Skip to main content
SpringerLink
Log in

Ultrasound-Guided ETs or Clinical Touch ETs?

  • Chapter
Human Embryo Transfer

  • 765 Accesses

Abstract

Embryo transfer (ET) is the final rate-limiting step that concludes an assisted reproductive technology (ART) cycle and determines its clinical outcome. Hence, an absolute knowledge of the factors that positively influence the outcome, utmost skill and experience with the technique of ET is paramount to the desired success. Several factors, such as a routine uterine evaluation, prior knowledge about the uterine position, cavity depth, utero-cervical angle and abnormalities, if any, a mock ET to assess transfer difficulty, the use of ultrasound guidance to monitor ET, soft catheters, avoidance of uterine contractions or blood or mucus on the catheter, depositing embryos in the mid-portion of the endometrial cavity and, most importantly, the experience of the provider in performing ET, have been documented to positively impact the ET outcome. Though the use of ultrasound guidance versus clinical touch ET has been a much debated issue, clinical practice has now largely settled in favour of ultrasound-guided ET, owing to the numerous advantages provided by the technology, significantly, the possibility of executing an accurate and atraumatic embryo transfer under visual guidance.

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 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
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. Kably Ambe A, Campos Cañas JA, Aguirre Ramos G, Carballo Mondragón E, Carrera Lomas E, Ortiz Reyes H, Kisel Laska R. Evaluation of two transfer embryo systems performed by six physicians. [Article in Spanish]. Ginecol Obstet Mex. 2011;79(4):196–9.

    PubMed  Google Scholar 

  2. Eskandar M, Abou-Setta AM, Almushait MA, El-Amin M, Mohmad SE. Ultrasound guidance during embryo transfer: a prospective, single-operator, randomized, controlled trial. Fertil Steril. 2008;90(4):1187–90.

    Article  PubMed  Google Scholar 

  3. Porter MB. Ultrasound in assisted reproductive technology. Semin Reprod Med. 2008;26(3):266–76.

    Article  PubMed  Google Scholar 

  4. Buckett WM. A meta-analysis of ultrasound-guided versus clinical touch embryo transfer. Fertil Steril. 2003;80(4):1037–41.

    Article  PubMed  Google Scholar 

  5. Matorras R, Urquijo E, Mendoza R, Corcóstegui B, Expósito A, Rodríguez-Escudero FJ. Ultrasound-guided embryo transfer improves pregnancy rates and increases the frequency of easy transfers. Hum Reprod. 2002;17(7):1762–6.

    Article  CAS  PubMed  Google Scholar 

  6. 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(4):769–75.

    Article  PubMed  Google Scholar 

  7. Allahbadia GN. Ultrasonography-guided embryo transfer: evidence-based practice. In: Rizk BRMB, editor. Ultrasonography in reproductive medicine and infertility. New York: Cambridge University Press; 2010.

    Google Scholar 

  8. Poncelet C, Sifer C, Hequet D, Porcher R, Wolf JP, Uzan M, Ducarme G. Hysteroscopic evaluation of endocervical and endometrial lesions observed after different procedures of embryo transfer: a prospective comparative study. Eur J Obstet Gynecol Reprod Biol. 2009;147(2):183–6.

    Article  PubMed  Google Scholar 

  9. Allahbadia GN, Kadam K, Gandhi G, Arora S, Valliappan JB, Joshi A, Allahbadia S, Wolman I. Embryo transfer using the Sure View catheter-beacon in the womb. Fertil Steril. 2010;93(2):344–50.

    Article  PubMed  Google Scholar 

  10. Coroleu B, Barri PN, Carreras O, Belil I, Buxaderas R, Veiga A, Balasch J. Effect of using an echogenic catheter for ultrasound-guided embryo transfer in an IVF programme: a prospective, randomized, controlled study. Hum Reprod. 2006;21(7):1809–15.

    Article  PubMed  Google Scholar 

  11. Karande V, Hazlett D, Vietzke M, Gleicher N. A prospective randomized comparison of the Wallace catheter and the Cook Echo-Tip catheter for ultrasound-guided embryo transfer. Fertil Steril. 2002;77(4):826–30.

    Article  PubMed  Google Scholar 

  12. Pope CS, 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(1):51–8.

    Article  PubMed  Google Scholar 

  13. Coroleu B, Barri PN, Carreras O, Martínez 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(2):341–6.

    Article  PubMed  Google Scholar 

  14. Lambers MJ, Dogan E, Lens JW, Schats R, Hompes PG. The position of transferred air bubbles after embryo transfer is related to pregnancy rate. Fertil Steril. 2007;88(1):68–73.

    Article  PubMed  Google Scholar 

  15. Angelini A, Brusco GF, Barnocchi N, El-Danasouri I, Pacchiarotti A, Selman HA. Impact of physician performing embryo transfer on pregnancy rates in an assisted reproductive program. J Assist Reprod Genet. 2006;23(7–8):329–32.

    Article  PubMed  Google Scholar 

  16. Desparoir A, Capelle M, Banet J, Noizet A, Gamerre M, Courbière B. Does the experience of the provider affect pregnancy rates after embryo transfer? J Reprod Med. 2011;56(9–10):437–43.

    PubMed  Google Scholar 

  17. De Placido G, Wilding M, Stina I, Mollo A, Alviggi E, Tolino A, Colacurci N, De ML, Marino M, Dale B. The effect of ease of transfer and type of catheter used on pregnancy and implantation rates in an IVF program. J Assist Reprod Genet. 2002;19(1):14–8.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Mains L, Van Voorhis BJ. Optimizing the technique of embryo transfer. Fertil Steril. 2010;94(3):785–90.

    Article  PubMed  Google Scholar 

  19. Derks RS, Farquhar C, Mol BW, Buckingham K, Heineman MJ. Techniques for preparation prior to embryo transfer. Cochrane Database Syst Rev 2009 Oct 7;(4):CD007682.

    Google Scholar 

  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(3):710–4.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Selman H, Mariani M, Barnocchi N, Mencacci A, Bistoni F, Arena S, Pizzasegale S, Brusco GF, Angelini A. Examination of bacterial contamination at the time of embryo transfer, and its impact on the IVF/pregnancy outcome. J Assist Reprod Genet. 2007;24(9):395–9.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Grygoruk C, Pietrewicz P, Modlinski JA, Gajda B, Greda P, Grad I, Pietrzycki B, Mrugacz G. Influence of embryo transfer on embryo preimplantation development. Fertil Steril. 2012;97(6):1417–21.

    Article  PubMed  Google Scholar 

  23. Tiboni GM, Colangelo EC, Leonzio E, Gabriele E. Assisted reproduction outcomes after embryo transfers requiring a malleable stylet. J Assist Reprod Genet. 2012;29(7):585–8.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Cevrioglu AS, Esinler I, Bozdag G, Yarali H. Assessment of endocervical and endometrial damage inflicted by embryo transfer trial: a hysteroscopic evaluation. Reprod Biomed Online. 2006;13(4):523–7.

    Article  PubMed  Google Scholar 

  25. Spitzer D, Haidbauer R, Corn C, Stadler J, Wirleitner B, Zech NH. Effects of embryo transfer quality on pregnancy and live birth delivery rates. J Assist Reprod Genet. 2012;29(2):131–5.

    Article  PubMed Central  PubMed  Google Scholar 

  26. 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(4):135–42.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Muñoz M, Meseguer M, Lizán C, Ayllón Y, Pérez-Cano I, Garrido N. Bleeding during transfer is the only parameter of patient anatomy and embryo quality that affects reproductive outcome: a prospective study. Fertil Steril. 2009;92(3):953–5.

    Article  PubMed  Google Scholar 

  28. 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(2):239–42.

    Article  PubMed  Google Scholar 

  29. Moragianni VA, Cohen JD, Smith SE, Schinfeld JS, Somkuti SG, Lee A, Barmat LI. Effect of macroscopic or microscopic blood and mucus on the success rates of embryo transfers. Fertil Steril. 2010;93(2):570–3.

    Article  PubMed  Google Scholar 

  30. Sallam HN. Embryo transfer: factors involved in optimizing the success. Curr Opin Obstet Gynecol. 2005;17(3):289–98.

    Article  PubMed  Google Scholar 

  31. Levi Setti PE, Albani E, Cavagna M, Bulletti C, Colombo GV, Negri L. The impact of embryo transfer on implantation – a review. Placenta. 2003;24(Suppl B):S20–6.

    Article  PubMed  Google Scholar 

  32. Schoolcraft WB, Surrey ES, Gardner DK. Embryo transfer: techniques and variables affecting success. Fertil Steril. 2001;76(5):863–70.

    Article  CAS  PubMed  Google Scholar 

  33. Kroon B, Hart RJ, Wong BM, Ford E, Yazdani A. Antibiotics prior to embryo transfer in ART. Cochrane Database Syst Rev 2012;14;3:CD008995.

    Google Scholar 

  34. 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(11):2911–5.

    Article  CAS  PubMed  Google Scholar 

  35. Moreno V, Balasch J, Vidal E, Calafell JM, Cívico S, Vanrell JA. Air in the transfer catheter does not affect the success of embryo transfer. Fertil Steril. 2004;81(5):1366–70.

    Article  PubMed  Google Scholar 

  36. Forman EJ, Tao X, Ferry KM, Taylor D, Treff NR, Scott Jr RT. Single embryo transfer with comprehensive chromosome screening results in improved ongoing pregnancy rates and decreased miscarriage rates. Hum Reprod. 2012;27(4):1217–22.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. Meseguer M, Herrero J, Tejera A, Hilligsøe KM, Ramsing NB, Remohí J. The use of morphokinetics as a predictor of embryo implantation. Hum Reprod. 2011;26(10):2658–71.

    Article  PubMed  Google Scholar 

  38. Zander-Fox DL, Tremellen K, Lane M. Single blastocyst embryo transfer maintains comparable pregnancy rates to double cleavage-stage embryo transfer but results in healthier pregnancy outcomes. Aust N Z J Obstet Gynaecol. 2011;51(5):406–10.

    Article  PubMed  Google Scholar 

  39. Marsh CA, Farr SL, Chang J, Kissin DM, Grainger DA, Posner SF, Macaluso M, Jamieson DJ. Trends and factors associated with the Day 5 embryo transfer, assisted reproductive technology surveillance, USA, 2001–2009. Hum Reprod. 2012;27(8):2325–31.

    Article  PubMed  Google Scholar 

  40. Kresowik JD, Stegmann BJ, Sparks AE, Ryan GL, van Voorhis BJ. Five-years of a mandatory single-embryo transfer (mSET) policy dramatically reduces twinning rate without lowering pregnancy rates. Fertil Steril. 2011;96(6):1367–9.

    Article  PubMed  Google Scholar 

  41. 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(2):333–41.

    Article  PubMed  Google Scholar 

  42. Brown J, Buckingham K, Abou-Setta AM, Buckett W. Ultrasound versus ‘clinical touch’ for catheter guidance during embryo transfer in women. Cochrane Database Syst Rev. 2010;1, CD006107.

    PubMed  Google Scholar 

  43. Surrey ES. Should diagnostic hysteroscopy be performed before in vitro fertilization-embryo transfer? J Minim Invasive Gynecol. 2012;19(5):643–6.

    Article  PubMed  Google Scholar 

  44. Henne MB, Milki AA. Uterine position at real embryo transfer compared with mock embryo transfer. Hum Reprod. 2004;19(3):570–2.

    Article  CAS  PubMed  Google Scholar 

  45. Sallam HN, Agameya AF, Rahman AF, Ezzeldin F, Sallam AN. Ultrasound measurement of the uterocervical angle before embryo transfer: a prospective controlled study. Hum Reprod. 2002;17(7):1767–72.

    Article  CAS  PubMed  Google Scholar 

  46. Pacchiarotti A, Mohamed MA, Micara G, Tranquilli D, Linari A, Espinola SM, Aragona C. The impact of the depth of embryo replacement on IVF outcome. J Assist Reprod Genet. 2007;24(5):189–93.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Tiras B, Polat M, Korucuoglu U, Zeyneloglu HB, Yarali H. Impact of embryo replacement depth on in vitro fertilization and embryo transfer outcomes. Fertil Steril. 2010;94(4):1341–5.

    Article  PubMed  Google Scholar 

  48. Järvelä IY, Sladkevicius P, Kelly S, Ojha K, Campbell S, Nargund G. Evaluation of endometrial receptivity during in-vitro fertilization using three-dimensional power Doppler ultrasound. Ultrasound Obstet Gynecol. 2005;26(7):765–9.

    Article  PubMed  Google Scholar 

  49. Lindhard A, Ravn V, Bentin-Ley U, Horn T, Bangsboell S, Rex S, Toft B, Soerensen S. Ultrasound characteristics and histological dating of the endometrium in a natural cycle in infertile women compared with fertile controls. Fertil Steril. 2006;86(5):1344–55.

    Article  CAS  PubMed  Google Scholar 

  50. Mirkin S, Jones EL, Mayer JF, Stadtmauer L, Gibbons WE, Oehninger S. Impact of transabdominal ultrasound guidance on performance and outcome of transcervical uterine embryo transfer. J Assist Reprod Genet. 2003;20(8):318–22.

    Article  PubMed Central  PubMed  Google Scholar 

  51. Ressler IB, Pakrashi T, Sroga JM, Dipaola KB, Thomas MA, Lindheim SR. Effects of embryo transfer catheters on the endometrial surface noted at hysteroscopy. J Minim Invasive Gynecol. 2013;20(3):381–5.

    Article  PubMed  Google Scholar 

  52. 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(7):2263–8.

    Article  PubMed  Google Scholar 

  53. Letterie GS. Three-dimensional ultrasound-guided embryo transfer: a preliminary study. Am J Obstet Gynecol. 2005;192(6):1983–7.

    Article  PubMed  Google Scholar 

  54. Xin ZM, Xu B, Jin HX, Song WY, Sun YP. Day 3 embryo transfer may have better pregnancy outcomes in younger than 35-year-old patients with poor ovarian response. J Assist Reprod Genet. 2012;29(10):1077–81.

    Article  PubMed Central  PubMed  Google Scholar 

  55. Fang L, Sun Y, Su Y, Guo Y. Advantages of 3-dimensional sonography in embryo transfer. J Ultrasound Med. 2009;28(5):573–8.

    PubMed  Google Scholar 

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

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  57. Tiras B, Korucuoglu U, Polat M, Saltik A, Zeyneloglu HB, Yarali H. Effect of air bubble localization after transfer on embryo transfer outcomes. Eur J Obstet Gynecol Reprod Biol. 2012;164(1):52–4.

    Article  PubMed  Google Scholar 

  58. Lambers MJ, Dogan E, Kostelijk H, Lens JW, Schats R, Hompes PG. Ultrasonographic-guided embryo transfer does not enhance pregnancy rates compared with embryo transfer based on previous uterine length measurement. Fertil Steril. 2006;86(4):867–72.

    Article  PubMed  Google Scholar 

  59. Flisser E, Grifo JA, Krey LC, Noyes N. Transabdominal ultrasound-assisted embryo transfer and pregnancy outcome. Fertil Steril. 2006;85(2):353–7.

    Article  PubMed  Google Scholar 

  60. Kosmas IP, Janssens R, De Munck L, Al Turki H, Van der Elst J, Tournaye H, Devroey P. Ultrasound-guided embryo transfer does not offer any benefit in clinical outcome: a randomized controlled trial. Hum Reprod. 2007;22(5):1327–34.

    Article  CAS  PubMed  Google Scholar 

  61. Allahbadia GN, Merchant R, Gandhi G. Embryo transfer. In: Jain K, Talwar P, editors. IVF techniques for the beginners. New Delhi: Jaypee Brothers Medical Publishers Pvt. Ltd; 2013. p. 12–35.

    Chapter  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Assisted Reproduction, New Hope IVF, Sharjah, UAE

    Gautam N. Allahbadia MD, DNB, FNAMS

  2. Rotunda-The Center for Human Reproduction, Mumbai, India

    Gautam N. Allahbadia MD, DNB, FNAMS

  3. Rotunda-Blue Fertility Clinic & Keyhole Surgery Center, Mumbai, India

    Gautam N. Allahbadia MD, DNB, FNAMS

  4. Department of Assisted Reproduction, Rotunda – The Center for Human Reproduction, Mumbai, India

    Rubina Merchant PhD, Goral Gandhi MSc & Akanksha Allahbadia MBBS

Authors
  1. Gautam N. Allahbadia MD, DNB, FNAMS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rubina Merchant PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Goral Gandhi MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Akanksha Allahbadia MBBS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gautam N. Allahbadia MD, DNB, FNAMS .

Editor information

Editors and Affiliations

  1. Rotunda - Blue Fertility Clinic & Keyhole Surgery Center, Medical Director, Rotunda- The Center for Human Reproduction, Mumbai, India

    Gautam N. Allahbadia

  2. Director of Matercell, Department of Reproductive Medicine, Center for Studies in Genetics and Reproduction, Buenos Aires, Argentina

    Claudio F. Chillik

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer India

About this chapter

Cite this chapter

Allahbadia, G.N., Merchant, R., Gandhi, G., Allahbadia, A. (2015). Ultrasound-Guided ETs or Clinical Touch ETs?. In: Allahbadia, G., Chillik, C. (eds) Human Embryo Transfer. Springer, New Delhi. https://doi.org/10.1007/978-81-322-1115-0_4

Download citation

  • DOI: https://doi.org/10.1007/978-81-322-1115-0_4

  • Publisher Name: Springer, New Delhi

  • Print ISBN: 978-81-322-1114-3

  • Online ISBN: 978-81-322-1115-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation