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44
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Boone WR, Higdon HL, Johnson JE. Quality Management Issues in the Assisted Reproduction Laboratory. ACTA ACUST UNITED AC 2010. [DOI: 10.1177/205891581000100103] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the United States, the Clinical Laboratory Improvement Act (CLIA) of 1988 describes requirements and guidelines for implementing a quality control/quality assurance (QC/QA) program for moderate and high complexity laboratories. These requirements and guidelines apply to Assisted Reproductive Technology (ART) laboratories as well. The general topic of QC and QA as it pertains to in vitro fertilization (IVF) and embryo transfer (ET) is extensively reviewed. This review summarizes many of the QC and QA events that contribute to the advancement of knowledge in this biotechnological field. These events include control of the culture environment inside and outside of the incubator, as well as factors that affect culture media. This review also discusses, in considerable detail, the QC and the QA that pertain to equipment used within the laboratory and how to control for potential contaminants, which reside within the laboratory. This review provides evidence to indicate the need for laboratory personnel to monitor quality improvement issues on a continuous basis. Personnel must be willing to change as improvements in technology occur in order to meet the ever-evolving demands of a more difficult patient population. Suggestions for meeting these demands are offered.
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Affiliation(s)
- William R. Boone
- Greenville Hospital System University Medical Center, Greenville, South Carolina Department of Obstetrics and Gynecology
| | - H. Lee Higdon
- Greenville Hospital System University Medical Center, Greenville, South Carolina Department of Obstetrics and Gynecology
| | - Jane E. Johnson
- Greenville Hospital System University Medical Center, Greenville, South Carolina Department of Obstetrics and Gynecology
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Kamath MS, Aleyamma TK, Muthukumar K, Kumar RM, George K. A rare case report: ovarian heterotopic pregnancy after in vitro fertilization. Fertil Steril 2010; 94:1910.e9-11. [PMID: 20362282 DOI: 10.1016/j.fertnstert.2010.02.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Revised: 02/17/2010] [Accepted: 02/18/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report a case of ovarian heterotopic pregnancy after an IVF cycle. DESIGN Case report. SETTING Reproductive medicine unit, Christian Medical College Hospital, Vellore, India. PATIENT(S) A woman with an ovarian heterotopic pregnancy. INTERVENTION(S) Laparoscopic removal of ovarian ectopic pregnancy. MAIN OUTCOME MEASURE(S) Early detection and successful treatment of heterotopic pregnancy. RESULT(S) Successful laparoscopic management of ovarian pregnancy resulting in a single viable ongoing intrauterine pregnancy. CONCLUSION(S) Clinicians need to be aware of such rare and potentially fatal presentations after IVF, because early diagnosis and management in these cases can yield a favorable outcome.
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Affiliation(s)
- Mohan S Kamath
- Reproductive Medicine Unit, Christian Medical College Hospital, Vellore, India
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46
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Mock embryo transfer does not affect uterine contractility. Fertil Steril 2010; 93:1343-6. [DOI: 10.1016/j.fertnstert.2008.10.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2008] [Revised: 10/24/2008] [Accepted: 10/29/2008] [Indexed: 11/24/2022]
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Muñoz M, Meseguer M, Lizán C, Ayllón Y, Pérez-Cano I, Garrido N. Bleeding during transfer is the only parameter of patient anatomy and embryo quality that affects reproductive outcome: a prospective study. Fertil Steril 2009; 92:953-955. [DOI: 10.1016/j.fertnstert.2009.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 02/03/2009] [Accepted: 02/04/2009] [Indexed: 11/29/2022]
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Two interesting cases of ovarian pregnancy after in vitro fertilization-embryo transfer and its successful laparoscopic management. Fertil Steril 2009; 92:394.e17-9. [PMID: 19403128 DOI: 10.1016/j.fertnstert.2009.03.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 03/10/2009] [Accepted: 03/10/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To report two interesting and rare cases of ovarian pregnancies, after IVF-embryo transfer, and their successful laparoscopic management. DESIGN Case report. SETTING Fertility Research Centre, G G Hospital, Chennai, India. PATIENT(S) Two patients with primary infertility. INTERVENTION(S) Detection of ovarian pregnancy. MAIN OUTCOME MEASURE(S) Early detection and successful laparoscopic management. RESULT(S) Pregnancy outcome following IVF-ET, early detection of ovarian ectopic pregnancy and successful laparoscopic management. CONCLUSION(S) The women who conceive after IVF-embryo transfer are at a significantly higher risk of ectopic pregnancy. Although ovarian ectopic pregnancy is a rare event, the clinician should always keep the possibility in mind as the condition can be easily missed.
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50
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Uterine cavity shape and the best site for embryo transfer. Int J Gynaecol Obstet 2009; 105:140-4. [PMID: 19249047 DOI: 10.1016/j.ijgo.2009.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Revised: 12/19/2008] [Accepted: 01/09/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the best site for embryo placement in uterine cavities of varying shapes. METHOD In this prospective investigation, 638 embryo transfers were allocated to two groups: for group 1 (n=558) embryos were transferred into uterine cavities of normal shape; for group 2 (n=80) embryos were transferred into uterine cavities of abnormal shape. The uterine cavity was divided into 3 equal regions: upper, middle, and lower. Pregnancy outcomes for placements in each region were compared within and between the 2 groups. RESULTS No significant differences were found in rates of pregnancy or implantation among the 3 regions in group 1. In contrast, the implantation rate in group 2 was highest when embryos were placed in the middle region of the uterine cavity: 28.8% compared with 6.8% and 8.3% for the upper and lower regions, respectively (P<0.05). CONCLUSION For the normal uterine cavity, pregnancy outcomes do not depend on embryo placement. However, for uterine anomalies, embryo placement in the middle region of the uterine cavity gave the best outcome.
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