Human Reproduction, Vol 13, 2452-2455, Copyright © 1998 by Oxford University Press
I Tur-Kaspa, Y Yuval, D Bider, J Levron, A Shulman and J Dor
In order to assist the medical team in the decision-making process and in
adequate counselling of patients when encountering technical difficulties
at the time of embryo transfer, we investigated the effect of difficult
embryo transfer, with or without the need for cervical dilatation or
repeated sequential attempts because of retained embryos in the catheter
system, on in-vitro fertilization (IVF) pregnancy rates and outcome. A
total of 854 consecutive embryo transfer procedures were prospectively
categorized as (i) easy (smooth, unforced), (ii) difficult (requiring
uterine manipulation or increased force or cervical grasping and/or
accompanied by trauma), (iii) requiring cervical dilatation, or (iv)
multiple (two or three) sequential attempts because of embryos retained in
the catheter system. Embryo transfer was easy in 734 cases (85.9%). It was
difficult in 72 (8.4%), cervical dilatation was required in 21 (2.5%), and
one or two repeated attempts were needed in 27 cases (3.2%). Pregnancy
rates for the different categories of embryo transfer were 23.3, 23.6, 23.8
and 29.6% respectively. There were no significant differences in the
percentage of the ongoing/delivered pregnancies for the different
categories of embryo transfer (69, 64.6, 60 and 62.5% respectively). There
were no significant differences in the distribution of embryo transfer
types among the six infertility specialists who performed the procedures.
To conclude, embryo transfers that are difficult to perform or that require
cervical dilatation or repeated attempts do not adversely affect pregnancy
rates and outcome following IVF. Cervical dilatation, if needed for
patients with cervical stenosis, should be performed at the time of the
embryo transfer and not earlier. Surgical transmyometrial embryo transfer
or rescheduling patients for delayed embryo transfer could be avoided in
most patients. This information is important for patient management and
counselling in cases of embryo transfer that are not easy to perform.
ARTICLES
Difficult or repeated sequential embryo transfers do not adversely affect in-vitro fertilization pregnancy rates or outcome
Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel.
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