Skip to main content
SpringerLink
Log in

Ultrasound Guidance in Embryo Transfer

  • Chapter
  • First Online:
Book cover Ultrasound Imaging in Reproductive Medicine

  • 952 Accesses

Abstract

A quick, atraumatic, and technically accurate embryo transfer (ET) has always been regarded as quintessential for the achievement of high pregnancy rates in human IVF. There are several studied factors that may affect the success of ET: ease of the transfer, location of the embryo deposition, type of catheter, and the level of experience of the physician performing the transfer. Ultrasound (US) guidance allows to discharge the embryos in the optimal area of the uterine cavity, 1.0–1.5 cm from the fundus, and was shown in prospective randomized studies as well as meta-analysis to significantly increase the rate of easy transfers, embryo implantation, clinical pregnancy, and live birth rates vs. clinical touch ET. The use of either transabdominal or transvaginal US imaging results in similar success rates. US observation of the marker bubbles immediately after ET has an obvious psychological value to the patients, reaffirms optimal embryo deposition, and enables physicians to teach ET to young doctors without a decline in IVF results. The disadvantages of US guidance in ET are the need for an assistant and the inconvenience for patients caused by a full bladder. It is highly recommended for the reader to review the 2017 ASRM practice guidelines for ET. This chapter will review the data available today on the important role of US guidance in ET.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Tarlatzis BC, Laufer N, Decherney AH. The use of ovarian ultrasonography in monitoring ovulation induction. J In Vitro Fert Embryo Transf. 1984;1:226–32.

    Article  CAS  Google Scholar 

  2. Peluso JJ, Damien M, Nulsen JC, Luciano AA. Identification of follicles with fertilizable oocytes by sequential ultrasound measurements during follicular development. J In Vitro Fert Embryo Transf. 1990;7:304–9.

    Article  CAS  Google Scholar 

  3. Practice Committee of the American Society for Reproductive Medicine. Performing the embryo transfer: a guideline. Fertil Steril. 2017;107:882–96.

    Article  Google Scholar 

  4. Uyar A, Bener A, Ciray HN, Bahceci M. Physician experience in performing embryo transfers may affect outcome. Fertil Steril. 2011;95:1860–2.

    Article  Google Scholar 

  5. Coroleu B, Barri PN, Varreras O, Martinez F, Parriego M, Hereter L, Parera N, Veiga A, Balasch J. The influence of the depth of embryo replacement into the uterine cavity on implantation rates after IVF: a controlled, ultrasound-guided study. Hum Reprod. 2002;17:341–6.

    Article  Google Scholar 

  6. Cenksoy PO, Fıcıcıoglu C, Yesiladali M, Akcin OA, Kaspar C. The importance of the length of uterine cavity, the position of the tip of the inner catheter and the distance between the fundal endometrial surface and the air bubbles as determinants of the pregnancy rate in IVF cycles. Eur J Obstet Gynecol Reprod Biol. 2014;172:46–50.

    Article  Google Scholar 

  7. 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;81:1273–7.

    Article  Google Scholar 

  8. Pope CS, Cook EKD, Arny M, Novak A, Grow D. Influence of embryo transfer depth on in vitro fertilization and embryo transfer outcome. Fertil Steril. 2004;81:51–8.

    Article  Google Scholar 

  9. Rovei V, Dalmasso P, Gennarelli G, Lantieri T, Basso G, Benedetto C, et al. IVF outcome is optimized when embryos are replaced between 5 and 15 mm from the fundal endometrial surface: a prospective analysis on 1184 IVF cycles. Reprod Biol Endocrinol. 2013;11:114–20.

    Article  Google Scholar 

  10. Alvero R, Hearns-Stokes RM, Catherino WH, Leondires MP, Segars JH. The presence of blood in the transfer catheter negatively influences outcome at embryo transfer. Hum Reprod. 2003;18:1848–52.

    Article  CAS  Google Scholar 

  11. Fanchin R, Righini C, Olivennes F, Taylor S, de Ziegler D, Frydman R. Uterine contractions at time of embryo transfer alter pregnancy rates after in vitro fertilization. Hum Reprod. 1998;13:1968–74.

    Article  CAS  Google Scholar 

  12. Lesny P, Killick SR, Tetlow RL, Robinson J, Maginess SD. Embryo transfer - can we learn anything from the observation of junctional zone contractions? Hum Reprod. 1998;13:1540–6.

    Article  CAS  Google Scholar 

  13. Gera PS, Allemand MC, Tatpati LL, Galanits TM, Morbeck D, Coddington CC. Role of saline infusion sonography in uterine evaluation before frozen embryo transfer cycle. Fertil Steril. 2008;89:562–6.

    Article  Google Scholar 

  14. Sankpal RS, Confino E, Matzel A, Cohen LS. Investigation of the uterine cavity and fallopian tubes using three-dimensional saline sonohysterosalpingography. Int J Gynaecol Obstet. 2001;73:125–9.

    Article  CAS  Google Scholar 

  15. Yoldemir T, Erenus M. Does the timing of mock embryo transfer trial improve implantation in intracytoplasmic sperm injection cycles? Gynecol Endocrinol. 2011;27:396–400.

    Article  Google Scholar 

  16. 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;54:678–81.

    Article  CAS  Google Scholar 

  17. Henne MB, Milki AA. Uterine position at real embryo transfer compared with mock embryo transfer. Hum Reprod. 2004;19:570–2.

    Article  CAS  Google Scholar 

  18. Strickler RC, Christianson C, Crane JP, Curato A, Knight AB, Yang V. Ultrasound guidance for human embryo transfer. Fertil Steril. 1985;43:54–61.

    Article  CAS  Google Scholar 

  19. Sallam HN, Sadek SS. Ultrasound-guided embryo transfer: a meta-analysis of randomized controlled trials. Fertil Steril. 2003;80:1042–6.

    Article  Google Scholar 

  20. Matorras R, Urquijo 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;17:1762–6.

    Article  CAS  Google Scholar 

  21. 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;88:333–41.

    Article  Google Scholar 

  22. Brown J1, Buckingham K, Buckett W, Abou-Setta AM. Ultrasound versus ‘clinical touch’ for catheter guidance during embryo transfer in women. Cochrane Database Syst Rev. 2016;(3):CD006107.

    Google Scholar 

  23. Flisser E, Grifo JA. Is what we clearly see really so obvious? Ultrasonography and transcervical embryo transfer--a review. Fertil Steril. 2007;87:1–5.

    Article  Google Scholar 

  24. Buckett WM. A meta-analysis of ultrasound-guided versus clinical touch embryo transfer. Fertil Steril. 2003;80:1037–41.

    Article  Google Scholar 

  25. Teixeira DM, Dassunção LA, Vieira CV, Barbosa MA, Coelho Neto MA, Nastri CO, Martins WP. Ultrasound guidance during embryo transfer: a systematic review and meta-analysis of randomized controlled trials. Ultrasound Obstet Gynecol. 2015;45:139–48.

    Article  CAS  Google Scholar 

  26. Tiras B, Korucuoglu U, Polat M, Saltik A, Zeyneloglu HB, Yarali H. Effect of blood and mucus on the success rates of embryo transfers. Eur J Obstet Gynecol Reprod Biol. 2012;165:239–42.

    Article  Google Scholar 

  27. Allahbadia GN, Kadam K, Gandhi G, Arora S, Valliappan JB, Joshi A, et al. Embryo transfer using the SureView catheter-beacon in the womb. Fertil Steril. 2010;93:344–50.

    Article  Google Scholar 

  28. Kato O, Takatsuka R, Asch RH. Transvaginal-transmyometrial embryo transfer: the Towako method; experiences of 104 cases. Fertil Steril. 1993;59:51–3.

    Article  CAS  Google Scholar 

  29. 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;67:1073–6.

    Article  CAS  Google Scholar 

  30. Hurley VA, Osborn JC, Leoni MA, Leeton J. Ultrasound-guided embryo transfer: a controlled trial. Fertil Steril. 1991;55:559–62.

    Article  CAS  Google Scholar 

  31. Woolcott R, Stanger J. Potentially important variables identified by transvaginal ultrasound-guided embryo transfer. Hum Reprod. 1997;12:963–6.

    Article  CAS  Google Scholar 

  32. Kojima K, Nomiyama M, Kumamoto T, Matsumoto Y, Iwasaka T. Transvaginal ultrasound-guided embryo transfer improves pregnancy and implantation rates after IVF. Hum Reprod. 2001;16:2578–82.

    Article  CAS  Google Scholar 

  33. 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;77:769–75.

    Article  Google Scholar 

  34. Porat N, Boehnlein LM, Schouweiler CM, Kang J, Lindheim SR. Interim analysis of a randomized clinical trial comparing abdominal versus transvaginal ultrasound-guided embryo transfer. J Obstet Gynaecol Res. 2010;36:384–92.

    Article  Google Scholar 

  35. Bodri D, Colodrón M, García D, Obradors A, Vernaeve V, Coll O. Transvaginal versus transabdominal ultrasound guidance for embryo transfer in donor oocyte recipients: a randomized clinical trial. Fertil Steril. 2011;95:2263–8.

    Article  Google Scholar 

  36. Lambers MJ, Dogan E, Kostelijk H, Lens JW, Schats R, Hompes PGA. Ultrasonographic-guided embryo transfer does not enhance pregnancy rates compared with embryo transfer based on previous uterine length measurement. Fertil Steril. 2006;86:867–72.

    Article  Google Scholar 

  37. Maldonado LG, Ajzen SA, Busato WC, Iaconelli A Jr, Bibancos M, Borges E Jr. Impact of previous hysterossonometry on embryo transfer. Fertil Steril. 2005;84:S364.

    Article  Google Scholar 

  38. Maldonado LG, Aoki T, Busato W, Pasqualotto FF, Iaconelli A Jr, Borges E Jr. Embryo transfer based on previous uterine length measurement: a prospective randomized study. Hum Reprod. 2010;25:i99.

    Article  Google Scholar 

  39. Revelli A, Rovei V, Dalmasso P, Gennarelli G, Racca C, Evangelista F, Benedetto C. Large randomized trial comparing transabdominal ultrasound-guided embryo transfer with a technique based on uterine length measurement before embryo transfer. Ultrasound Obstet Gynecol. 2016;48:289–95.

    Article  CAS  Google Scholar 

  40. Woolcott R, Stanger J. Ultrasound tracking of the movement of embryo-associated air bubbles on standing after transfer. Hum Reprod. 1998;13:2107–9.

    Article  CAS  Google Scholar 

  41. Confino E, Zhang J, Risquez F. Air bubble migration is a random event post embryo transfer. J Assist Reprod Genet. 2007;24:223–6.

    Article  CAS  Google Scholar 

  42. Shah DK, Missmer SA, Correia KF, Racowsky C, Ginsburg E. Efficacy of intrauterine inseminations as a training modality for performing embryo transfer in reproductive endocrinology and infertility fellowship programs. Fertil Steril. 2013;100(2):386–91.

    Article  Google Scholar 

  43. Harris ID, Styer AK, Petrozza JC. Ultrasonographer experience does not impact outcomes following ultrasound-guided embryo transfer. Fertil Steril. 2009;92:918–22.

    Article  Google Scholar 

  44. Practice Committee of the American Society for Reproductive Medicine. ASRM standard embryo transfer protocol template: a committee opinion. Fertil Steril. 2017;107:897–900.

    Article  Google Scholar 

  45. Heitmann RJ, Hill MJ, Csokmay JM, Pilgrim J, AH DC, Deering S. Embryo transfer simulation improves pregnancy rates and decreases time to proficiency in reproductive endocrinology and infertility fellow embryo transfers. Fertil Steril. 2017;107:1166–72.

    Article  Google Scholar 

  46. 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;76:630–2.

    Article  CAS  Google Scholar 

  47. Mains L, Van Voorhis BJ. Optimizing the technique of embryo transfer. Fertil Steril. 2010;94:785–90.

    Article  Google Scholar 

  48. Lee MS, Cardozo ER, Karmon AE, Wright DL, Toth TL. Impact of transfer time on pregnancy outcomes in frozen-embryo transfer cycles. Fertil Steril. 2018;109:467–72.

    Article  Google Scholar 

  49. Saravelos SH, Kong GW, Chung JP, Mak JS, Chung CH, Cheung LP, Li TC. A prospective randomized controlled trial of 3D versus 2D ultrasound-guided embryo transfer in women undergoing ART treatment. Hum Reprod. 2016;31:2255–60.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sant’Anna Hospital, University of Turin, Department of Obstetrics and Gynecology, Turin, Italy

    Alberto Revelli

  2. Wesleyan University, Middletown, CT, USA

    Tomer Tur-Kaspa

  3. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Edmond Confino

Authors
  1. Alberto Revelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tomer Tur-Kaspa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Edmond Confino
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. The Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, Norfolk, VA, USA

    Laurel A. Stadtmauer

  2. Institute for Human Reproduction, Chicago, IL, USA

    Ilan Tur-Kaspa

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Revelli, A., Tur-Kaspa, T., Confino, E. (2019). Ultrasound Guidance in Embryo Transfer. In: Stadtmauer, L., Tur-Kaspa, I. (eds) Ultrasound Imaging in Reproductive Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-16699-1_20

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-16699-1_20

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-16698-4

  • Online ISBN: 978-3-030-16699-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation