A randomized controlled clinical trial of 2295 ultrasound-guided embryo transfers

Abstract

We set out to determine whether ultrasound-guided embryo transfer improved clinical pregnancy rates and live birth rates in assisted conception. We used an appropriately powered RCT design. We did not demonstrate a difference. This outcome is at odds with the UKs National Institute of Clinical Excellence recommendations for fertility treatment (Fertility Assessment and Treatment for People with Fertility Problems. London, UK: RCOG Press, 2004, 112.) which used a meta-analysis of four smaller trials (range 362-800 patients, totalling 2051 embryo transfers) to conclude that ultrasound should be offered. We suggest that the current Cochrane review should be updated with data from our trial and recommend that consideration is given to accounting for heterogeneity between the included trials.

Effects of embryo transfer quality on pregnancy and live birth delivery rates

“…These difficult ETs were reported to be negatively associated with the CPR [13]. Notably, Drakeley et al were able to show in 2,295 ultrasound-guided ETs that grasping the portio vaginalis (1.7%) negatively affects the CPR (8% vs. 24%, 22%, and 20%, respectively, in the other three groups) [14]. These findings are in line with our results as regards the percentage of difficult ETs and the decrease in the CPR.…”

Among women undergoing embryo transfer, is the probability of pregnancy and live birth improved with ultrasound guidance over clinical touch alone? A systemic review and meta-analysis of prospective randomized trials

“…Of these, three studies (19 -21) were excluded initially for duplicate publication (i.e., published as abstract in a conference proceeding and as full text in a peer-reviewed journal). In addition, two trials (10,12) were excluded because no data were available for review. Finally, the methodologic quality of the remaining 20 trials was assessed and data extracted to allow for an intention-to-treat analysis ( Table 1).…”

Ultrasound guidance during embryo transfer: a systematic review and meta‐analysis of randomized controlled trials

“…However one study (from one record) comparing US guidance with clinical touch was not subsequently included in the quantitative meta‐analysis because there were insufficient data available. Included were: 12 studies (from 14 records) comparing US guidance with clinical touch using the same type of catheter; four studies (from seven records) comparing US guidance with clinical touch using different types of catheter; one study (from one record) comparing US guidance with clinical touch that had participants in the non‐US group using either the same or different types of catheter and that was therefore included in both subgroups; one study (from three records) comparing transvaginal US with transabdominal US using similar catheter type; two studies (from four records) comparing transvaginal US with transabdominal US using different catheter types; and one study (from one record) comparing hysterosonometry before ET with transabdominal US during ET using the same catheter.…”