Abstract
Purpose: To determine the impact of transabdominal ultrasound guidance on embryo transfer during IVF therapy.
Methods: Retrospective analysis of 823 consecutive embryo transfers. Three hundred and sixty-seven procedures performed with transabdominal ultrasound guidance were compared to 456 cases performed with the “clinical touch” method.
Results: Ultrasound-guided embryo transfer yielded higher, but not statistically significant, clinical pregnancy (48% vs. 44%) and implantation rates (22% vs. 20%). The incidence of multiple pregnancies, ectopic and multiple pregnancy rates were similar. The frequency of negative factors typically associated with difficult transfers, such as requirement of use of tenaculum, and presence of blood or mucus in the catheter tip, were significantly lower in the ultrasound-guided group in comparison with the clinical touch group. Ultrasound-guided embryo transfer was associated with a significantly increased easiness of transfer performance; 95% of the transfers were rated as very easy in the ultrasound-guidance group compared to 87% in the clinical touch group. The use of a soft pass catheter was the only variable independently and significantly associated with pregnancy success (odds ratio = 2.74).
Conclusion(s): Ultrasound-guidance facilitates embryo transfer and in combination with the use of a soft catheter should be implemented to optimize embryo transfer results.
Keywords: Catheter, embryo transfer, IVF, pregnancy rate, ultrasound guidance
Full Text
The Full Text of this article is available as a PDF (61.7 KB).
References
- 1.Mansour RT, Aboulghar MA. Optimizing the embryo transfer technique. Hum Reprod. 2002;17:1149–1153. doi: 10.1093/humrep/17.5.1149. [DOI] [PubMed] [Google Scholar]
- 2.Cohen J. How to avoid multiple pregnancies in assisted reproduction. Hum Reprod. 1998;13:197–214. doi: 10.1093/humrep/13.suppl_3.197. [DOI] [PubMed] [Google Scholar]
- 3.Karande VC, Morris R, Chapman C, Rinehart J, Gleicher N. Impact of the “physician factor” on pregnancy rates in a large assisted reproductive technology program: Do too many cooks spoil the broth? Fertil Steril. 1999;71:1001–1009. doi: 10.1016/s0015-0282(99)00139-9. [DOI] [PubMed] [Google Scholar]
- 4.Hearns-Stokes RM, Miller BT, Scott L, Creuss D, Chakraborty PK, Segars JH. Pregnancy rates after embryo transfer depend on the provider at embryo transfer. Fertil Steril. 2000;74:80–86. doi: 10.1016/s0015-0282(00)00582-3. [DOI] [PubMed] [Google Scholar]
- 5.Strickler RC, Christianson C, Crane JP, Curato A, Knight AB, Yang V. Ultrasound guidance for human embryo transfer. Fertil Steril. 1985;43:54–61. doi: 10.1016/s0015-0282(16)48317-2. [DOI] [PubMed] [Google Scholar]
- 6.Leong M, Leung C, Tucker M, Wong C, Chan H. Ultrasound-assisted embryo transfer. J In Vitro Fert Embryo Transf. 1986;3:383–385. doi: 10.1007/BF01133254. [DOI] [PubMed] [Google Scholar]
- 7.Lindheim SR, Cohen MA, Sauer MV. Ultrasound guided embryo transfer significantly improves pregnancy rates in women undergoing oocyte donation. Int J Gynaecol Obstet. 1999;66:281–284. doi: 10.1016/s0020-7292(99)00077-6. [DOI] [PubMed] [Google Scholar]
- 8.Wood EG, Batzer FR, Go KJ, Gutmann JN, Corson SL. Ultrasound-guided soft catheter embryo transfers will improve pregnancy rates in in-vitro fertilization. Hum Reprod. 2000;15:107–112. doi: 10.1093/humrep/15.1.107. [DOI] [PubMed] [Google Scholar]
- 9.Prapas Y, Prapas N, Hatziparasidou A, Vanderzwalmen P, Nijs M, Prapa S, Vlassis G. Ultrasound-guided embryo transfer maximizes the IVF results on day 3 and day 4 embryo transfer but has no impact on day 5. Hum Reprod. 2001;16:1904–1908. doi: 10.1093/humrep/16.9.1904. [DOI] [PubMed] [Google Scholar]
- 10.Coroleu B, Carreras O, Veiga A, et al. Embryo transfer under ultrasound guidance improves pregnancy rates after in-vitro fertilization. Hum Reprod. 2000;15:616–620. doi: 10.1093/humrep/15.3.616. [DOI] [PubMed] [Google Scholar]
- 11.Hurley VA, Osborn JC, Leoni MA, Leeton J. Ultrasound-guided embryo transfer: A controlled trial. Fertil Steril. 1991;55:559–562. doi: 10.1016/s0015-0282(16)54185-5. [DOI] [PubMed] [Google Scholar]
- 12.al Shawaf T, Yang D, al Magid Y, Seaton A, Iketubosin F, Craft I. Ultrasonic monitoring during replacement of frozen/thawed embryos in natural and hormone replacement cycles. Hum Reprod. 1993;8:2068–2074. doi: 10.1093/oxfordjournals.humrep.a137983. [DOI] [PubMed] [Google Scholar]
- 13.Kan AK, Abdalla HI, Gafar AH, et al. Embryo transfer: Ultrasound-guided versus clinical touch. Hum Reprod. 1999;14:1259–1261. doi: 10.1093/humrep/14.5.1259. [DOI] [PubMed] [Google Scholar]
- 14.Tang OS, Ng EH, So WW, Ho PC. Ultrasound-guided embryo transfer: A prospective randomized controlled trial. Hum Reprod. 2001;16:2310–2315. doi: 10.1093/humrep/16.11.2310. [DOI] [PubMed] [Google Scholar]
- 15.Anderson RE, Nugent NL, Gregg AT, Nunn SL, Behr BR. Transvaginal ultrasound-guided embryo transfer improves outcome in patients with previous failed in vitro fertilization cycles. Fertil Steril. 2002;77:769–775. doi: 10.1016/s0015-0282(01)03279-4. [DOI] [PubMed] [Google Scholar]
- 16.Oehninger S, Veeck L, Lanzendorf S, Maloney M, Toner J, Muasher S. Intracytoplasmic sperm injection: Achievement of high pregnancy rates in couples with severe male factor infertility is dependent primarily upon female and not male factors. Fertil Steril. 1995;64:977–981. doi: 10.1016/s0015-0282(16)57913-8. [DOI] [PubMed] [Google Scholar]
- 17.Veeck LL. An Atlas of Human Gametes and Conceptuses. New York: Parthenon; 1998. pp. 40–45. [Google Scholar]
- 18.Lesny P, Killick SR, Tetlow RL, Robinson J, Maguiness SD. Embryo transfer—Can we learn anything new from the observation of junctional zone contractions? Hum Reprod. 1998;13:1540–1546. doi: 10.1093/humrep/13.6.1540. [DOI] [PubMed] [Google Scholar]
- 19.Schulz KF, Grimes DA. Case-control studies: Research in reverse. Lancet. 2002;359:431–434. doi: 10.1016/S0140-6736(02)07605-5. [DOI] [PubMed] [Google Scholar]
- 20.Schoolcraft WB, Surrey ES, Gardner DK. Embryo transfer: Techniques and variables affecting success. Fertil Steril. 2001;76:863–870. doi: 10.1016/s0015-0282(01)02731-5. [DOI] [PubMed] [Google Scholar]
- 21.Lewin A, Schenker JG, Avrech O, Shapira S, Safran A, Friedler S. The role of uterine straightening by passive bladder distension before embryo transfer in IVF cycles. J Assist Reprod Genet. 1997;14:32–34. doi: 10.1007/BF02765749. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Lesny P, Killick SR, Robinson J, Raven G, Maguiness SD. Junctional zone contractions and embryo transfer: Is it safe to use a tenaculum? Hum Reprod. 1999;14:2367–2370. doi: 10.1093/humrep/14.9.2367. [DOI] [PubMed] [Google Scholar]
- 23.Dorn C, Reinsberg J, Schlebusch H, Prietl G, van der Ven H, Krebs D. Serum oxytocin concentration during embryo transfer procedure. Eur J Obstet Gynecol Reprod Biol. 1999;87:77–80. doi: 10.1016/s0301-2115(99)00077-9. [DOI] [PubMed] [Google Scholar]
- 24.Kovacs GT. What factors are important for successful embryo transfer after in-vitro fertilization? Hum Reprod. 1999;14:590–592. doi: 10.1093/humrep/14.3.590. [DOI] [PubMed] [Google Scholar]
- 25.Matorras R, Urquijo E, Mendoza R, Corcostegui B, Exposito A, Rodriguez-Escudero FJ. Ultrasound-guided embryo transfer improves pregnancy rates and increases the frequency of easy transfers. Hum Reprod. 2002;17:1762–1766. doi: 10.1093/humrep/17.7.1762. [DOI] [PubMed] [Google Scholar]
- 26.Ghazzawi IM, Al H. S., Karaki R, Souso S. Transfer technique and catheter choice influence the incidence of transcervical embryo expulsion and the outcome of IVF. Hum Reprod. 1999;14:677–682. doi: 10.1093/humrep/14.3.677. [DOI] [PubMed] [Google Scholar]