IVF success rates are improved with ultrasound guided embryo transfer

Over the last decade significant advances have been made in optimizing the in vitro environment used to maintain the sperm and eggs and grow the human embryos. This has resulted in a marked increase in the number and quality of the embryos that can be placed in the woman’s uterus. In spite of all these advances in the field, many of transferred embryos fail to implant. Furthermore, the low pregnancy rates combined with the high cost of IVF have prompted patients to request that more embryos be transferred in the hopes of conceiving. This has lead to a very high rate of multiple gestations.

In recent years more attention been placed on the Embryo Transfer (ET) technique and ways to improve it. It is now generally agreed that an atraumatic ET transfer and embryo placement in the optimal part of the endometrial cavity are essential for a successful embryo implantation. However, proper placement of the ET catheter into the endometrial cavity without traumatizing the endometrial lining may be difficult to do relying solely on the clinician’s ‘feel’. Because of this more emphasis has been placed on using transabdominal ultrasound (US) to allow the clinician to see the catheter inside the endometrial cavity during the ET. Several prospective, randomized studies suggest that US guided ET decreases the number of traumatic transfers and significantly improves implantation and pregnancy rates.

After some consideration, US guided ET was added to the IVF procedure at the end of 2002 and so far the results have been very positive (see below).

In preparation for the ET the patients are asked to drink four to six 8-oz glasses of water one hour before the transfer. When the bladder is adequately full, the patient is prepared for the ET. The tip of the ET catheter with the embryos is then introduced into the endometrial cavity approximately 1.5 cm from the fundus and the embryos are gently placed in the cavity while being observed on the US monitor. An added feature of US guided ET is that the patient can observe the placement of the embryo containing micro-droplet into the endometrial cavity. This visualization of the ET has proven to be very comforting and reassuring to the patients. Ten minutes after the transfer the patients are allowed to empty their bladder and go home.

Due to the success of US guided ET procedure, we now recommend that all embryo transfers be performed in this fashion. To better determine the depth of the endometrial cavity, we also recommend that all patients have a mock, ultrasound guided ET prior to their actual IVF cycle. In this way we can more accurately measure the depth of the endometrial cavity and patients become accustomed to having the catheter introduced into their uterus while having a full bladder.

ULTRASOUND GUIDED EMBRYO TRANSFER IMPROVES IVF AND FROZEN EMBRYO TRANSFER (FET) PREGNENCY RATES (2002-2003)