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Kavrut M, Sagir FG, Atayurt Z. Large-scale retrospective analysis of methodological factors affecting pregnancy rates after embryo transfer for in vitro fertilization. Medicine (Baltimore) 2023; 102:e35146. [PMID: 37682170 PMCID: PMC10489353 DOI: 10.1097/md.0000000000035146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/18/2023] [Indexed: 09/09/2023] Open
Abstract
This study aimed to investigate the impact of methodological factors on pregnancy rates after embryo transfer (ET) for in vitro fertilization. This retrospective cross-sectional study was conducted between September 2020 and April 2022. A total of 2048 patients who underwent ultrasonography-guided first frozen embryo transfer (FET) or a fresh ET cycle due to infertility were included in the study. The effects of age, ET protocol (frozen or fresh), preimplantation genetic testing, number of embryos transferred (NET), and embryo fundus distance on pregnancy rate were investigated. The mean age of pregnant patients (31.51 ± 5.28) was significantly lower than that of non-pregnant patients (35.34 ± 6.39) (P < .001). Multiple regression analysis showed that women with lower age (P < .001), higher NET (P < .001), higher embryo fundus distance (P < .001), FET (P < .001), and preimplantation genetic testing (P = .012) had a significantly higher likelihood of pregnancy. Appropriate transfer depth, younger age, euploid embryo transfer, FET, and a higher NET can increase the likelihood of pregnancy. However, multiple factors must be considered when deciding the best protocol for a particular patient, including patient preference, costs and timing.
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Affiliation(s)
| | - Fulya Gokdagli Sagir
- Kolan International Hospital Gynecology, Obstetrics and IVF Center, Istanbul, Turkey
| | - Zafer Atayurt
- Sisli Kolan International Hospital, IVF Center, Istanbul, Turkey
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2
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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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3
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Rosas IM, Anagnostopoulou C, Singh N, Gugnani N, Singh K, Desai D, Darbandi M, Manoharan M, Darbandi S, Chockalingam A, Leonardi Diaz SI, Gupta S, Kuroda S, Finelli R, Sallam HN, Wirka KA, Boitrelle F, Agarwal A. Optimizing embryological aspects of oocyte retrieval, oocyte denudation, and embryo loading for transfer: a state of the art review. Panminerva Med 2022; 64:156-170. [PMID: 35146991 DOI: 10.23736/s0031-0808.22.04675-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Oocyte retrieval, oocyte denudation, and embryo transfer are crucial processes during assisted reproduction (ART). Air quality in the ART laboratory, temperature, pH of the media used and the time interval between oocyte retrieval and insemination are all critical factors. Anesthesia is required for oocyte retrieval, however evidence regarding the potential impact of different methods (general anesthesia, conscious sedation, and local anesthesia) on the clinical outcomes is unclear. The optimal timing of oocyte denudation following retrieval has not been established. Regarding the mechanical denudation process, there is a lack of evidence to demonstrate the safest minimum inner diameter of denuding pipettes used to complete the removal of granulosa cells surrounding the oocytes. During embryo transfer, many clinics worldwide flush the catheter before embryo loading, in an attempt to potentially rinse off any toxic agents; however, there is insufficient evidence to show that flushing the embryo transfer catheter before loading increases the success of ART outcome. Considering the serious gaps in knowledge in ART practice, the aim of this review is to provide an updated overview of the current knowledge regarding the various steps and techniques involved in oocyte retrieval, oocyte denudation, and embryo loading for transfer.
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Affiliation(s)
- Israel M Rosas
- Citmer Reproductive Medicine, IVF LAB, Mexico City, Mexico
| | | | | | - Nivita Gugnani
- BabySoon Fertility and IVF Center, India Institute of Medical Sciences, New Delhi, India
| | - Keerti Singh
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados
| | - Dimple Desai
- DPU IVF & ENDOSCOPY CENTER, Dr. D. Y. Patil Hospital & Research Centre, Pune, India
| | - Masha Darbandi
- Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran.,Gene Therapy and Regenerative Medicine Research Center, Hope Generation Foundation, Tehran, Iran
| | | | - Sara Darbandi
- Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran.,Gene Therapy and Regenerative Medicine Research Center, Hope Generation Foundation, Tehran, Iran
| | | | | | - Sajal Gupta
- American Center for Reproductive Medicine, Cleveland, OH, USA
| | | | - Renata Finelli
- American Center for Reproductive Medicine, Cleveland, OH, USA
| | - Hassan N Sallam
- Department of Obstetrics and Gynaecology, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Kelly A Wirka
- Fertility & Endocrinology, Medical Affairs, EMD Serono, USA
| | - Florence Boitrelle
- Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France.,Department of Biology, Reproduction, Epigenetics, Environment and Development, Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland, OH, USA -
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4
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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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5
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Mo J, Yang Q, Xia L, Niu Z. Embryo location in the uterus during embryo transfer: An in vitro simulation. PLoS One 2020; 15:e0240142. [PMID: 33017457 PMCID: PMC7535041 DOI: 10.1371/journal.pone.0240142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/21/2020] [Indexed: 12/04/2022] Open
Abstract
Objective To evaluate the location of transferred embryos under various parameters during embryo transfer in in vitro fertilization (IVF) by applying an in vitro experimental model for embryo transfer (ET). Methods Mock ET simulations were conducted with a laboratory model of the uterine cavity. The transfer catheter was loaded with a sequence of air and liquid volumes, including development-arrested embryos donated by patients. The transfer procedure was recorded using a digital video camera. An orthogonal design, including three independent variables (uterine orientation, distance of the catheter tip to the fundus, and injection speed) and one dependent variable (final embryo position), was applied. Results The uterine cavity was divided into six regions. The distribution of the transferred matter within the uterine cavity varied according to the uterine orientation. Medium speed-injected embryos were mostly found in the static region while fast- and slow-speed injected embryos were mostly found in the fundal region and the cervical-left region, respectively. The possibility of embryo separation from the air bubble increased from 11.1% in slow injection cases to 29.6% and 48.1% in medium and fast injection cases, respectively. Conclusion The experimental model provides a new method for investigating ET procedures. Fast injection of embryos into a retroverted uterus may be more likely to result in embryo separation from the air bubble.
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Affiliation(s)
- Jinqiu Mo
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Qing Yang
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Lan Xia
- Reproductive Medical Center, Obstetrics and Gynecology Department, Ruijin Hospital Affiliated with the Medical School of Shanghai Jiao Tong University, Shanghai, China
| | - Zhihong Niu
- Reproductive Medical Center, Obstetrics and Gynecology Department, Ruijin Hospital Affiliated with the Medical School of Shanghai Jiao Tong University, Shanghai, China
- * E-mail:
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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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7
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Saravelos SH, Li TC. Embryo transfer techniques. Best Pract Res Clin Obstet Gynaecol 2019; 59:77-88. [PMID: 30711373 DOI: 10.1016/j.bpobgyn.2019.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/03/2019] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
Embryo transfer is the final and rate-limiting step of the assisted reproductive technique. Few advances have occurred in the last few decades with regard to this procedure. Studies conducted thus far have focused on factors and interventions taking place before, during and after this procedure. These factors are highly varied and range from methods to improve the psychological state of the patients to methods aimed at reducing uterine contractility and methods aimed at optimising the precise transfer of the embryo. The key question is which factors and interventions have thus far been proven to increase pregnancy rates and live birth rates. This paper aims to review the evidence relating to embryo transfer techniques in a systematic manner with a view to provide practical recommendations to practitioners involved in the procedure.
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Affiliation(s)
| | - Tin-Chiu Li
- Assisted Reproductive Technology Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
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8
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Wang Y, Zhu Y, Sun Y, Di W, Qiu M, Kuang Y, Shen H. Ideal embryo transfer position and endometrial thickness in IVF embryo transfer treatment. Int J Gynaecol Obstet 2018; 143:282-288. [PMID: 30238667 DOI: 10.1002/ijgo.12681] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 08/02/2018] [Accepted: 09/18/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To establish an ideal transfer strategy by investigating the relationships among embryo transfer (ET) depth, endometrial thickness, and subsequent in vitro fertilization treatment clinical pregnancy outcomes. METHODS In the present retrospective analysis, data from in vitro fertilization-ET treatment cycles conducted at a fertility center in Shanghai, China, between October 2014 and March 2015 were analyzed. Women were divided into groups 1-4 according to transfer depth (<10; 10-15, 15-20, and >20 mm, respectively), as measured by air bubbles. Additionally, 391 women were divided into groups A-C according to endometrial thickness (<7, 1-12, and >12 mm, respectively). Clinical pregnancy outcomes were assessed by group. RESULTS Data from 501 cycles were included. Clinical pregnancy and live delivery rates were significantly higher in group 2 (P=0.009 and P=0.002, respectively) and group 3 (P=0.008 and P=0.001, respectively) than in group 4. Among the 394 patients with endometrial thickness data available, clinical pregnancy and live delivery rates were higher in group B (P=0.028 and P=0.015, respectively) and group (P=0.013 and P=0.013, respectively) than in group A. CONCLUSION Correct transfer depth and endometrial thickness can increase the rates of clinical pregnancy, implantation, and live delivery. Placing the embryos at 10-20 mm from the fundus and at an endometrial thickness of more than 7 mm is recommended for optimal clinical pregnancy outcomes.
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Affiliation(s)
- Yao Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanwen Zhu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Sun
- Center for Reproductive Medicine, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen Di
- Department of Gynecology and Obstetrics, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Meiting Qiu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanping Kuang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haoran Shen
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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9
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Sigalos GΑ, Michalopoulos Y, Kastoras AG, Triantafyllidou O, Vlahos NF. Low versus high volume of culture medium during embryo transfer: a randomized clinical trial. J Assist Reprod Genet 2018; 35:693-699. [PMID: 29234954 PMCID: PMC5949098 DOI: 10.1007/s10815-017-1099-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/30/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE The aim of this prospective randomized control trial was to evaluate if the use of two different volumes (20-25 vs 40-45 μl) of media used for embryo transfer affects the clinical outcomes in fresh in vitro fertilization (IVF) cycles. METHODS In total, 236 patients were randomized in two groups, i.e., "low volume" group (n = 118) transferring the embryos with 20-25 μl of medium and "high volume" group (n = 118) transferring the embryos with 40-45 μl of medium. The clinical pregnancy, implantation, and ongoing pregnancy rates were compared between the two groups. RESULTS No statistically significant differences were observed in clinical pregnancy (46.8 vs 54.3%, p = 0.27), implantation (23.7 vs 27.8%, p = 0.30), and ongoing pregnancy (33.3 vs 40.0%, p = 0.31) rates between low and high volume group, respectively. CONCLUSION Higher volume of culture medium to load the embryo into the catheter during embryo transfer does not influence the clinical outcome in fresh IVF cycles. TRIAL REGISTRATION NUMBER NCT03350646.
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Affiliation(s)
- George Α Sigalos
- 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, University of Athens, Athens, Greece.
- Reproductive Medicine Unit, "Leto" Maternity Hospital, Athens, Greece.
| | | | | | | | - Nikos F Vlahos
- 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, University of Athens, Athens, Greece
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10
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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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11
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Liu R, Li Y, Miao Y, Wei Y, Guan M, Zhou R, Li X. Intrauterine air impairs embryonic postimplantation development in mice. Eur J Obstet Gynecol Reprod Biol 2017; 219:20-27. [PMID: 29031908 DOI: 10.1016/j.ejogrb.2017.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 09/19/2017] [Accepted: 10/09/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Although most embryologists load air bubbles into the catheter along with embryos during embryo transfer, the effects of these air bubbles on embryo transfer success rate are not clear. STUDY DESIGN Air bubbles were nonsurgically injected into unilateral uterine horns of mice to demonstrate the negative effects of intrauterine air bubbles on embryonic development. RESULTS Our data showed that when air bubbles are nonsurgically injected into unilateral uterine horns of pregnant 4days mice the litter size is significantly decreased. Four days after the introduction of air, abnormal decidua and dead conceptuses were detected in the uterine horns receiving the air bubbles. In addition, intrauterine air also significantly impaired murine embryo transfer success rates, and induced an increase in endometrial capillary permeability and decidualization in mice on day 4 of pseudopregnancy. These results strongly indicated that the air bubbles loaded into embryo transfer catheters to bracket the embryo-containing medium may have negative effect on embryonic implantation and development. CONCLUSIONS Intrauterine air impaired murine embryonic postimplantation development, and this provided some clues for improving embryo transfer techniques in human.
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Affiliation(s)
- Ruonan Liu
- College of Animal Science and Technology, Hebei Agricultural University, Baoding, Hebei, 071000, China
| | - Yimeng Li
- College of Basic Medical Science, Hebei Medical University, Shijiazhuang, Hebei, 050000, China
| | - Yanping Miao
- College of Animal Science and Technology, Hebei Agricultural University, Baoding, Hebei, 071000, China
| | - Yanhui Wei
- College of Animal Science and Technology, Hebei Agricultural University, Baoding, Hebei, 071000, China
| | - Mo Guan
- MRC Harwell Institute, Harwell Campus, Mary Lyon Centre, Oxfordshire, OX11 0RD, UK
| | - Rongyan Zhou
- College of Animal Science and Technology, Hebei Agricultural University, Baoding, Hebei, 071000, China.
| | - Xiangyun Li
- College of Animal Science and Technology, Hebei Agricultural University, Baoding, Hebei, 071000, China.
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12
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Sigalos G, Triantafyllidou O, Vlahos N. How do laboratory embryo transfer techniques affect IVF outcomes? A review of current literature. HUM FERTIL 2016; 20:3-13. [PMID: 27844488 DOI: 10.1080/14647273.2016.1255357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Over the last few years, many studies have focused on embryo selection methods, whereas little attention has been given to the standardization of the procedure of embryo transfer. In this review, several parameters of the embryo transfer procedure are examined, such as the: (i) culture medium volume and loading technique; (ii) syringe and catheters used for embryo transfer; (iii) viscosity and composition of the embryo transfer medium; (iv) environment of embryo culture; (v) timing of embryo transfer; (vi) and standardization of the embryo transfer techniques. The aim of this manuscript is to review these factors and compare the existing embryo transfer techniques and highlight the need for better embryo transfer standardization.
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Affiliation(s)
- George Sigalos
- a 2nd Department of Obstetrics and Gynaecology , Aretaieion Hospital University of Athens , Athens, Greece.,b Reproductive Medicine Unit , "Lito" Maternity Hospital , Athens , Greece
| | | | - Nikos Vlahos
- a 2nd Department of Obstetrics and Gynaecology , Aretaieion Hospital University of Athens , Athens, Greece
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Saravelos SH, Wong AWY, Chan CPS, Kong GWS, Li TC. How often does the embryo implant at the location to which it was transferred? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:106-112. [PMID: 26437908 DOI: 10.1002/uog.15778] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 09/29/2015] [Accepted: 09/29/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To determine how often the embryo implants exactly at the site of transfer and what additional factors may affect the eventual site of implantation in assisted reproductive technology (ART) cycles. METHODS This was a prospective observational study of women undergoing ART treatment in a tertiary university unit. Several factors inherent to the embryo transfer (ET), such as the location of the air bubbles and uterine contractility at 1 and at 60 min after ET were assessed with two-dimensional and three-dimensional (3D) ultrasound. In women in whom there was a resulting pregnancy, the position of the gestational sac (i.e. right, left, center or low) was subsequently assessed using 3D ultrasound, and predictors of its location were evaluated. RESULTS Of 239 recruited women with visualization of air bubbles at ET, 71 singleton gestational sacs were subsequently observed on 3D ultrasound. Overall, 40.8% (29/71) of embryos implanted at the location where the air bubbles were visualized at 1 min after ET, and 50.7% (36/71) implanted where the air bubbles were visualized at 60 min after ET (Cohen's kappa coefficients 0.21 and 0.37, respectively; comparison of agreement values: P = 0.28). Specifically, at 1 min the correspondence between the location of the air bubble and embryo implantation was 37.5% (6/16), 57.1% (8/14), 36.8% (7/19) and 36.4% (8/22) for right, left, central and lower uterus, respectively (4 × 4 contingency table, P < 0.01); at 60 min, the correspondence was 72.2% (13/18), 50.0% (9/18), 33.3% (8/24) and 85.7% (6/7), respectively (5 × 4 contingency table, P < 0.001). In addition, higher vs lower frequency of uterine contractions at 60 min was associated with different sites of implantation (5.6% (1/18), 11.1% (2/18), 27.8% (5/18) and 55.6% (10/18) vs 34.0% (18/53), 24.5% (13/53), 13.2% (7/53) and 28.3% (15/53) for right, left, central and lower uterus, respectively, P < 0.05). In particular, a high uterine contraction frequency following ET was associated with a twofold increased chance of the pregnancy implanting in the lower part of the uterine cavity (relative risk, 1.96 (95% CI, 1.08-3.56), P < 0.05). CONCLUSIONS The position of the air bubbles within the first 60 min of ET appears to predict the site of implantation in approximately half of cases, denoting an overall poor agreement. This implies significant embryo migration, and has important clinical implications, as it demonstrates that other factors such as uterine contractility may dictate where the embryo will eventually implant following transfer. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- S H Saravelos
- Assisted Reproductive Technology Unit, Department of Obstetrics & Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - A W Y Wong
- Assisted Reproductive Technology Unit, Department of Obstetrics & Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - C P S Chan
- Assisted Reproductive Technology Unit, Department of Obstetrics & Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - G W S Kong
- Assisted Reproductive Technology Unit, Department of Obstetrics & Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - T-C Li
- Assisted Reproductive Technology Unit, Department of Obstetrics & Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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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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Saravelos SH, Wong AWY, Chan CPS, Kong GWS, Cheung LP, Chung CHS, Chung JPW, Li TC. Assessment of the embryo flash position and migration with 3D ultrasound within 60 min of embryo transfer. Hum Reprod 2016; 31:591-6. [DOI: 10.1093/humrep/dev343] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 12/14/2015] [Indexed: 11/13/2022] Open
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Gingold JA, Lee JA, Rodriguez-Purata J, Whitehouse MC, Sandler B, Grunfeld L, Mukherjee T, Copperman AB. Endometrial pattern, but not endometrial thickness, affects implantation rates in euploid embryo transfers. Fertil Steril 2015; 104:620-8.e5. [PMID: 26079695 PMCID: PMC4561002 DOI: 10.1016/j.fertnstert.2015.05.036] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/29/2015] [Accepted: 05/29/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the relationship of endometrial thickness (EnT) and endometrial pattern (EnP) to euploid embryo transfer (ET) outcomes. DESIGN Retrospective cohort. SETTING Private academic clinic. PATIENT(S) Patients (n = 277; age 36.1 ± 4.0 years) whose embryos (n = 476) underwent aneuploidy screening with fresh (n = 176) or frozen (n = 180) ET from July 2010 to March 2014. INTERVENTION(S) The EnT and EnP were measured on trigger day and at ET. Patients were stratified by age and cycle type (fresh or frozen). Cycle data were combined at trigger day, but separated at ET day. MAIN OUTCOME MEASURE(S) Outcome measures were implantation rate, pregnancy rate, and clinical pregnancy rate. Analysis was conducted using χ(2) analysis and Fisher's exact test. RESULT(S) A total of 234 gestational sacs, 251 pregnancies, and 202 clinical pregnancies resulted from 356 cycles. The EnT (9.6 ± 1.8 mm; range: 5-15 mm) at trigger day (n = 241 cycles), as a continuous or categorical variable (≤8 vs. >8 mm), was not associated with implantation rate, pregnancy rate, or clinical pregnancy rate. The EnT at day of fresh ET (9.7 ± 2.2 mm; range: 4.4-17.9 mm) (n = 176 cycles) or frozen ET (9.1 ± 2.1 mm; range: 4.2-17.7 mm) (n = 180 cycles) was not associated with implantation rate, pregnancy rate, or clinical pregnancy rate. Type 3 EnP at trigger day was associated with increased serum progesterone at trigger and a decreased implantation rate, compared with type 2 EnP. The EnP at fresh or frozen ET was not associated with implantation rate, pregnancy rate, or clinical pregnancy rate. CONCLUSION(S) Within the study population, EnT was not significantly associated with clinical outcomes of euploid ETs. A type 3 EnP at trigger day suggests a prematurely closed window of implantation.
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Affiliation(s)
- Julian A Gingold
- Reproductive Medicine Associates of New York, New York, New York; Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Joseph A Lee
- Reproductive Medicine Associates of New York, New York, New York
| | | | | | - Benjamin Sandler
- Reproductive Medicine Associates of New York, New York, New York; Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lawrence Grunfeld
- Reproductive Medicine Associates of New York, New York, New York; Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tanmoy Mukherjee
- Reproductive Medicine Associates of New York, New York, New York; Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alan B Copperman
- Reproductive Medicine Associates of New York, New York, New York; Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
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Refaat B, Dalton E, Ledger WL. Ectopic pregnancy secondary to in vitro fertilisation-embryo transfer: pathogenic mechanisms and management strategies. Reprod Biol Endocrinol 2015; 13:30. [PMID: 25884617 PMCID: PMC4403912 DOI: 10.1186/s12958-015-0025-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/03/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Ectopic pregnancy (EP) is the leading cause of maternal morbidity and mortality during the first trimester and the incidence increases dramatically with in vitro fertilisation and embryo transfer (IVF-ET). The co-existence of an EP with a viable intrauterine pregnancy (IUP) is known as heterotopic pregnancy (HP) affecting about 1% of patients during assisted conception. EP/HP can cause significant morbidity and occasional mortality and represent diagnostic and therapeutic challenges, particularly during fertility treatment. Many risk factors related to IVF-ET techniques and the cause of infertility have been documented. The combination of transvaginal ultrasound (TVS) and serum human chorionic gonadotrophin (hCG) is the most reliable diagnostic tool, with early diagnosis of EP/HP permitting conservative management. This review describes the risk factors, diagnostic modalities and treatment approaches of EP/HP during IVF-ET and also their impact on subsequent fertility treatment. METHODS The scientific literature was searched for studies investigating EP/HP during IVF-ET. Publications in English and within the past 6 years were mostly selected. RESULTS A history of tubal infertility, pelvic inflammatory disease and specific aspects of embryo transfer technique are the most significant risk factors for later EP. Early measurement of serum hCG and performance of TVS by an expert operator as early as gestational week 5 can identify cases of possible EP. These women should be closely monitored with repeated ultrasound and hCG measurement until a diagnosis is reached. Treatment must be customised to the clinical condition and future fertility requirements of the patient. In cases of HP, the viable IUP can be preserved in the majority of cases but requires early detection of HP. No apparent negative impact of the different treatment approaches for EP/HP on subsequent IVF-ET, except for risk of recurrence. CONCLUSIONS EP/HP are tragic events in a couple's reproductive life, and the earlier the diagnosis the better the prognosis. Due to the increase incidence following IVF-ET, there is a compelling need to develop a diagnostic biomarker/algorithm that can predict pregnancy outcome with high sensitivity and specificity before IVF-ET to prevent and/or properly manage those who are at higher risk of EP/HP.
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Affiliation(s)
- Bassem Refaat
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al-Abdiyah Campus, PO Box 7607, Makkah, KSA.
| | - Elizabeth Dalton
- School of Women's & Children's Health, University of New South Wales, Sydney, NSW, 2031, Australia.
| | - William L Ledger
- School of Women's & Children's Health, University of New South Wales, Sydney, NSW, 2031, Australia.
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Christianson MS, Zhao Y, Shoham G, Granot I, Safran A, Khafagy A, Leong M, Shoham Z. Embryo catheter loading and embryo culture techniques: results of a worldwide Web-based survey. J Assist Reprod Genet 2014; 31:1029-36. [PMID: 24913025 DOI: 10.1007/s10815-014-0250-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 05/07/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To identify trends in embryo catheter loading and embryo culture techniques performed worldwide. METHODS A retrospective evaluation using the results of a web-based survey, (IVF Worldwide ( www.IVF-worldwide.com ), was performed. RESULTS Responses from 265 centers in 71 countries were obtained. Most centers (97 %) preferred a catheter with its orifice on top, with only 3 % preferring a catheter with the orifice on its side; 41 % preferred a catheter marked for clear ultrasound view. The most commonly-reported methods of embryo loading were medium-air-embryo-air-medium (42 %), medium in catheter with embryo at end (20 %) and medium-air-embryo (15 %). In 68 % of centers the final volume of the catheter was up to 0.3 ml, with only 19 % using 0.3-0.5 ml and 1 % using 0.5-0.7 ml. Using reduced oxygen concentrations for embryo culture was divided between those who used it in combination with the two-gas system (34 %) and those who did not use it at all (39 %); 24 % reported using a three-gas system. Most clinics using reduced oxygen concentrations used it throughout the entire culture period. Half of centers (51 %) reported using reduced oxygen concentrations for the entire IVF population while 6 % reserved it only for blastocyst transfer. The use of sequential media was highly dominant with 40 % reporting its use.
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Affiliation(s)
- Mindy S Christianson
- Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD, USA,
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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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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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Zhu L, Xiao L, Che H, Li Y, Liao J. Uterine peristalsis exerts control over fluid migration after mock embryo transfer. Hum Reprod 2013; 29:279-85. [DOI: 10.1093/humrep/det429] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Yaniv S, Jaffa AJ, Elad D. Modeling Embryo Transfer into a Closed Uterine Cavity. J Biomech Eng 2012; 134:111003. [DOI: 10.1115/1.4007628] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Embryo transfer (ET) is the last manual intervention after extracorporeal fertilization. After the ET procedure is completed, the embryos are conveyed in the uterus for another two to four days due to spontaneous uterine peristalsis until the window time for implantation. The role of intrauterine fluid flow patterns in transporting the embryos to their implantation site during and after ET was simulated by injection of a liquid bolus into a two-dimensional liquid-filled channel with a closed fundal end via a liquid-filled catheter inserted in the channel. Numerical experiments revealed that the intrauterine fluid field and the embryos transport pattern were strongly affected by the closed fundal end. The embryos re-circulated in small loops around the vicinity where they were deposited from the catheter. The transport pattern was controlled by the uterine peristalsis factors, such as amplitude and frequency of the uterine walls motility, as well as the synchronization between the onset of catheter discharge and uterine peristalsis. The outcome of ET was also dependent on operating parameters such as placement of the catheter tip within the uterine cavity and the delivery speed of the catheter load. In conclusion, this modeling study highlighted important parameters that should be considered during ET procedures in order to increase the potential for pregnancy success.
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Affiliation(s)
- Sarit Yaniv
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ariel J. Jaffa
- Ultrasound Unit in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel-Aviv 64239; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - David Elad
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv 69978, Israel
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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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