Human Reproduction, Vol. 14, No. 9, 2417,
September 1999
© 1999 European Society of Human Reproduction and Embryology
Letters to the Editor |
The effect of a difficult embryo transfer on the outcome of IVF
Bourn Hall Clinic, Bourn, Cambridge CB3 7TR, UK
Dear Sir,
We wish to congratulate Dr Kovacs (1999) and our Australian and New Zealand colleagues for addressing the embryo transfer procedure, an important and under-discussed issue. They asked 50 highly experienced clinicians in in-vitro fertilization (IVF) to score 12 variables by subjective assortment of their importance to the success of IVF from a questionnaire distributed to the participant clinics. However, we believe that a major factor (the most important one?) was omitted from this list: the subjective impression of the physician performing the transfer on the degree of difficulty of the procedure.
Dr Kovacs speculated that the presence of blood on the transfer catheter is probably a sign of a difficult transfer, but in effect, this in not necessarily so. Blood on the catheter or slight bleeding from the cervix is also seen in easy transfers. Although the importance of the presence of blood on the transfer catheter came very high on their list (number 2), the participants in this study were not asked directly how they scored technically difficult transfers.
The clinical implications of difficult embryo transfers are very controversial and hotly debated. While a few researchers have demonstrated reduced pregnancy rates in women who had difficult transfers (Leeton et al., 1982
; Visser et al., 1993), others have suggested that the difficulty of the procedure is not related to implantation and pregnancy rates (Wood et al., 1985; Nabi et al., 1997; Tur-Kaspa et al., 1998). Recently, we have shown that in patients with a difficult embryo transfer previously, cervical dilatation after pituitary suppression, and prior to gonadotrophin stimulation, leads to easier embryo transfers and improves the pregnancy rate in such patients (Abusheikha et al., 1999). We agree with Dr Kovacs that the crucial stage of embryo transfer should be studied further, preferably via multicentric clinical studies, in order to improve the implantation and pregnancy rates in IVF/embryo transfer.
Notes
1 To whom correspondence should be addressed 
References
Abusheikha, N., Lass, A., Akagbosu, F. and Brinsden, P. (1999) How useful is cervical dilation on patients with cervical stenosis in an in vitro fertilization–embryo transfer (IVF–ET) programme? – The Bourn Hall Experience. Fertil. Steril., in press.
Kovacs, G.T. (1999) What factors are important for successful embryo transfer after in-vitro fertilization? Hum. Reprod., 14, 590–592.
Leeton, J., Trounson, A., Jessop, D. and Wood, C. (1982) The technique for human embryo transfer Fertil. Steril., 38, 156–161.[Web of Science][Medline]
Nabi, A., Aawonuga, A., Birch, H. et al. (1997) Multiple attempts at embryo transfer. Does this affect in-vitro fertilization treatment outcome? Hum. Reprod., 12, 1188–1190.
Tur-Kaspa, I., Yuval, Y., Bider, D. et al. (1998) Difficult or repeated sequential embryo transfers do not adversely affect in-vitro fertilization pregnancy rates or outcome. Hum. Reprod., 13, 2452–2455.
Visser, D. S., Fourie, F. and Kruger, H.F. (1993) Multiple attempts at embryo transfer: effect on pregnancy outcome in an in vitro fertilization and embryo transfer programme. J. Assist. Reprod. Genet., 10, 37–43.[Web of Science][Medline]
Wood, C., McMaster, R., Rennie, G. et al. (1985) Factors influencing pregnancy rates following in-vitro fertilization and embryo transfer. Fertil. Steril., 43, 245–250.[Web of Science][Medline]
Reply
Department of Obstetrics and Gynaecology, Monash University, PO Box 94, Nelson Road, Box Hill, Victoria 3128, Australia
Dear Sir,
I totally agree with the comments of Lass et al., and with hindsight, this would have been a good question to ask. Maybe we should implement a multi-centre trial where patients with difficult transfers are randomized into pre-IVF cervical dilation, to answer the question whether such a procedure is beneficial.
CiteULike 
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