Fertility and Sterility
Volume 94, Issue 3 , Pages 785-790 , August 2010

Optimizing the technique of embryo transfer

  • Lindsay Mains, M.D.
    • ,
  • Bradley J. Van Voorhis, M.D.

      Affiliations

    • Corresponding Author InformationReprint requests: Van Voorhis, M.D., Division of Reproductive Endocrinology and Infertility, University of Iowa Hospitals and Clinics, 200 Hawkins Drive PFP-31335, Iowa City, IA 52242 (FAX: 319-384-9367).

Received 9 March 2010 ,Accepted 9 March 2010.

References 

  1. Englert Y, Puissant F, Camus M, Van Hoeck J, Leroy F. Clinical study on embryo transfer after human in vitro fertilization. J In Vitro Fert Embryo Transf. 1986;3:243
  2. Mansour R, Aboulghar M, Serour G. Dummy embryo transfer: a technique that minimizes the problems of embryo transfer and improves the pregnancy rate in human in vitro fertilization. Fertil Steril. 1990;54:678–681
  3. 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
  4. Visser DS, Fourie FL, Kruger HF. Multiple attempts at embryo transfer: effects on pregnancy outcome in an in vitro fertilization and embryo transfer program. J Assist Reprod Genetics. 1993;10:37–43
  5. Tomas C, Tikkinen K, Tuomivaaara L, Tapanqinen JS, Martikainen H. The degree of difficulty of embryo transfer is an independent factor for predicting pregnancy. Hum Reprod. 2002;17:2632
  6. 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
  7. Fanchin R, Righini C, Olivennes F, Taylor S, de Ziegler D, Frydman R. Uterine contractions at the time of embryo transfer alter pregnancy rates after in vitro fertilization. Hum Reprod. 1998;13:1968–1974
  8. 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
  9. Goudas VT, Hammitt DG, Damario MA, Session DR, Singh AP, Dumesic DA. Blood on the embryo transfer catheter is assocaited with decreased rates of embryo implantation and clinical pregnancy with the use of in vitro fertilization-embryo transfer. Fertil Steril. 1998;70:878–882
  10. Lass A, Abusheikha N, Brinsden P, Kovacs GT. The effect of a difficult embryo transfer on the outcome of IVF. Hum Reprod. 1999;14:2417
  11. Garzo VG. Embryo transfer technique. Clin Obstet Gynecol. 2006;49:117–122
  12. Prapas N, Prapas Y, Panagiotidis Y, Prapa S, Vanderzwalmen P, Makedos G. Cervical dilatation has a positive impact on the outcome of IVF in randomly assigned cases having two previous difficult embryo transfers. Hum Reprod. 2004;19:1791–1795
  13. Abusheikha N, Lass A, Akagbosu F, Brinsden P. How useful is cervical dilatation in patients with cervical stenosis who are participating in an in vitro fertilization embryo transfer program? The Bourn Hall experience. Fertil Steril. 1999;72:610–612
  14. Groutz A, Yovel I, Lessing J, Azem F, Wolf Y, Amit A. Cervical dilatation during ovum pick-up in patients with cervical stenosis: effect on pregnancy outcome in an in vitro fertilization-embryo transfer program. Fertil Steril. 1997;67:909–911
  15. Glatstein IZ, Pang SC, McShane PM. Successful pregnancies with the use of laminaria tents before embryo transfer for refractory cervical stenosis. Fertil Steril. 1997;67:1172–1174
  16. Serhal P, Ranieri D, Khadum I, Wakim R. Cervical dilatation with hygroscopic rods prior to ovarian stimulation facilitates embryo transfer. Hum Reprod. 2003;18:2618–2620
  17. Yanushpolsky E, Ginsburg S, Fox J, Stewart E. Transcervical placement of a Malecot catheter after hysteroscopic evaluation provides for easier entry into the endometrial cavity for women with histories of difficult intrauterine inseminations and/or embryo transfers: a prospective case series. Fertil Steril. 2000;73:402–405
  18. Aust T, Herod J, Gazvani R. Placement of a Malecot catheter to enable embryo transfer after radical trachelectomy. Fertil Steril. 2005;83:1842
  19. Pabuccu R, Ceyhan S, Onalan G, Goktolga U, Ercan C, Selam B. Successful treatment of cervical stenosis with hysteroscopic canalization before embryo transfer in patients undergoing IVF: a case series. J Min Inv Gyn. 2005;12:436–438
  20. Neithardt AB, Segars JH, Hennessy S, James AN, McKeeby JL. Embryo afterloading: a refinement in embryo transfer technique that may increase clinical pregnancy. Fertil Steril. 2005;83:710–714
  21. Henne MB, Milki AA. Uterine position at real embryo transfer compared with mock embryo transfer. Hum Reprod. 2004;19:570
  22. Katariya KO, Bates GW, Robinson RD, Arthur NJ, Propst AM. Does the timing of mock embryo transfer affect in vitro fertilization implantation and pregnancy rates?. Fertil Steril. 2007;88:1462–1464
  23. Sundrstrom P, Wramsby H, Person PH, Liedhom P. Filled bladder simplifies human embryo transfer. Br J Obstet Gynecol. 1984;91:506–507
  24. 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
  25. Oorusso F, Depalo R, Bettocchi S, Vacca M, Vimercati A, Selvaggi L. Outcome of in vitro fertilization after transabdominal ultrasound-assisted embryo transfer with a full or empty bladder. Fertil Steril. 2005;84:1046–1048
  26. Martins A, Baruffi R, Mauri A, Petersen C, Oliveira J, Contart P, et al. Ultrasound guidance is not necessary during easy embryo transfers. J Assist Rprod Genet. 2004;21:421–425
  27. Garcia Velasco J, Isaza V, Martinez-Salazar J, Landazabal A, Requena A, Remohi J, et al. Transabdominal ultrasound guided embryo transfer does not increase pregnancy rates in ooctye recipients. Fertil Steril. 2002;78:534–539
  28. Woolcott R, Stanger J. Potentially important variables identified by transvaginal ultrasound-guided embryo transfer. Hum Reprod. 1997;12:963–966
  29. Strickler RC, Christianson C, Crane JP, Curato A, Knight AB, Yang V. Ultrasound guidance for human embryo transfer. Fertil Steril. 1985;43:54–61
  30. Brown JA, Buckingham K, About-Setta A, Buckett W. Ultrasound versus “clinical touch” for catheter guidance during embryo transfer in women [review]. The Cochrane Database Syst Rev. 2010;Jan 20(1):CD006107.
  31. Buckett WM. A meta-analysis of ultrasound-guided versus clinical touch embryo transfer. Fertil Steril. 2003;80:1037–1041
  32. Abou-Setta AM, Mansour RT, Al-Inany HG, Aboulghar MM, Aboulghar MA, Serour GI. 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. Fertil Steril. 2007;88:333–341
  33. Tang OS, Ng EH, So WW, Ho PC. Ultrasound-guided embryo transfer: a prospective randomized controlled trial. Hum Reprod. 2001;16:2310–2315
  34. Sallam HN, Sadek S. Ultrasound-guided embryo transfer: a meta-analysis of randomized controlled trials. Fertil Steril. 2003;80:1042–1046
  35. Kosmas IP, Janssens R, De Munch L, Al Turki A, Van Der Elst J, Tournaye H, et al. Ultrasound-guided embryo transfer does not offer any benefit in clinical outcome: a randomized controlled trial. Hum Reprod. 2007;22:1327–1334
  36. Matorras R, Urguijo 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
  37. Gergely R, DeUgarte CM, Danzer H, Surrey M, Hill D, DeCherney AH. Three dimensional/four dimensional ultrasound-guided embryo transfer using the maximal implantation potential point. Fertil Steril. 2005;84:500–503
  38. Baba K, Ishihara O, Hayashi N, Saitoh M, Taya J, Kinoshita K. Three-dimensional ultrasound in embryo transfer. Ultrasound Obstet Gynecol. 2000;16:372–373
  39. 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
  40. Fanchin R, Righini C, de Ziegler D, Olivennes F, Ledee N, Frydman R. Effects of vaginal progesterone administration on uterine contractility at the time of embryo transfer. Fertil Steril. 2001;75:1136–1140
  41. Egbase PE, Al-Sharhan M, Grudzinskas JG. Influence of position and length of uterus on implantation and clinical pregnancy rates in IVF and embryo transfer treatment cycles. Hum Reprod. 2000;15:1943–1946
  42. Sowerby E, Parsons J. Prevention of iatrogenic pelvic infection during in vitro fertilization—current practice in the UK. Hum Fertil. 2004;7:135–140
  43. Egbase PE, al-Sharhan M, al-Othman S, al-Mutawa M, Udo EE, Grudzinskas J. Incidence of microbial growth from the tip of the embryo transfer catheter after embryo transfer in relation to clinical pregnancy rate following in-vitro fertilization and embryo transfer. Hum Reprod. 1996;11:1687–1689
  44. Moore DE, Soules MR, Klein NA, Fujimoto VY, Agnew KJ, Eschenbach DA. Bacteria in the transfer catheter tip influence the live-birth rate after in vitro fertilization. Fertil Steril. 2000;74:1118–1124
  45. Brook N, Khalaf Y, Coomarasamy A, Edgeworth J, Braude P. A randomized controlled trial of prophylactic antibiotics (co-amoxiclav) prior to embryo transfer. Hum Reprod. 2006;21:2911–2915
  46. Egbase PE, Edo E, Al-Sharhan M, Grudzinskas P. Prophylactic antibiotics and endocervical microbial inoculation of the endometrium at embryo transfer. Lancet. 1999;354:651–652
  47. Michael E, Ahmady A. The use of a cytobrush in cervical canal preparation for embryo transfer procedures. Fertil Steril. 2005;84:S357
  48. Eskandar MA, Abou-setta AM, El-Amin M, Almushait MA, Sobande AA. Removal of cervical mucus prior to embryo transfer improves pregnancy rates in women undergoing assisted reproduction. Reprod Biomed Online. 2007;14:308–313
  49. Visschers BA, Bots RS, Peeters MF, Mol BW, van Dessel JH. Removal of cervical mucus: effect on pregnancy rates in IVF/ICSI. Reprod Biomed Online. 2007;15:310–315
  50. McNamee P, Huang T, Carwile A. Significant increase in pregnancy rates achieved by vigorous irrigation of endocervical mucus prior to embryo transfer with a Wallace catheter in an IVF-ET program. Fertil Steril. 1998;70:S228
  51. Glass KB, Green CA, Fluker MR, Schoolcraft WB, McNamee PI, Meldrum DR. Multicenter randomized trial of cervical irrigation at the time of embryo transfer. Fertil Steril. 2000;74:S31
  52. McDonald JA, Norman RJ. A randomized controlled trial of a soft double lumen embryo transfer catheter versus a firm single lumen catheter: significant improvements in pregnancy rates. Hum Reprod. 2002;17:1502–1506
  53. Sallam HN, Agameya AF, Rahman AF, Ezzeldin F, Sallam AN. Impact of technical difficulties, choice of catheter, and the presence of blood on the success of embryo transfer: experience from a single provider. J Assist Reprod Genet. 2003;20:135–142
  54. Abou-Setta AM, Al-Inany HG, Mansour RT, Serour GI, Aboulghar MA. Soft versus firm embryo transfer catheters for assisted reproduction: a systematic review and meta-analysis. Hum Reprod. 2005;20:3114–3121
  55. Buckett W. A review and meta-analysis of prospective trials comparing different catheters used for embryo transfer. Fertil Steril. 2006;85:728–734
  56. Lavie O, Margalioth EJ, Geva-Eldar T, Ben-Chetrit A. Ultrasonographic endometrial changes after intrauterine insemination: a comparison of two catheters. Fertil Steril. 1997;68:731–734
  57. Marconi G, Vilela M, Bello J, Diradourian M, Quintana R, Sueldo C. Endometrial lesions caused by catheters used for embryo transfers: a preliminary report. Fertil Steril. 2003;80:363–367
  58. Al-Shawaf T, Dave R, Harper J, Linehan D, Riley P, Craft I. Transfer of embryos into the uterus: how much do technical factors affect pregnancy rates?. J Assist Reprod Genet. 1993;10:31–36
  59. Ghazzawi IM, Al-Hasani 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
  60. Urman B, Aksoy S, Alatas C, Mercan R, Nuhoglu A, Isiklar A, et al. Comparing two embryo transfer catheters. Use of a trial transfer to determine the catheter applied. J Reprod Med. 2000;45:135–138
  61. Burke LM, Davenport AT, Russell GB, Deaton JL. Predictors of success after embryo transfer: experience from a single provider. Am J Obstet Gynecol. 2000;182:1001–1004
  62. Saldeen P, Abou-Etta A, Bergh T, Sundstrom P, Holte J. A prospective randomized controlled trial comparing two embryo transfer catheters in an ART program. Fertil Steril. 2008;90:599–603
  63. Silberstein T, Weitzen S, Franfurter D, Trimarchi FR, Keefe DL, Plosker SM. Cannulation of a resistant internal os with the malleable outer sheath of a coaxial soft embryo transfer catheter does not affect in vitro fertilization-embryo transfer outcome. Fertil Steril. 2004;82:1402–1406
  64. Poindexter AN, Thompson DJ, Gibbons WE, Findley WE, Dodson MG, Young RL. Residual embryos in failed embryo transfer. Fertil Steril. 1986;46:262–267
  65. Ebner T, Yaman C, Moser M, Sommergruber M, Polz W, Tews G. The ineffective loading process of the embryo transfer catheter alters implantation and pregnancy rates. Fertil Steril. 2001;76:630–632
  66. Moreno V, Balasch J, Vidal E, Calafell JM, Civico S, Vanrell JA. Air in the transfer catheter does no affect the success of embryo transfer. Fertil Steril. 2004;81:1366–1370
  67. Khan I, Staessen C, Devroey P, Van Steirteghem AC. Human serum albumin versus serum: a comparative study on embryo transfer medium. Fertil Steril. 1991;56:98–101
  68. Menezo Y, Arnal F, Humeau C, Ducret L, Nicollet B. Increased viscosity in transfer medium does not improve the pregnancy rates after embryo transfer. Fertil Steril. 1989;52:680–682
  69. Feichtinger W, Strohmer H, Radner KH, Goldin M. The use of fibrin sealant for ET: development and clinical studies. Hum Reprod. 1992;7:890–893
  70. Ben-Rafael Z, Ashkenazi J, Shelef M, Farhi J, Voliovitch I, Feldberg D, et al. The use of fibrin sealant in in vitro fertilization and embryo transfer. Int J Fertil Menopausal Stud. 1995;40:303–306
  71. Urman B, Yakin K, Ata B, Isiklar A, Balaban B. Effect of hyaluronan-enriched transfer medium on implantation and pregnancy rates after day 3 and day 5 transfers: a prospective randomized study. Fertil Steril. 2008;90:604–612
  72. Karimian L, Rezazadeh VM, Baghestani AR, Moeini A. A prospective randomized comparison of two commercial embryo transfer medium in IVF/ICSI cycles. Hum Reprod. 2004;19(Suppl 1):i52
  73. Friedler S, Schacter M, Strassburger D, Esther K, Ron El R, Raziel A. A randomized clinical trial comparing recombinant hyaluronan/recombinant albumin versus human tubal fluid for cleavage stage embryo transfer in patients with multiple IVF-embryo transfer failure. Hum Reprod. 2007;22:2444–2448
  74. Jones HW. In vitro fertilization. In:  Behrman SJ,  Kistner RW,  Patton GW editor. Progress in infertility. 3rd ed. Boston: Little, Brown; 1998;p. 543–561
  75. Coroleu B, Barri PN, Carreras O, Martinez F, Parriego M, Mereter L, et al. The influence of the depth of the embryo replacement into the uterine cavity on implantation rates after IVF: a controlled, ultrasound-guided study. Hum Reprod. 2002;17:341–346
  76. Pope CD, Cook EK, Arny M, Novak A, Grow DR. Influence of embryo transfer depth on in vitro-fertilization and embryo transfer outcomes. Fertil Steril. 2004;81:51–58
  77. Yovich JL, Turner SR, Murphy AJ. Embryo transfer technique as a cause of extopic pregnancies in in vitro fertilization. Fertil Steril. 1985;44:318–321
  78. Nazari A, Askari HA, Check JH, O'Shaughnessy A. Embryo transfer technique as a cause of ectopic pregnancy in in vitro fertilization. Fertil Steril. 1993;60:919–921
  79. Frankfurter D, Trimarchi JB, Silva CP, Keefe DL. Middle to lower uterine segment embryo transfer improves implantation and pregnancy rates compared with fundal embryo transfer. Fertil Steril. 2004;81:1273–1277
  80. Franco JG, Bai G, Prosinecki V, Abrunhosa F, Ferreira GC, Bastos M. Best site for ET: the upper or lower half of endometrial cavity?. Hum Reprod. 2004;19:1785–1790
  81. Frankfurter D, Silva C, Mota F, Trimarchi JB, Keefe DC. The transfer point is a novel measure of embryo placement. Fertil Steril. 2003;79:1416–1421
  82. Waterstone J, Curson R, Parsons J. Embryo transfer to low uterine cavity. Lancet. 1991;337:1413
  83. Martinez F, Coroleu B, Parriego M, Carreras O, Belil I, Parera N, et al. Ultrasound-guided embryo transfer: immediate withdrawal of the catheter versus a 30 second wait. Hum Reprod. 2001;16:871–874
  84. Matorras R, Mendosa R, Exposito A, Rodriguez-Escudero FJ. Influence of the time interval between embryo catheter loading and discharging on the success of IVF. Hum Reprod. 2004;19:2027–2030
  85. Ciray HN, Tosum S, Hacifazlioglu O, Mesut A, Bahceci M. Prolonged duration of transfer does not affect outcome in cycles with good embryo quality. Fertil Steril. 2007;87:1218–1221
  86. Nabi A, Awonuga A, Birch H, Barlow S, Stewart B. Multiple attempts at embryo transfer: does this affect in-vitro fertilization treatment outcome?. Hum Reprod. 1997;12:1188–1190
  87. Sharif K, Afnan M, Lashen H, Elgendy M, Morgan C, Sinclair L. Is bed rest following ET necessary?. Fertil Steril. 1998;69:478–481
  88. Botta G, Grudzinskas G. Is a prolonged bed rest following embryo transfer useful?. Hum Reprod. 1997;12:2489–2492
  89. Amarin ZO, Obeidat BR. Bed rest versus free mobilization following ET: a prospective randomized study. BJOG In J Obstet Gynecol. 2004;111:1273–1276
  90. Purcell KJ, Schembri M, Telles TL, Fujimoto VY, Cedars MI. Bed rest after embryo transfer: a randomized controlled trial. Fertil Steril. 2007;87:322–326
  91. Tremellen KP, Valbuena D, Landeras J, Ballesteros A, Martinez J, Mendoza S, et al. The effect of intercourse on pregnancy rates during assisted human reproduction. Hum Reprod. 2000;15:2653–2658
  92. Kato O, Takatsuka R, Asch RH. Transvaginal-transmyometrial embryo transfer: the Towako method; experiences of 104 cases. Fertil Steril. 1993;59:51–53
  93. Groutz A, Lessing JB, Wolf Y, Azem F, Yovel I, Amit A. Comparison of transmyometrial and transcervical embryo transfer in patients with previously failed in vitro fertilization-embryo transfer cycles and/or cervical stenosis. Fertil Steril. 1997;67:1073–1076

 Edward E. Wallach, M.D.Associate Editor

 L.M. has nothing to disclose. B.J.V.V. has nothing to disclose.

PII: S0015-0282(10)00467-X

doi: 10.1016/j.fertnstert.2010.03.030

Fertility and Sterility
Volume 94, Issue 3 , Pages 785-790 , August 2010

Article Tools

* Image Usage & Resolution