Transfer of embryos into the uterus: How much do technical factors affect pregnancy rates?

Purpose The purpose of this study was to evaluate the best protocol to prepare endometrium for frozen embryo replacement (FER) cycles. Methods This study is a systematic review and meta-analysis. Following PubMed and OvidSP search, a total of 1166 studies published after 1990 were identified following removal of duplicates. Following exclusion of studies not matching our inclusion criteria, a total of 33 studies were analyzed. Primary outcome measure was live birth. The following protocols, including true natural cycle (tNC), modified natural cycle (mNC), artificial cycle (AC) with or without suppression, and mild ovarian stimulation (OS) with gonadotropin (Gn) or aromatase inhibitor (AI), were compared. Results No statistically significant difference for both clinical pregnancy and live birth was noted between tNC and mNC groups. When tNC and AC without suppression groups are compared, there was a statistically significant difference in clinical pregnancy rate in favor of tNC, whereas it failed to reach statistical significance for live birth. When tNC and AC with suppression groups are compared, there was a statistically significant difference in live birth rate favoring the latter. Similar pregnancy outcome was noted among mNC versus AC with or without suppression groups. Similarly, no difference in clinical pregnancy and live birth was noted when ACs with or without suppression groups are compared. Conclusions There is no consistent superiority of any endometrial preparation for FER. However, mNC has several advantages (being patient-friendly; yielding at least equivalent or better pregnancy rates when compared with tNC and AC with or without suppression; may not require LPS). Mild OS with Gn or AI may be promising.

show abstract

“…In three studies, LPS was not employed in the tNC arm [44,46,47]. In only one study, LPS was administered in the tNC arm [48].…”

Section: Tnc Versus Ac With Suppressionmentioning

confidence: 99%

“…A total of six studies, one RCT [44] and one quasi-randomized [45] and four retrospective cohort studies [46][47][48][49], making a total of 2933 ET cycles, were included.…”

Section: Tnc Versus Ac With Suppressionmentioning

confidence: 99%

Preparation of endometrium for frozen embryo replacement cycles: a systematic review and meta-analysis

Yaralı́

Polat

Mümüşoğlu

et al. 2016

J Assist Reprod Genet

108

View full text Add to dashboard Cite

show abstract

“…Moreover, retention of transfer catheter in-situ up to 60 s was recommended in this study. Al-Shawaf et al [7] studied the effects of ultrasound assistance, use of different transfer catheters, and patient position on fertility outcomes and reported that, similar to the former, delayed removal of the catheter was associated with improved outcomes. Conversely, Zech et al [8] stressed that immediate removal of the transfer catheter was associated with better reproductive outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Even though immediate removal of the transfer catheter from the uterine cavity may theoretically initiate uterine contractility and, hereby, engender the expulsion of embryos transferred, it has not been clearly demonstrated whether delayed catheter removal contributes to improved fertility outcomes in ART cycles. The results of the studies investigating the timing of transfer catheter removal have remained conflicting [6][7][8][9][10] .…”

mentioning

confidence: 99%

The Timing of Embryo Transfer Catheter Removal: Should It be Delayed or Done Immediately? A Prospective Randomized Trial

Devranoğlu

Özdamar

Çakıroğlu

et al. 2017

Gynecol Obstet Invest

View full text Add to dashboard Cite

Background/Aims: Data on the timing of catheter removal technique following embryo transfer (ET) are quite limited. We aimed to compare the reproductive outcomes of intracytoplasmic sperm injection (ICSI)/ET cycles in which the transfer catheter was removed immediately with those in which the catheter was removed after a delay period and hereby to evaluate the impact that the time interval before removal of the catheter following embryo deposit may have on the fertility outcomes. Methods: A prospective randomized study was designed. ICSI/ET patients <40 years were randomly assigned to either of the group from which catheter was withdrawn immediately within the first 5 s (Group A) or after a 30 s delay (Group B) following ET. Results: Groups A and B consisted of 147 and 148 patients, respectively. Patient demographics and stimulation characteristics were comparable between the groups. Pregnancy rate was 32.2% (95 of 295) and clinical pregnancy rate was 28.8% (85 of 295), whereas ongoing pregnancy was 24.4% (72 of 295) and implantation rate was 29.6% (100 of 338). The comparison of reproductive outcomes revealed no significant differences in pregnancy (p = 0.933), clinical pregnancy (p = 0.673), ongoing pregnancy (p = 0.590), multiple pregnancy (p = 0.801), and implantation rates (p = 0.979) between the groups. Conclusion: No significant difference was observed in the reproductive outcomes between the groups; thus, there appears no requirement to delay the withdrawal of the catheter to improve the outcomes in ICSI cycles.

show abstract

“…Thirty percent of failed implantations can be attributed to poor techniques of embryo transfer. Embryo transfer, therefore, is a vital step in IVF (1)(2)(3). Recently, ultrasound-guided embryo transfer has been reported to improve the clinical pregnancy rate after IVF.…”

Section: Introductionmentioning

confidence: 99%

Abdominal Ultrasound-Guided Embryo Transfer Improves Clinical Pregnancy Rates After In Vitro Fertilization: Experiences from 330 Clinical Investigations

Lü

Hao

et al. 2005

J Assist Reprod Genet

View full text Add to dashboard Cite

Purpose : To investigate the effect of ultrasound-guided embryo transfer on the rate of implantation and clinical pregnancy. Methods : A prospective randomized trial was performed to compare ultrasound-guided embryo transfer with the traditional method. A total of 330 patients were randomly divided into two groups on the day of embryo transfer. For the cases (n = 178), ultrasound-guided was used; controls (n = 152) was performed using routine methods. Results : The rate of implantation and clinical pregnancy for the cases (19.6 and 37.1%, respectively) was significantly higher than for the controls (12.6 and 25%, respectively; p < 0.05). Conclusion : Ultrasound-guided embryo transfer can significantly increase the rate of implantation and clinical pregnancy, and should be recommended as a routine procedure in the process of in vitro fertilization and embryo transfer (IVF-ET).

show abstract

Transfer of embryos into the uterus: How much do technical factors affect pregnancy rates?

Abstract: The parameter studies did not affect the outcome of IVF/ET or FER. Some factors encouraged us to recommend ultrasound-assisted transfer in some cases, and the use of a Frydman catheter for transfer and to encourage the supine position after transfer for longer periods.

Cited by 109 publications

References 7 publications

Preparation of endometrium for frozen embryo replacement cycles: a systematic review and meta-analysis

Preparation of endometrium for frozen embryo replacement cycles: a systematic review and meta-analysis

The Timing of Embryo Transfer Catheter Removal: Should It be Delayed or Done Immediately? A Prospective Randomized Trial

Abdominal Ultrasound-Guided Embryo Transfer Improves Clinical Pregnancy Rates After In Vitro Fertilization: Experiences from 330 Clinical Investigations

Contact Info

Product

Resources

About