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Peregrin-Alvarez I, Roman R, Schenk L, McKenzie L, Woodard T, Detti L. Ultrasound Evaluation of Uterine Cavity Changes After Stimulation for In Vitro Fertilization. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 38856180 DOI: 10.1002/jum.16513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 05/27/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVES Mock embryo transfer (ET) before in vitro fertilization (IVF) allows for the clinical determination of uterine cavity length (UCL) to optimize embryo placement during clinical ET. Most studies have shown that optimal pregnancy rates occur with clinical ET at a depth of 15 mm from the uterine fundus. In our study, we sought to determine the effect of ovarian stimulation and endometrial preparation on UCL using 2D transabdominal ultrasound. METHODS We performed a retrospective cohort study comparing documented 2D transabdominal ultrasound measurements of UCL at the time of mock ET and clinical ET. Statistical analyses were performed with SPSS v. 26 with paired sample t-test and significance determined with P < .05. RESULTS Seventy patients who underwent 91 IVF-ET cycles between 2015 and 2018 at our academic center met inclusion criteria. Patient's demographics include a median age of 34 (interquartile range [IQR]: 31, 37), gravida 1 (IQR: 0, 2), parity 0 (IQR: 0, 0), and body mass index 25.87 (IQR: 21.78, 30.01). There was a statistically significant increase in UCL by 11.9 mm after IVF stimulation (P < .001), compared to mock ET. Mean UCL at the time of mock ET was 7.66 cm (±0.98 cm) and at clinical ET was 8.85 cm (±0.98 cm). CONCLUSIONS The uterine cavity undergoes a significant length change during ovarian stimulation and endometrial preparation. These findings confirm the remarkable uterine plasticity in response to hormonal stimulation even before pregnancy ensues. These changes in UCL should be considered during ultrasound-guided clinical ET to ensure optimal embryo placement.
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Affiliation(s)
- Irene Peregrin-Alvarez
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Robert Roman
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Leah Schenk
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Laurie McKenzie
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
- MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Terri Woodard
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
- MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Laura Detti
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
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He L, He J, Ma Q, Jin S, Lu Y, Zhang D, Liao X. The impact of transferred air bubble position on clinical pregnancy rate in FET cycles. REPRODUCTION AND FERTILITY 2023; 5:RAF-23-0053. [PMID: 38064285 PMCID: PMC10831539 DOI: 10.1530/raf-23-0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/08/2023] [Indexed: 02/03/2024] Open
Abstract
We aim to investigate the correlation of the position of the transferred air bubble with the clinical pregnancy rate (PR) in frozen-thawed embryo transfer(FET) cycles. A prospective clinical study was carried out at Reproductive medicine center of West China Second University Hospital between June 2020 and May 2021. 1159 women underwent FET were included in this study. Transabdominal ultrasonographic guidance was used during the transfer procedure. The distance from the air bubble to endometrial cavity fundus(DAF)was measured in the freeze-frame ultrasound immediately after ET. In group DAF ≤3mm, 3-15mm and ≥15mm, the clinical PR in women transferred with cleavage embryos were 33.3% (7/21), 55.0% (153/280), and 31.3% (5/16), respectively, the difference was statistically significant (P<0.05). Among women transferred with blastocysts, the clinical PR was 63.0% (34/54), 68.5% (485/708) and 55.0% (44/80), respectively, the difference was statistically significant (P<0.05). In multivariate logistic regression model for clinical PR, the clinical PR was associated with age, embryo quality, number of embryo transferred, and endometrial thickness. DAF was an independent risk factor influencing clinical PR in blastocysts FET cycles rather than in cleavage embryos FET cycles.In conclusion, our results suggested that DAF was associated with the clinical PR and DAF between 3mm and 15mm is the optimal position in blastocysts FET cycles.
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Affiliation(s)
- Lixia He
- Reproductive Medicine Center, West China Second University Hospital, Sichuan University, Sichuan, China
| | - Junyong He
- Health Management Center of West China Hospital of Sichuan University, Sichuan, China
| | - Qianhong Ma
- Reproductive Medicine Center, West China Second University Hospital, Sichuan University, Sichuan, China
| | - Song Jin
- Reproductive Medicine Center, West China Second University Hospital, Sichuan University, Sichuan, China
| | - Yuechao Lu
- Reproductive Medicine Center, West China Second University Hospital, Sichuan University, Sichuan, China
| | - Dongmei Zhang
- Reproductive Medicine Center, West China Second University Hospital, Sichuan University, Sichuan, China
| | - Xu Liao
- Reproductive Medicine Center, West China Second University Hospital, Sichuan University, Sichuan, China
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Mizrachi Y, McQueen DB. Embryo transfer success: It is in our hands. Fertil Steril 2022; 118:815-819. [PMID: 36192230 DOI: 10.1016/j.fertnstert.2022.08.858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 01/13/2023]
Abstract
Embryo transfer (ET) is considered as a critical step in the process of in vitro fertilization. Interestingly, studies have consistently shown significant outcome differences between physicians. Although the outcome of ET is not related to the physician's experience and specifically not different between fellows and attending physicians, certain techniques have been found to affect the success rate. This review summarizes the existing evidence regarding the impact of the individual physician performing ET and the techniques used.
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Affiliation(s)
- Yossi Mizrachi
- Reproductive Services Unit, The Royal Women's Hospital, and University of Melbourne, Victoria, Australia
| | - Dana B McQueen
- Reproductive Medicine Associates, San Francisco, California.
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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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Cozzolino M, Troiano G, Esencan E. Bed rest after an embryo transfer: a systematic review and meta-analysis. Arch Gynecol Obstet 2019; 300:1121-1130. [DOI: 10.1007/s00404-019-05296-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/05/2019] [Indexed: 11/29/2022]
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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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Performing the embryo transfer: a guideline. Fertil Steril 2017; 107:882-896. [DOI: 10.1016/j.fertnstert.2017.01.025] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 01/27/2017] [Indexed: 11/17/2022]
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Improving the safety of the embryo and the patient during in vitro fertilization procedures. Wideochir Inne Tech Maloinwazyjne 2016; 11:137-143. [PMID: 27829935 PMCID: PMC5095273 DOI: 10.5114/wiitm.2016.61940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 08/08/2016] [Indexed: 11/17/2022] Open
Abstract
In vitro fertilization (IVF) is a method of treatment for infertility in selected indications. Recent years have brought dynamic development of technologies related to IVF. This article presents problems pertaining to the safety of technology with respect to the patient, as well as the embryo, based on an analysis of scientific reports and our own experience. Invasiveness of the IVF procedure for the woman and the embryo varies on an individual basis. Minimization of the invasiveness of IVF requires experience of the staff performing the procedure, especially with respect to the assessment of risk for an individual patient. Technologies related to IVF are constantly being improved, and the effectiveness of the selected individual treatment methods is not always scientifically confirmed.
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