Embryo transfer: factors involved in optimizing the success

Purpose of review Embryo transfer is arguably the most critical step in assisted reproduction. The purpose of this article is to review the different aspects of the procedure in the light of recent evidence. Recent findings Randomized trials have shown that significantly higher pregnancy rates are obtained when embryo transfer is performed under ultrasound guidance, the embryos are deposited in the middle part of the uterine cavity, an atraumatic technique is used and when low-dose aspirin is routinely administered following the procedure. Blood in the catheter and leaving the embryos inside it for more than 120 s diminish the pregnancy rate significantly. Air in the catheter, immediate removal of the catheter, performing two transfers in the same cycle, prolonged bed rest, sexual intercourse after embryo transfer or the use of sildenafil do not affect the results. Based on currently available evidence, Cochrane reviews have concluded that the live birth rate is not increased by delaying embryo transfer from day two to three or to the blastocyst stage, and that single embryo transfer leads to lower live birth rates than the transfer of two embryos. The value of a mock transfer a few days before the actual procedure has been challenged as the position of the uterus may change. The effect of holding the cervix with a volsellum, routinely administering antibiotics and the superiority of one catheter over the others is still to be determined. Summary Recent studies confirm the importance of the various aspects of embryo transfer. More randomized studies are needed to further evaluate them.

[1]  Xiao-hui Zhao,et al.  [Influence of embryo transfer depth on in vitro fertilization and embryo transfer outcomes]. , 2007, Zhonghua fu chan ke za zhi.

[2]  J. Schenker,et al.  The role of uterine straightening by passive bladder distension before embryo transfer in IVF cycles , 2007, Journal of Assisted Reproduction and Genetics.

[3]  P. Brinsden,et al.  'The presence of blood in the transfer catheter negatively influences outcome at embryo transfer'. , 2005, Human reproduction.

[4]  E. Coonen,et al.  Elective single embryo transfer (eSET) policy in the first three IVF/ICSI treatment cycles. , 2005, Human reproduction.

[5]  Y. Sorokin,et al.  Pregnancies following the interval double-transfer technique in an in vitro fertilization-embryo transfer program , 1988, Journal of in Vitro Fertilization and Embryo Transfer.

[6]  Y. Englert,et al.  Clinical study on embryo transfer after human in vitro fertilization , 1986, Journal of in Vitro Fertilization and Embryo Transfer.

[7]  W. Feichtinger,et al.  The use of synthetic culture medium and patient serum for human in vitro fertilization and embryo replacement , 1986, Journal of in Vitro Fertilization and Embryo Transfer.

[8]  F. Fourie,et al.  Multiple attempts at embryo transfer: Effect on pregnancy outcome in an in vitro fertilization and embryo transfer program , 2005, Journal of Assisted Reproduction and Genetics.

[9]  J. Harper,et al.  Transfer of embryos into the uterus: How much do technical factors affect pregnancy rates? , 2005, Journal of Assisted Reproduction and Genetics.

[10]  O. Ozturk,et al.  Number of embryos for transfer following in-vitro fertilisation or intra-cytoplasmic sperm injection. , 2014, The Cochrane database of systematic reviews.

[11]  S. Weitzen,et al.  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. , 2004, Fertility and sterility.

[12]  Z. Amarin,et al.  Bed rest versus free mobilisation following embryo transfer: a prospective randomised study , 2004, BJOG : an international journal of obstetrics and gynaecology.

[13]  B. Joo,et al.  Treatment with piroxicam before embryo transfer increases the pregnancy rate after in vitro fertilization and embryo transfer. , 2004, Fertility and sterility.

[14]  R. Matorras,et al.  Influence of the time interval between embryo catheter loading and discharging on the success of IVF. , 2004, Human reproduction.

[15]  J. Dumoulin,et al.  Early cleavage is a valuable addition to existing embryo selection parameters: a study using single embryo transfers. , 2004, Human reproduction.

[16]  T. Imbar,et al.  Synchronization between endometrial and embryonic age is not absolutely crucial for implantation. , 2004, Fertility and sterility.

[17]  D. Seifer,et al.  Impact of retained embryos on the outcome of assisted reproductive technologies. , 2004, Fertility and sterility.

[18]  R. Jansen,et al.  Moving to blastocyst biopsy for preimplantation genetic diagnosis and single embryo transfer at Sydney IVF. , 2004, Fertility and sterility.

[19]  J. Dodd,et al.  Single or multiple embryo transfer following in vitro fertilisation for improved neonatal outcome: A systematic review of the literature , 2004, The Australian & New Zealand journal of obstetrics & gynaecology.

[20]  P. Vanderzwalmen,et al.  Cervical dilatation has a positive impact on the outcome of IVF in randomly assigned cases having two previous difficult embryo transfers. , 2004, Human reproduction.

[21]  A. Pontes,et al.  Best site for embryo transfer: the upper or lower half of endometrial cavity? , 2004, Human reproduction.

[22]  F. Sharara,et al.  Successful pregnancies in the setting of exaggerated endometrial thickness. , 2004, Fertility and sterility.

[23]  U. Waldenström,et al.  Low-dose aspirin in a short regimen as standard treatment in in vitro fertilization: a randomized, prospective study. , 2004, Fertility and sterility.

[24]  D. De Neubourg,et al.  Single top quality embryo transfer as a model for prediction of early pregnancy outcome. , 2004, Human reproduction.

[25]  Hannu Martikainen,et al.  Day 2 elective single embryo transfer in clinical practice: better outcome in ICSI cycles. , 2004, Human reproduction.

[26]  J. Balasch,et al.  Air in the transfer catheter does not affect the success of embryo transfer. , 2004, Fertility and sterility.

[27]  D. Keefe,et al.  Middle to lower uterine segment embryo transfer improves implantation and pregnancy rates compared with fundal embryo transfer. , 2004, Fertility and sterility.

[28]  H. Au,et al.  Assessment of changes in utero‐ovarian arterial impedance during the peri‐implantation period by Doppler sonography in women undergoing assisted reproduction , 2004, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[29]  P. Sutter,et al.  A real-life prospective health economic study of elective single embryo transfer versus two-embryo transfer in first IVF/ICSI cycles. , 2004, Human reproduction.

[30]  David K Gardner,et al.  Single blastocyst transfer: a prospective randomized trial. , 2004, Fertility and sterility.

[31]  E. Lunenfeld,et al.  Blastocyst-stage embryo transfer in patients who failed to conceive in three or more day 2-3 embryo transfer cycles: a prospective, randomized study. , 2004, Fertility and sterility.

[32]  A. Jaffa,et al.  A glance into the uterus during in vitro simulation of embryo transfer. , 2004, Human reproduction.

[33]  J. Ohl,et al.  Colonisation bactérienne vaginale anormale et implantation en assistance médicale à la procréation , 2004 .

[34]  A. Mauri,et al.  Effects of Vaginal Progesterone Administration Starting on the Day of Oocyte Retrieval on Pregnancy Rates , 2003, Journal of Assisted Reproduction and Genetics.

[35]  F. Facchinetti,et al.  Embryonic Production of Nitric Oxide and Its Role in Implantation: A Pilot Study , 2003, Journal of Assisted Reproduction and Genetics.

[36]  N. Dean,et al.  Consecutive Transfer of Day 3 Embryos and of Day 5–6 Blastocysts Increases Overall Pregnancy Rates Associated with Blastocyst Culture , 2003, Journal of Assisted Reproduction and Genetics.

[37]  M. Henne,et al.  Uterine position at real embryo transfer compared with mock embryo transfer. , 2003, Human reproduction.

[38]  L. Westphal,et al.  Elective single blastocyst transfer. , 2003, Fertility and sterility.

[39]  H. Sallam,et al.  Impact of Technical Difficulties, Choice of Catheter, and the Presence of Blood on the Success of Embryo Transfer—Experience from a Single Provider , 2003, Journal of Assisted Reproduction and Genetics.

[40]  J. Check,et al.  Neither sildenafil nor vaginal estradiol improves endometrial thickness in women with thin endometria after taking oral estradiol in graduating dosages. , 2002, Clinical and experimental obstetrics & gynecology.

[41]  A. Pontes,et al.  Increased implantation and pregnancy rates obtained by placing the tip of the transfer catheter in the central area of the endometrial cavity. , 2004, Reproductive biomedicine online.

[42]  D. Stavrou,et al.  Blastocyst versus early cleavage embryo transfer: a retrospective analysis of 4,165 transfers. , 2004, Clinical and experimental obstetrics & gynecology.

[43]  D. Loutradis,et al.  A double embryo transfer on days 2 and 4 or 5 improves pregnancy outcome in patients with good embryos but repeated failures in IVF or ICSI. , 2004, Clinical and experimental obstetrics & gynecology.

[44]  M. Bahçeci,et al.  Transfer of early-cleaved embryos increases implantation rate in patients undergoing ovarian stimulation and ICSI-embryo transfer. , 2004, Reproductive biomedicine online.

[45]  F. Rísquez,et al.  Monochorionic triplets after single embryo transfer. , 2004, Reproductive biomedicine online.

[46]  G. Patrizi,et al.  Experimental results on the recognition of embryos in human assisted reproduction. , 2004, Reproductive biomedicine online.

[47]  C. Rongières,et al.  [Abnormal bacterial colonisation of the vagina and implantation during assisted reproduction]. , 2004, Gynecologie, obstetrique & fertilite.

[48]  B. Dale,et al.  The Effect of Ease of Transfer and Type of Catheter Used on Pregnancy and Implantation Rates in an IVF Program , 2004, Journal of Assisted Reproduction and Genetics.

[49]  J. Dietl,et al.  Endometrial volume as assessed by three-dimensional ultrasound is a predictor of pregnancy outcome after in vitro fertilization and embryo transfer. , 2003, Fertility and sterility.

[50]  G. Sher,et al.  The graduated embryo score predicts the outcome of assisted reproductive technologies better than a single day 3 evaluation and achieves results associated with blastocyst transfer from day 3 embryo transfer. , 2003, Fertility and sterility.

[51]  P. Serhal,et al.  Cervical dilatation with hygroscopic rods prior to ovarian stimulation facilitates embryo transfer. , 2003, Human reproduction.

[52]  M. Hinckley,et al.  Rapid reaccumulation of hydrometra after drainage at embryo transfer in patients with hydrosalpinx. , 2003, Fertility and sterility.

[53]  W. Buckett.  A meta-analysis of ultrasound-guided versus clinical touch embryo transfer. , 2003, Fertility and sterility.

[54]  L. Rombauts,et al.  Replacement of one selected embryo is just as successful as two embryo transfer, without the risk of twin pregnancy , 2003, The Australian & New Zealand journal of obstetrics & gynaecology.

[55]  H. Sallam,et al.  Ultrasound-guided embryo transfer: a meta-analysis of randomized controlled trials. , 2003, Fertility and sterility.

[56]  P. Warikoo,et al.  Ultrasound detection of pyometra at the time of embryo transfer after ovum retrieval for in vitro fertilization. , 2003, Fertility and sterility.

[57]  R. Quintana,et al.  Endometrial lesions caused by catheters used for embryo transfers: a preliminary report. , 2003, Fertility and sterility.

[58]  B. Reubinoff,et al.  Hyaluronic acid can successfully replace albumin as the sole macromolecule in a human embryo transfer medium. , 2003, Fertility and sterility.

[59]  D. Keefe,et al.  The transfer point is a novel measure of embryo placement. , 2003, Fertility and sterility.

[60]  O. Hovatta,et al.  Embryo transfer by midwife or gynecologist: a prospective randomized study , 2003, Acta obstetricia et gynecologica Scandinavica.

[61]  Z. Rosenwaks,et al.  Difficult embryo transfer has a negative impact on the outcome of in vitro fertilization. , 2003, Fertility and sterility.

[62]  E. Mocanu.  The influence of the depth of embryo replacement into the uterine cavity on implantation rates after IVF: a controlled, ultrasound-guided study. , 2003, Human reproduction.

[63]  Jan Gerris,et al.  Single embryo transfer - state of the art. , 2003, Reproductive biomedicine online.

[64]  L. Rombauts,et al.  Embryo transfer: hysteroscopic assessment of transfer catheter effects on the endometrium. , 2003, Reproductive Biomedicine Online.

[65]  R. Frydman,et al.  Infertility therapy-associated multiple pregnancies (births): an ongoing epidemic. , 2003, Reproductive biomedicine online.

[66]  Hannu Martikainen,et al.  The degree of difficulty of embryo transfer is an independent factor for predicting pregnancy. , 2002, Human reproduction.

[67]  C. Simón,et al.  Transabdominal ultrasound-guided embryo transfer does not increase pregnancy rates in oocyte recipients. , 2002, Fertility and sterility.

[68]  H. Sallam,et al.  Ultrasound measurement of the uterocervical angle before embryo transfer: a prospective controlled study. , 2002, Human reproduction.

[69]  R. Norman,et al.  A randomized controlled trial of a soft double lumen embryo transfer catheter versus a firm single lumen catheter: significant improvements in pregnancy rates. , 2002, Human reproduction.

[70]  N. Johnson,et al.  Cleavage stage versus blastocyst stage embryo transfer in assisted conception. , 2002, The Cochrane database of systematic reviews.

[71]  J. Vink,et al.  The impact of the embryo transfer catheter on the pregnancy rate in IVF. , 2002, Human reproduction.

[72]  P. Ho,et al.  Ultrasound-guided embryo transfer: a prospective randomized controlled trial. , 2001, Human reproduction.

[73]  R. Fanchin,et al.  Effects of vaginal progesterone administration on uterine contractility at the time of embryo transfer. , 2001, Fertility and sterility.

[74]  F. Martínez,et al.  Ultrasound-guided embryo transfer: immediate withdrawal of the catheter versus a 30 second wait. , 2001, Human reproduction.

[75]  A. Kurjak,et al.  Assessment of endometrial receptivity by transvaginal color Doppler and three‐dimensional power Doppler ultrasonography in patients undergoing in vitro fertilization procedures. , 2001, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[76]  K. Agnew,et al.  Bacteria in the transfer catheter tip influence the live-birth rate after in vitro fertilization. , 2000, Fertility and sterility.

[77]  D. Valbuena,et al.  The effect of intercourse on pregnancy rates during assisted human reproduction. , 2000, Human reproduction.

[78]  J. Segars,et al.  Pregnancy rates after embryo transfer depend on the provider at embryo transfer. , 2000, Fertility and sterility.

[79]  G. Russell,et al.  Predictors of success after embryo transfer: experience from a single provider. , 2000, American journal of obstetrics and gynecology.

[80]  A. Nuhoğlu,et al.  Comparing two embryo transfer catheters. Use of a trial transfer to determine the catheter applied. , 2000, The Journal of reproductive medicine.

[81]  C. Dorn,et al.  Serum oxytocin concentration during embryo transfer procedure. , 1999, European journal of obstetrics, gynecology, and reproductive biology.

[82]  N. Abusheikha,et al.  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. , 1999, Fertility and sterility.

[83]  G. Raven,et al.  Junctional zone contractions and embryo transfer: is it safe to use a tenaculum? , 1999, Human reproduction.

[84]  J. Grudzinskas,et al.  Prophylactic antibiotics and endocervical microbial inoculation of the endometrium at embryo transfer , 1999, The Lancet.

[85]  J. Grifo,et al.  In vitro fertilization outcome relative to embryo transfer difficulty: a novel approach to the forbidding cervix. , 1999, Fertility and sterility.

[86]  S. Al-Hasani,et al.  Transfer technique and catheter choice influence the incidence of transcervical embryo expulsion and the outcome of IVF. , 1999, Human reproduction.

[87]  D. Dumesic,et al.  Blood on the embryo transfer catheter is associated with decreased rates of embryo implantation and clinical pregnancy with the use of in vitro fertilization-embryo transfer. , 1998, Fertility and sterility.

[88]  Y. Yuval,et al.  Difficult or repeated sequential embryo transfers do not adversely affect in-vitro fertilization pregnancy rates or outcome. , 1998, Human reproduction.

[89]  R. Fanchin,et al.  [Uterine contractions at the time of embryo transfer: a hindrance to implantation?]. , 1998, Contraception, fertilite, sexualite.

[90]  M. Afnan,et al.  Is bed rest following embryo transfer necessary? , 1998, Fertility and sterility.

[91]  M. Afnan,et al.  Nurses performing embryo transfer: the development and results of the Birmingham experience. , 1998, Human reproduction.

[92]  L. Gianaroli,et al.  Preimplantation genetic diagnosis increases the implantation rate in human in vitro fertilization by avoiding the transfer of chromosomally abnormal embryos. , 1997, Fertility and sterility.

[93]  G. Botta,et al.  Is a prolonged bed rest following embryo transfer useful? , 1997, Human reproduction.

[94]  J. Van der Elst,et al.  Prospective randomized study comparing human serum albumin with fetal cord serum as protein supplement in culture medium for in-vitro fertilization. , 1997, Human reproduction.

[95]  A. Awonuga,et al.  Multiple attempts at embryo transfer: does this affect in-vitro fertilization treatment outcome? , 1997, Human reproduction.

[96]  J. Grudzinskas,et al.  Fertilization and early embryology: 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 , 1996 .

[97]  J. Grudzinskas,et al.  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. , 1996, Human reproduction.

[98]  M. Afnan,et al.  Transmyometrial embryo transfer after difficult immediate mock transcervical transfer. , 1996, Fertility and sterility.

[99]  D. Barber,et al.  Nurses performing embryo transfer: successful outcome of in-vitro fertilization. , 1996, Human reproduction.

[100]  R. Edwards.  Clinical approaches to increasing uterine receptivity during human implantation. , 1995, Human reproduction.

[101]  Z. Ben-Rafael,et al.  The use of fibrin sealant in in vitro fertilization and embryo transfer. , 1995, International journal of fertility and menopausal studies.

[102]  S. Campbell,et al.  Endometrial thickness, morphology, vascular penetration and velocimetry in predicting implantation in an in vitro fertilization program , 1995, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[103]  M. Afnan,et al.  Mock embryo transfer with a full bladder immediately before the real transfer for in-vitro fertilization treatment: the Birmingham experience of 113 cases. , 1995, Human reproduction.

[104]  J. Check,et al.  Embryo transfer technique as a cause of ectopic pregnancy in in vitro fertilization. , 1993, Fertility and sterility.

[105]  P. Patton,et al.  Difficult embryo transfer managed with a coaxial catheter system. , 1993, Fertility and sterility.

[106]  H. Strohmer,et al.  The use of fibrin sealant for embryo transfer: development and clinical studies. , 1992, Human reproduction.

[107]  V. Knutzen,et al.  Mock embryo transfer in early luteal phase, the cycle before in vitro fertilization and embryo transfer: a descriptive study. , 1992, Fertility and sterility.

[108]  P. Devroey,et al.  Human serum albumin versus serum: a comparative study on embryo transfer medium. , 1991, Fertility and sterility.

[109]  G. Serour,et al.  Dummy embryo transfer: a technique that minimizes the problems of embryo transfer and improves the pregnancy rate in human in vitro fertilization. , 1990, Fertility and sterility.

[110]  E. Loumaye,et al.  Evaluation of a synthetic serum substitute to replace fetal cord serum for human oocyte fertilization and embryo growth in vitro. , 1989, Fertility and sterility.

[111]  P. Devroey,et al.  Performance of different embryo transfer catheters in a human in vitro fertilization program. , 1989, Fertility and sterility.

[112]  A. Trounson,et al.  Factors influencing pregnancy rates following in vitro fertilization and embryo transfer. , 1985, Fertility and sterility.

[113]  R. Strickler,et al.  Ultrasound guidance for human embryo transfer. , 1985, Fertility and sterility.

[114]  A. Trounson,et al.  The technique for human embryo transfer. , 1982, Fertility and sterility.

[115]  R. Sinha.  PROGRESS IN OBSTETRICS AND GYNAECOLOGY , 1939, Journal of the Indian Medical Association.