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Ghanem ME, Bedairy MH, Shaaban A, Albahlol IA. Does the Time of Starting Progesterone Luteal Support Affect Embryo Transfer in Long Agonist Protocol Downregulated ICSI Cycles? A Randomized Controlled Trial. Reprod Sci 2020; 28:897-903. [PMID: 32909190 DOI: 10.1007/s43032-020-00309-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/27/2020] [Indexed: 11/28/2022]
Abstract
The aim of this study was to compare the effects of starting progesterone (P4) luteal support (LS) on day of egg retrieval (ER) or day of embryo transfer (ET) on the ratio of difficult ET and cycle outcome. This was a RCT ( ClinicalTrials.gov Identifier: NCT03040830) carried out at Mansoura Integrated Fertility Center (MIFC), Mansoura, Egypt, from November 2015 to January 2017. A total of 171 eligible long agonist ICSI cases were randomly allocated on day of ER into group A (86) starting LS as daily IM 100 mg P4 on day of ER and group B (85) starting P4-LS on day of ET. Difficult ET was defined as blood on ET catheter and/or sounding or dilating the cervix. Primary outcome was the overall ratio of difficult ET and ratios on day 3 and 5 ET. Secondary outcome was the ongoing pregnancy rate (OPR) and implantation rate (IR). The results are presented as % for groups A and B respectively: overall difficult ET (44.1, 24.7) (p = 0.009); day 3 difficult ET (23.2, 24.4) (p = 0.45); day 5 difficult ET (62.7, 25.6) (p = 0.001); overall OPR (38.3, 44.7) (p = 0.43); day 3 ET OPR (41.8, 33.3) (p = 0.51); day 5 ET OPR (34.8, 57.5) (p = 0.048); overall IR (20.0, 22.5) (p = 0.62); day 3 ET IR (17.8, 13.4) (p = 0.44); day 5 ET IR (22, 34.1) (p = 0.09). In conclusion, starting P4 luteal support on egg retrieval day is associated with significantly higher ratio of difficult embryo transfer and lower ongoing pregnancy rate and tendency to lower IR in day 5 ET, so starting P4-LS on day of ET is recommended.
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Affiliation(s)
- M E Ghanem
- Mansoura Integrated Fertility Centre (MIFC), Mansoura, Egypt
| | - M H Bedairy
- Mansoura Integrated Fertility Centre (MIFC), Mansoura, Egypt.,Department of Obstetrics and Gynecology, College of Medicine, Mansoura University, Mansoura, Egypt
| | - A Shaaban
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ibrahim A Albahlol
- Mansoura Integrated Fertility Centre (MIFC), Mansoura, Egypt. .,Department of Obstetrics and Gynecology, College of Medicine, Mansoura University, Mansoura, Egypt. .,Department of Obstetrics and Gynecology, College of Medicine, Jouf University, Sakaka, Saudi Arabia.
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Yuan C, Song H, Fan L, Su S, Dong B. The Effect of Atosiban on Patients With Difficult Embryo Transfers Undergoing In Vitro Fertilization-Embryo Transfer. Reprod Sci 2019; 26:1613-1617. [PMID: 30791824 DOI: 10.1177/1933719119831791] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to evaluate the effect of atosiban on the outcomes of infertile women undergoing in vitro fertilization (IVF) with difficult embryo transfers (ETs). This randomized double-blind study enrolled 204 infertile women with difficult ETs during IVF treatment between June 2014 and June 2018. According to a computer-generated randomization list, participants were randomized into placebo (n = 102) and atosiban (n = 102) groups. In atosiban group, atosiban with a total dose of 37.5 mg was administered. All of the patients underwent IVF-ET using cryopreserved embryos. The clinical pregnancy rate per cycle and implantation rate per transfer (45.1% and 26.5%) in atosiban group were significantly higher than those of placebo group (15.6% and 9.7%, respectively; P < .05). This study showed that administration of atosiban during ET was extraordinarily effective for patients with difficult transfers.
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Affiliation(s)
- Caixia Yuan
- Department of Gynecology and Obstetrics, Qilu Hospital, Shandong University, Jinan, People's Republic of China.,Department of Reproductive Medicine, Shanxi Provincial People's Hospital, Taiyuan, People's Republic of China
| | - Haixia Song
- Department of Reproductive Medicine, Shanxi Provincial People's Hospital, Taiyuan, People's Republic of China
| | - Lingling Fan
- Department of Reproductive Medicine, Shanxi Provincial People's Hospital, Taiyuan, People's Republic of China
| | - Shili Su
- Department of Gynecology and Obstetrics, Qilu Hospital, Shandong University, Jinan, People's Republic of China
| | - Baihua Dong
- Department of Gynecology and Obstetrics, Qilu Hospital, Shandong University, Jinan, People's Republic of China
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Abstract
We performed a systematic review on the clinical epidemiology and outcome of difficult embryo transfers (ETs) in infertility patients who present with difficult ET. We searched PubMed, ScienceDirect, and Elsevier journals from 1980 to June 2017. We aimed to determine the most successful method resulting in highest pregnancy rates (PRs) in patients with difficult ET. We identified 50 articles, in which 36 were reviewed and 15 were included. Analysis of the data collected showed that the majority of the difficult ETs were caused by cervical stenosis and the most common treatment was cervical dilation. We concluded that cervical dilation was effective at managing difficult ET. Hegar dilators used a minimum of 3 weeks before ET showed to have higher PR.
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Affiliation(s)
- Puneet Arora
- Bourn Hall Fertility Centre, Gurgaon, Haryana, India
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Huang QY, Rong MH, Lan AH, Lin XM, Lin XG, He RQ, Chen G, Li MJ. The impact of atosiban on pregnancy outcomes in women undergoing in vitro fertilization-embryo transfer: A meta-analysis. PLoS One 2017; 12:e0175501. [PMID: 28422984 PMCID: PMC5396917 DOI: 10.1371/journal.pone.0175501] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 03/26/2017] [Indexed: 12/01/2022] Open
Abstract
Background Atosiban is administered to women undergoing in vitro fertilization-embryo transfer (IVF-ET) to improve pregnancy outcomes. However, the results of this treatment were controversial. We conducted this meta-analysis to investigate whether atosiban improves pregnancy outcomes in the women undergoing in vitro fertilization (IVF). Methods Databases of PubMed, EMBASE, Web of Science, China BioMedicine, and Google Scholar were systematically searched. Meta-analyses were performed to investigate whether atosiban improves pregnancy outcomes in the women undergoing IVF. Results Our results showed that atosiban was associated with higher implantation (OR = 1.63, 95% CI: 1.17–2.27; P = 0.004) and clinical pregnancy (OR = 1.84, 95% CI: 1.31–2.57; P < 0.001) rates. However, atosiban showed no significant association with the miscarriage, live birth, multiple pregnancy or ectopic pregnancy rates. When a further subgroup analysis was performed in the women undergoing repeated implantation failure (RIF), implantation (OR = 1.93, 95% CI: 1.45–2.57; P < 0.001), clinical pregnancy (OR = 2.48, 95% CI: 1.70–3.64; P <0.001) and the live birth (OR = 2.89, 95% CI: 1.78–4.67; P < 0.001) rates were significantly higher in the case group. Nevertheless, no significant difference was detected in the miscarriage and multiple pregnancy rates between the case and control groups. Conclusion Atosiban may be more appropriate for women undergoing RIF and play only a limited role in improving pregnancy outcomes in the general population of women undergoing IVF. These conclusions should be verified in large and well-designed studies.
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Affiliation(s)
- Qian-Yi Huang
- Department of Reproductive Medical Research Center, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Min-Hua Rong
- Research Department, Affiliated Cancer Hospital, Guangxi Medical University, Nanning, China
| | - Ai-Hua Lan
- Department of Reproductive Medical Research Center, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiao-Miao Lin
- Department of Children Rehabilitation Medicine, Guangxi Matemal and Child Health Hospital, Nanning, China
| | - Xing-Gu Lin
- Center of Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China
| | - Rong-Quan He
- Center of Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China
| | - Gang Chen
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Mu-Jun Li
- Department of Reproductive Medical Research Center, First Affiliated Hospital of Guangxi Medical University, Nanning, China
- * E-mail:
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Larue L, Keromnes G, Massari A, Roche C, Moulin J, Gronier H, Bouret D, Cassuto NG, Ayel JP. Transvaginal ultrasound-guided embryo transfer in IVF. J Gynecol Obstet Hum Reprod 2017; 46:411-416. [PMID: 28428123 DOI: 10.1016/j.jogoh.2017.02.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/01/2017] [Accepted: 02/01/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine whether transvaginal ultrasound-guided embryo transfer is a technique that can be used routinely, whether it improves IVF outcomes and whether it makes difficult transfers easier and more successful. MATERIAL AND METHOD Non-randomized retrospective study conducted between 2012 and 2016 in the fertility center of the Diaconesses-Croix St-Simon hospital group. The outcomes of 3910 transfers, performed by 5 senior operators, under transabdominal ultrasound guidance are compared with those of 800 transfers, performed by 1 senior operator under transvaginal ultrasound guidance. The criteria studied are the feasibility of the technique and the percentage of pregnancies per transfer in the two populations described, as well as in the difficult and very difficult transfer populations. RESULTS All the transfers were feasible under transvaginal ultrasound guidance without the use of forceps or additional instruments. The percentage of pregnancies per transfer is significantly increased, when the transfer is performed under transvaginal ultrasound guidance compared with that performed under transabdominal ultrasound guidance, in the general population (38%, n=800 vs 30%, n=3910; P 0.0004) and in the reference population characterized by age <38 years and >6 oocytes collected per puncture (45%, n=490 vs 36%, n=1968; P 0.002). The percentage of pregnancies per transfer (P/T) is not significantly different in the populations of easy transfers (n 695, 38% P/T), difficult transfers (n 58, 46% P/T; P=ns) and very difficult transfers (n 47, 34% P/T; P=ns). CONCLUSIONS Embryo transfer is a key stage in IVF, in which the quality of performance determines the outcome. In this study, transvaginal ultrasound guidance of the transfer, which is the reference procedure in gynaecological imaging, significantly increases the percentage of pregnancies per transfer, both in the general population and in the reference population, compared with transfers performed under transabdominal ultrasound guidance. Transvaginal ultrasound facilitates the performance of difficult transfers and in particular achieves outcomes in these situations that are not significantly different from those of easy transfers. Visual monitoring of transcervical passage, which is rendered more precise and less traumatic and precision of embryo deposition are the factors that probably account for the improvement in outcomes.
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Affiliation(s)
- L Larue
- Centre de fertilité, groupe hospitalier Diaconesses-Croix, Saint-Simon, 18, rue du Sergent-Bauchat, 75012 Paris, France.
| | - G Keromnes
- Centre de fertilité, groupe hospitalier Diaconesses-Croix, Saint-Simon, 18, rue du Sergent-Bauchat, 75012 Paris, France
| | - A Massari
- Centre de fertilité, groupe hospitalier Diaconesses-Croix, Saint-Simon, 18, rue du Sergent-Bauchat, 75012 Paris, France
| | - C Roche
- Centre de fertilité, groupe hospitalier Diaconesses-Croix, Saint-Simon, 18, rue du Sergent-Bauchat, 75012 Paris, France
| | - J Moulin
- Centre de fertilité, groupe hospitalier Diaconesses-Croix, Saint-Simon, 18, rue du Sergent-Bauchat, 75012 Paris, France
| | - H Gronier
- Centre de fertilité, groupe hospitalier Diaconesses-Croix, Saint-Simon, 18, rue du Sergent-Bauchat, 75012 Paris, France
| | - D Bouret
- Laboratoire Drouot, 19, rue Drouot, 75009 Paris, France
| | - N G Cassuto
- Laboratoire Drouot, 19, rue Drouot, 75009 Paris, France
| | - J P Ayel
- Centre de fertilité, groupe hospitalier Diaconesses-Croix, Saint-Simon, 18, rue du Sergent-Bauchat, 75012 Paris, France
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Chung CHS, Wong AWY, Chan CPS, Saravelos SH, Kong GWS, Cheung LP, Chung JPW, Li TC. The changing pattern of uterine contractions before and after fresh embryo transfer and its relation to clinical outcome. Reprod Biomed Online 2017; 34:240-247. [DOI: 10.1016/j.rbmo.2016.12.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 12/01/2016] [Accepted: 12/02/2016] [Indexed: 11/12/2022]
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Anatomical causes of difficult embryo transfer during in vitro fertilization. J Gynecol Obstet Hum Reprod 2017; 46:77-86. [DOI: 10.1016/j.jgyn.2016.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 08/31/2016] [Accepted: 09/07/2016] [Indexed: 11/24/2022]
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8
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Akhtar MA, Netherton R, Majumder K, Edi-Osagie E, Sajjad Y. Methods employed to overcome difficult embryo transfer during assisted reproduction treatment. Arch Gynecol Obstet 2015; 292:255-62. [DOI: 10.1007/s00404-015-3657-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 02/06/2015] [Indexed: 11/28/2022]
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9
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Lin YH, Hwang JL, Huang LW, Seow KM, Chen HJ, Tzeng CR. Efficacy of Hysteroscopic Cervical Resection for Cervical Stenosis. J Minim Invasive Gynecol 2013; 20:836-41. [DOI: 10.1016/j.jmig.2013.04.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 04/21/2013] [Accepted: 04/24/2013] [Indexed: 11/16/2022]
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10
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Difficult embryo transfers or blood on catheter and assisted reproductive outcomes: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2013; 168:121-8. [DOI: 10.1016/j.ejogrb.2012.12.030] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 09/27/2012] [Accepted: 12/31/2012] [Indexed: 11/21/2022]
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11
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Tiras B, Korucuoglu U, Polat M, Saltik A, Zeyneloglu HB, Yarali H. Effect of blood and mucus on the success rates of embryo transfers. Eur J Obstet Gynecol Reprod Biol 2012; 165:239-42. [DOI: 10.1016/j.ejogrb.2012.07.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 05/03/2012] [Accepted: 07/29/2012] [Indexed: 10/28/2022]
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12
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Spitzer D, Haidbauer R, Corn C, Stadler J, Wirleitner B, Zech NH. Effects of embryo transfer quality on pregnancy and live birth delivery rates. J Assist Reprod Genet 2011; 29:131-5. [PMID: 22116647 DOI: 10.1007/s10815-011-9680-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 11/09/2011] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND To analyze the effects of embryo transfer (ET) quality on clinical pregnancy (CPR) and live birth delivery rates (LBDR). METHODS In a retrospective study at a single, private infertility center between November 2005 and December 2009 one thousand fifty-five day-3 and day-5 ETs following IVF/ICSI/IMSI were evaluated. We analyzed the impact of an atraumatic ET with a soft catheter (ET 1), after external guidance (ET 2), after probing of the cervix with a stylet (ET 3), or after grasping the portio vaginalis with a tenaculum (ET 4) on CPR and LBDR. RESULTS The use of external guidance showed a significantly reduced LBDR as compared to an atraumatic ET (26.0% vs. 32.5%). The lowest CPR and LBDR were found in ET 4. The application of stylets in cases of difficult ETs was superior to the use of external guidance. No differences in miscarriages between ET 1-4 were noted. CONCLUSIONS Besides embryo culture and patient history, the quality of an ET might also have an important impact on pregnancy outcome. Techniques to ensure an atraumatic ET, such as mechanic uterine cavity length measurements, before starting treatment might help identify patients at risk for a difficult ET and lead to modified treatments, such as the primary use of a stylet. Limitation of study: retrospective analysis.
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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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Moraloglu O, Tonguc E, Var T, Zeyrek T, Batioglu S. Treatment with oxytocin antagonists before embryo transfer may increase implantation rates after IVF. Reprod Biomed Online 2010; 21:338-43. [PMID: 20638340 DOI: 10.1016/j.rbmo.2010.04.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Revised: 03/12/2010] [Accepted: 04/07/2010] [Indexed: 11/16/2022]
Abstract
This report aimed to examine the effects of atosiban on pregnancy outcome after IVF-embryo transfer. A prospective, randomized, placebo-controlled clinical study was performed. A total of 180 women undergoing intracytoplasmic sperm injection who had top-quality embryos were randomly allocated into treatment and control groups. All the patients had infertility due to tubal factor, hormonal-anovulatory disorders, male factor or unexplained reasons. The treatment group received intravenous administration of atosiban before embryo transfer with a total administered dose of 37.5 mg. In the control group, the same number of cycles was performed with placebo medication. The clinical pregnancy rate (PR) per cycle and implantation rate (IR) per transfer were 46.7% and 20.4% in the atosiban-treated group, which were significantly higher than in the control group (28.9% and 12.6%, respectively, P=0.01). The miscarriage rates of groups 1 and 2 were 16.7% and 24.4%, respectively (P=0.01). These results have indicated that atosiban increases the IR and PR after IVF-embryo transfer. These results suggest that atosiban treatment before embryo transfer is effective in priming of the uterus for implantation. This is the first study to investigate the possible contributions of atosiban for improving the PR after IVF-embryo transfer.
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Affiliation(s)
- Ozlem Moraloglu
- Dr. Zekai Tahir Burak Woman's Health Education and Research Hospital, Assisted Reproduction Unit, Ankara, Turkey
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Moragianni VA, Cohen JD, Smith SE, Schinfeld JS, Somkuti SG, Lee A, Barmat LI. Effect of macroscopic or microscopic blood and mucus on the success rates of embryo transfers. Fertil Steril 2010; 93:570-3. [DOI: 10.1016/j.fertnstert.2008.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2008] [Revised: 10/26/2008] [Accepted: 11/02/2008] [Indexed: 11/17/2022]
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Sifer C, Cédrin-Durnerin I, Hugues JN, Poncelet C. [Views of each member of an Assisted Reproductive Technologies centre on the embryo transfer procedure]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2009; 37:645-652. [PMID: 19589713 DOI: 10.1016/j.gyobfe.2009.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 04/27/2009] [Indexed: 05/28/2023]
Abstract
The embryo transfer (ET) is probably the key step of Assisted Reproductive Technologies (ART), end point of the collaboration of a multidisciplinary clinical team and an infertile couple. Thus, a perfect knowledge of available data regarding ET is required to optimize the results of ART. Indeed, numerous published studies demonstrate the impact of defined parameters onto the effectiveness of ET procedure. The aim of this study is to provide views of physicians dealing with ART, i.e. endocrinologist, ultrasound scan specialist, surgeon and biologist to put in perspective questions and answers about ET.
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Affiliation(s)
- C Sifer
- Service d'histologie-embryologie-cytogénétique, CHU Jean-Verdier, AP-HP, avenue du 14-Juillet, 93143 Bondy, France.
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Gera PS, Allemand MC, Tatpati LL, Galanits TM, Morbeck D, Coddington CC. Role of saline infusion sonography in uterine evaluation before frozen embryo transfer cycle. Fertil Steril 2008; 89:562-6. [PMID: 17517405 DOI: 10.1016/j.fertnstert.2007.03.067] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Revised: 03/21/2007] [Accepted: 03/21/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the role of saline infusion sonography (SIS) in uterine evaluation before a frozen embryo transfer (FET) cycle. DESIGN Retrospective cohort analysis. SETTING University hospital. PATIENT(S) Thirty-six patients who had uterine evaluation by SIS before FET cycle. INTERVENTION(S) The SIS was performed in the follicular phase of the menstrual cycle before the actual FET cycle. MAIN OUTCOME MEASURE(S) The SIS findings, clinical pregnancy rate (PR), ongoing PR, and correlation between positive SIS findings with and without subsequent treatment and pregnancy outcome. RESULT(S) Positive SIS findings were found in 11/36 patients (30.5%), which included uterine septum (9.0%), endometrial polyp (45.4%), intramural fibroid with normal cavity (9.0%), cystic endometrial changes (9.0%), cervical stenosis (18.1%), and calcification with normal cavity (9.0%). The overall clinical PR in all groups was 51.4%, with an ongoing PR of 45.7%. Patients with positive SIS finding who underwent subsequent hysteroscopic correction (7/11) had a clinical PR of 85.7% as compared to 54.1% in patients with normal uterine cavity (24/35). Patients with positive SIS findings and no operative hysteroscopy (4/11) had a clinical PR of 50% and pregnancy loss rate of 100%. CONCLUSION(S) Obtaining an SIS before the FET cycle can be helpful in the detection of uterine abnormalities. If time since uterine evaluation has been more than 1-2 years, performing an SIS is recommended as subsequent correction of the anomalies may improve FET outcome.
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Affiliation(s)
- Puja S Gera
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
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18
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Abstract
PURPOSE OF REVIEW Embryo transfer is arguably the most critical step in assisted reproduction. The purpose of this article is to review the different aspects of the procedure in the light of recent evidence. RECENT FINDINGS Randomized trials have shown that significantly higher pregnancy rates are obtained when embryo transfer is performed under ultrasound guidance, the embryos are deposited in the middle part of the uterine cavity, an atraumatic technique is used and when low-dose aspirin is routinely administered following the procedure. Blood in the catheter and leaving the embryos inside it for more than 120 s diminish the pregnancy rate significantly. Air in the catheter, immediate removal of the catheter, performing two transfers in the same cycle, prolonged bed rest, sexual intercourse after embryo transfer or the use of sildenafil do not affect the results. Based on currently available evidence, Cochrane reviews have concluded that the live birth rate is not increased by delaying embryo transfer from day two to three or to the blastocyst stage, and that single embryo transfer leads to lower live birth rates than the transfer of two embryos. The value of a mock transfer a few days before the actual procedure has been challenged as the position of the uterus may change. The effect of holding the cervix with a volsellum, routinely administering antibiotics and the superiority of one catheter over the others is still to be determined. SUMMARY Recent studies confirm the importance of the various aspects of embryo transfer. More randomized studies are needed to further evaluate them.
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Affiliation(s)
- Hassan N Sallam
- Department of Obstetrics and Gynaecology, University of Alexandria and Alexandria Fertility Center, Alexandria, Egypt.
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19
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Alvero R, Segars J. Reply: ‘The presence of blood in the transfer catheter negatively influences outcome at embryo transfer’. Hum Reprod 2005. [DOI: 10.1093/humrep/deh813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Raynal P, Houdeau E. Comparaison de l’activité réflexe de l’utérus au cours de l’insémination artificielle et de l’accouplement chez la brebis. ACTA ACUST UNITED AC 2004; 33:725-33. [PMID: 15687944 DOI: 10.1016/s0368-2315(04)96634-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To identify and to compare the reflex mechanisms involved in the activation of the uterine motility following artificial insemination (AI) and mating in the ewe. MATERIALS AND METHODS The contractile activity of the uterus was monitored in presence and absence of adrenergic (phentolamine) and cholinergic (atropine) antagonists, using an implantable telemetric device equipped with a sensor catheter inserted into the uterine lumen, and connected to a radio-telemetric transmitter. RESULTS During AI, a uterine contraction (UC) of short duration (<20 seconds) appeared in direct response to animal restraint, to the speculum introduction, then when the speculum was opened. Both the UC evoked by restraint of the ewe and insertion of the speculum were abolished in presence of phentolamine, while atropine inhibited the UC in response to opening of the speculum only. After AI, the uterine activity increased sharply and was all the more intense and extended with higher vaginal wall pressure. Phentolamine or atropine did not inhibit this motor response, whereas a similar pattern of uterine hyperactivity occurred following i.v. injection of oxytocin (100 and 200 mIU; Syntocinon). After mating, an increase in uterine activity was never observed. Only penis intromission evoked a UC of short duration (about 20 seconds), abolished in presence of phentolamine only. CONCLUSION Artificial insemination in the ewe increases uterine motility, resulting from the reflex activation of adrenergic and cholinergic nerve fibres of the autonomic nervous system, following by a reflex release of oxytocin from the pituitary gland (also called "Ferguson reflex"). This secretion of OT was elicited by the excessive dilation of the vaginal wall with the speculum. By comparison, mating did not evoke a period of uterine hyperactivity and respects the physiological post-coital resting period.
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Affiliation(s)
- P Raynal
- Service de Gynécologie-Obstétrique, Hôpital Saint Vincent de Paul, 74-82, avenue Denfert-Rochereau, 75674 Paris Cedex 14.
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Sallam HN. Should embryo transfer always be performed under ultrasound guidance? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 24:383-386. [PMID: 15343590 DOI: 10.1002/uog.1722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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Lee HC, Seifer DB, Shelden RM. Impact of retained embryos on the outcome of assisted reproductive technologies. Fertil Steril 2004; 82:334-7. [PMID: 15302280 DOI: 10.1016/j.fertnstert.2004.01.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2003] [Revised: 01/12/2004] [Accepted: 01/12/2004] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the impact of embryo retention in the embryo transfer catheter followed by "immediate" retransfer on pregnancy outcome in women undergoing assisted reproduction. DESIGN Retrospective analysis of embryo transfer following in vitro fertilization. SETTING Assisted reproductive technology practice in a university in vitro fertilization program. PATIENT(S) In vitro fertilization charts for 1,812 embryo transfer cycles representing 1,139 patients between January 1997 and March 2002 were reviewed. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Pregnancy rate, implantation rate, delivery rate. RESULT(S) Three embryo transfer cycles were excluded from analysis because of missing data, leaving 1,364 embryo transfers during oocyte recovery cycles and 445 embryo transfer cycles using thawed embryos. Seventy-one embryo transfers (3.9% of all transfers) were complicated by finding retained embryos after the initial embryo transfer-all retained embryos were immediately retransferred. There was no difference in the frequency of retained embryos during oocyte retrieval versus thawed embryo cycles. The pregnancy, implantation, and delivery rates per embryo transfer were not negatively affected by embryo(s) retained in the transfer catheter. Age, fresh versus frozen embryo, use of ultrasound during the procedure, or transferring physician did not influence pregnancy outcome. CONCLUSION(S) Immediate retransfer of embryos retained in the catheter following the initial transfer attempt did not have an adverse effect on pregnancy outcome.
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Affiliation(s)
- Hye-Chun Lee
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Reproductive Endocrinology and Infertility, UMDNJ-Robert Wood Johnson Medical School, 303 George Street, New Brunswick, NJ 08901, USA
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Lindheim SR, Adsuar N, Kushner DM, Pritts EA, Olive DL. Sonohysterography: a valuable tool in evaluating the female pelvis. Obstet Gynecol Surv 2004; 58:770-84. [PMID: 14581828 DOI: 10.1097/01.ogx.0000094386.63363.d7] [Citation(s) in RCA: 295] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED A number of medical conditions, including abnormal uterine bleeding, endometrial cancer, monitoring tamoxifen therapy, infertility, and recurrent abortion, warrant investigation of the female genital tract. Diagnostic studies including hysterosalpingogram, ultrasound, and sonohysterography have proved useful in the investigation of these gynecologic conditions. This article discusses each of these tests with particular emphasis on sonohysterography and their current and potential contributions in both diagnostic and therapeutic applications. The utility of each as well as their comparative value to each other and existing gold standards is reviewed. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES After completion of this article, the reader should be able to outline the current screening methods for uterine cavity and pelvic abnormalities, to list the advantages of sonohysterography, and to describe the clinical situations where sonohysterography can be used.
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Affiliation(s)
- Steven R Lindheim
- Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin 53792, USA.
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Lindheim SR, Olive DL. Oversight, overlap, or not immediately relevant? Fertil Steril 2004; 80:1540-1; author reply 1541. [PMID: 14708137 DOI: 10.1016/j.fertnstert.2003.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Correa-Pérez JR, Fernández-Pelegrina R. Oversight, overlap, or not immediately relevant? Fertil Steril 2003; 80:1540; author reply 1541. [PMID: 14667916 DOI: 10.1016/j.fertnstert.2003.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Levi Setti PE, Albani E, Cavagna M, Bulletti C, Colombo GV, Negri L. The Impact of Embryo Transfer on Implantation—A Review. Placenta 2003; 24 Suppl B:S20-6. [PMID: 14559026 DOI: 10.1016/s0143-4004(03)00187-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Embryo transfer has received little clinical attention and has been, until recently, the most inefficient step in in-vitro fertilization (IVF). In this article, the authors review the literature and their personal experience regarding the process of intrauterine transfer of embryos, which remains the object of much discussion. Factors which appear to influence implantation rates are: contamination of the catheter tip with cervical bacteria, stimulation of uterine contractions during the procedure, the type of catheter, ultrasound guidance during the transfer, and the position of the embryos in the uterine cavity. Easy and atraumatic transfer is essential for successful implantation and the embryos need to be placed in the middle of the cavity, away from the fundus. Knowing, beforehand, the position and length of the uterus can provide better results and may reduce the rate of ectopic pregnancies. Evidence from randomized studies has supported this claim. Despite the number of available studies controlling certain variables, most authors, even using the same catheter, ultrasound guidance and/or a trial transfer use different protocols or similar instruments in different ways. Standardization of the transcervical intrauterine transfer of embryos in a large randomized study is needed before definitive conclusions can be drawn. The goal of improved implantation and pregnancy rates deserve these efforts.
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Affiliation(s)
- P E Levi Setti
- Operative Unit of Reproductive Medicine, Humanitas Clinical Institute, Via Manzoni 56, I-20156 Rozzano, Italy [corrected].
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