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54 - Optimizing Embryo Transfer

from PART III - ASSISTED REPRODUCTION

Published online by Cambridge University Press:  04 August 2010

By
Hassan N. Sallam
Edited by
Botros R. M. B. Rizk ,
Juan A. Garcia-Velasco ,
Hassan N. Sallam  and
Antonis Makrigiannakis
Botros R. M. B. Rizk
Affiliation:
University of South Alabama
Juan A. Garcia-Velasco
Affiliation:
Rey Juan Carlos University School of Medicine,
Hassan N. Sallam
Affiliation:
University of Alexandria School of Medicine
Antonis Makrigiannakis
Affiliation:
University of Crete
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Summary

Despite numerous developments in assisted reproduction, the implantation rate of the replaced embryos in IVF and ICSI remains low. In 1995, Edwards observed that despite the replacement of good quality embryos, 85 percent of these embryos do not implant (1). These low success rates have been variously blamed on compromised endometrial receptivity, compromised implantation capacity of the embryo, or a suboptimal embryo transfer (ET) technique. The aim of this review is to describe the technique of ET, to evaluate the various modifications proposed in order to maximize the chances of pregnancy, and to discuss the different approaches available for managing difficult ETs.

THE TECHNIQUE OF ET

ET is usually performed two to five days after oocyte retrieval. Although the knee-chest position was originally recommended by some authors, most of the transfers are now performed in the lithotomy position (2, 3). The procedure is performed under sterile conditions; the patient is draped, a speculum is inserted in the vagina, and the cervix exposed. The cervical mucus is aspirated using a mucus aspirator and the cervix is then cleansed with a swab soaked with saline or culture medium.

Different types of plastic catheters are used for ET varying in length, diameter, stiffness, and memory and are checked for embryo toxicity. Catheters are either preloaded or afterloaded, depending on whether embryos are loaded directly into the catheter or whether the outer sheath is first placed in the uterine cavity using a guide wire or obturator.

Keywords

cervical mucusembryo selectionembryo transferemrbyo catheterultrasounduterine contractilitypregnancy
Type
Chapter
Information
Infertility and Assisted Reproduction , pp. 506 - 517
Publisher: Cambridge University Press
Print publication year: 2008

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References

Edwards, RG. Clinical approaches to increasing uterine receptivity during human implantation. Hum Reprod 1995;10 (Suppl. 2):60–6.CrossRefGoogle ScholarPubMed
Edwards, RG, Steptoe, PC, Purdy, JM. Establishing full-term human pregnancies using cleaving embryos grown in vitro. Br J Obstet Gynaecol 1980;87:737–56.CrossRefGoogle ScholarPubMed
Jones, HW Jr., Acosta, AA, Garcia, JE, Sandow, BA, Veeck, L. On the transfer of conceptuses from oocytes fertilized in vitro. Fertil Steril 1983;39:241–3.CrossRefGoogle ScholarPubMed
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;83:710–14.CrossRefGoogle ScholarPubMed
Sharif, K, Afnan, M, Lenton, W, et al. Do patients need to remain in bed following embryo transfer? The Birmingham experience of 103 in-vitro fertilization cycles with no bed rest following embryo transfer. Hum Reprod 1995;10:1427–9.CrossRefGoogle ScholarPubMed
Botta, G, Grudzinskas, G. Is a prolonged bed rest following embryo transfer useful?Hum Reprod 1997;12:2489–92.CrossRefGoogle ScholarPubMed
Sharif, K, Afnan, M, Lashen, H, Elgendy, M, Morgan, C, Sinclair, L. Is bed rest following embryo transfer necessary?Fertil Steril 1998;69:478–81.CrossRefGoogle ScholarPubMed
El-Toukhy, T, Khalaf, Y, Braude, P. IVF results: optimize not maximize. Am J Obstet Gynecol 2006;194:322–31.CrossRefGoogle Scholar
Gerris, JM. Single embryo transfer and IVF/ICSI outcome: a balanced appraisal. Hum Reprod Update 2005;11:105–21.CrossRefGoogle ScholarPubMed
Kovacs, G, MacLachlan, V, Rombauts, L, Healy, D, Howlett, D. Replacement of one selected embryo is just as successful as two embryo transfer, without the risk of twin pregnancy. Aust N Z J Obstet Gynaecol 2003;43:369–71.CrossRefGoogle ScholarPubMed
Neubourg, D, Gerris, J. Single embryo transfer—state of the art. Reprod Biomed Online 2003;7:615–22.CrossRefGoogle ScholarPubMed
Fisch, JD, Sher, G, Adamowicz, M, Keskintepe, L. The graduated embryo score predicts the outcome of assisted reproductive technologies better than a single day 3 evaluation and achieves results associated with blastocyst transfer from day 3 embryo transfer. Fertil Steril 2003;80:1352–8.CrossRefGoogle ScholarPubMed
Manna, C, Patrizi, G, Rahman, A, Sallam, H. Experimental results on the recognition of embryos in human assisted reproduction. Reprod Biomed Online 2004;8:460–9.CrossRefGoogle ScholarPubMed
Montfoort, AP, Dumoulin, JC, Kester, AD, Evers, JL. Early cleavage is a valuable addition to existing embryo selection parameters: a study using single embryo transfers. Hum Reprod 2004;19:2103–8.CrossRefGoogle ScholarPubMed
Ciray, HN, Ulug, U, Bahceci, M. Transfer of early-cleaved embryos increases implantation rate in patients undergoing ovarian stimulation and ICSI-embryo transfer. Reprod Biomed Online 2004;8:219–23.CrossRefGoogle ScholarPubMed
Gardner, DK, Surrey, E, Minjarez, D, et al. Single blastocyst transfer: a prospective randomized trial. Fertil Steril 2004;81:551–5.CrossRefGoogle ScholarPubMed
Milki, AA, Hinckley, MD, Westphal, LM, Behr, B. Elective single blastocyst transfer. Fertil Steril 2004;81:1697–8.CrossRefGoogle ScholarPubMed
Gianaroli, L, Magli, MC, Ferraretti, AP, et al. Preimplantation genetic diagnosis increases the implantation rate in human in vitro fertilization by avoiding the transfer of chromosomally abnormal embryos. Fertil Steril 1997;68:1128–31.CrossRefGoogle ScholarPubMed
Boer, KA, Catt, JW, Jansen, RP, et al. Moving to blastocyst biopsy for preimplantation genetic diagnosis and single embryo transfer at Sydney IVF. Fertil Steril 2004;82:295–8.CrossRefGoogle ScholarPubMed
Lopes, AS, Greve, T, Callesen, H. Quantification of embryo quality by respirometry. Theriogenology 2007;67:21–31.CrossRefGoogle ScholarPubMed
Sallam, HN, El-Kassar, Y, Hany Abdel-Rahman, A, Agameya, A, Farrag, A, Shams, A. Glucose consumption and total protein production by preimplantation embryos in pregnant and non-pregnant women—possible methods for embryo selection. Fertil Steril 2006;86 (3) (Suppl.): S114.Google Scholar
Houghton, FD, Hawkhead, JA, Humpherson, PG, Hogg, JE, Balen, AH, Rutherford, AJ, Leese, HJ. Non-invasive amino acid turnover predicts human embryo developmental capacity. Hum Reprod 2002;17:999–1005.CrossRefGoogle ScholarPubMed
Abou-Setta, AM, Al-Inany, HG, Mansour, RT, Serour, GI, Aboulghar, MA. Soft versus firm embryo transfer catheters for assisted reproduction: a systematic review and meta-analysis. Hum Reprod 2005;20:3114–21.CrossRefGoogle ScholarPubMed
Buckett, WM. A review and meta-analysis of prospective trials comparing different catheters used for embryo transfer. Fertil Steril 2006;85:728–34.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Knutzen, V, Stratton, CJ, Sher, G, et al. Mock embryo transfer in early luteal phase, the cycle before in vitro fertilization and embryo transfer: a descriptive study. Fertil Steril 1992;57:156–62.CrossRefGoogle ScholarPubMed
Sallam, HN. Embryo transfer—the elusive step. In: Progress in Obstetrics and Gynaecology. Studd, John, Ed. Edinburgh and London: Churchill Livingstone; 2003:363–80.Google Scholar
Sharif, K, Afnan, M, Lenton, W. Mock embryo transfer with a full bladder immediately before the real transfer for in-vitro fertilization treatment: the Birmingham experience of 113 cases. Hum Reprod 1995;10:1715–18.CrossRefGoogle ScholarPubMed
Urman, B, Aksoy, S, Alatas, C, et al. Comparing two embryo transfer catheters. Use of a trial transfer to determine the catheter applied. J Reprod Med 2000;45:135–8.Google ScholarPubMed
Henne, MB, Milki, AA. Uterine position at real embryo transfer compared with mock embryo transfer. Hum Reprod 2004;19:570–2.CrossRefGoogle ScholarPubMed
Sallam, HN, Agameya, AF, Rahman, AF, et al. Ultrasound measurement of the uterocervical angle before embryo transfer: a prospective controlled study. Hum Reprod 2002;17:1767–72.CrossRefGoogle ScholarPubMed
Shamonki, MI, Spandorfer, SD, Rosenwaks, Z. Ultrasound-guided embryo transfer and the accuracy of trial embryo transfer. Hum Reprod 2005;20:709–16.CrossRefGoogle ScholarPubMed
Shamonki, MI, Schattman, GL, Spandorfer, SD, Chung, PH, Rosenwaks, Z. Ultrasound-guided trial transfer may be beneficial in preparation for an IVF cycle. Hum Reprod 2005;20:2844–9.CrossRefGoogle ScholarPubMed
Feichtinger, W, Kemeter, P, Menezo, Y. The use of synthetic culture medium and patient serum for human in vitro fertilization and embryo replacement. J In Vitro Fert Embryo Transf 1986;3:87–92.CrossRefGoogle ScholarPubMed
Psalti, I, Loumaye, E, Pensis, M, Depreester, S, Thomas, K. Evaluation of a synthetic serum substitute to replace fetal cord serum for human oocyte fertilization and embryo growth in vitro. Fertil Steril 1989;52:807–11.CrossRefGoogle ScholarPubMed
Khan, I, Staessen, C, Devroey, P, Steirteghem, AC. Human serum albumin versus serum: a comparative study on embryo transfer medium. Fertil Steril 1991;56:98–101.CrossRefGoogle ScholarPubMed
Laverge, H, Sutter, P, Desmet, R, Elst, J, Dhont, M. Prospective randomized study comparing human serum albumin with fetal cord serum as protein supplement in culture medium for in-vitro fertilization. Hum Reprod 1997;12:2263–6.CrossRefGoogle ScholarPubMed
Simon, A, Safran, A, Revel, A, et al. Hyaluronic acid can successfully replace albumin as the sole macromolecule in a human embryo transfer medium. Fertil Steril 2003;79:1434–8.CrossRefGoogle Scholar
Loutradi, KE, Prassas, I, Bili, E, Sanopoulou, T, Bontis, I, Tarlatzis, BC. Evaluation of a transfer medium containing high concentration of hyaluronan in human in vitro fertilization. Fertil Steril 2006.Google ScholarPubMed
Feichtinger, W, Strohmer, H, Radner, KM, Goldin, M. The use of fibrin sealant for embryo transfer: development and clinical studies. Hum Reprod 1992;7:890–3.CrossRefGoogle ScholarPubMed
Ben-Rafael, Z, Ashkenazi, J, Shelef, M, et al. The use of fibrin sealant in in vitro fertilization and embryo transfer. Int J Fertil Menopausal Stud 1995;40:303–6.Google ScholarPubMed
Valojerdi, MR, Karimian, L, Yazdi, PE, Gilani, MA, Madani, T, Baghestani, AR. Efficacy of a human embryo transfer medium: a prospective, randomized clinical trial study. J Assist Reprod Genet 2006;23:207–12.CrossRefGoogle ScholarPubMed
Hinckley, MD, Milki, AA. Rapid reaccumulation of hydrometra after drainage at embryo transfer in patients with hydrosalpinx. Fertil Steril 2003;80:1268–71.CrossRefGoogle ScholarPubMed
Hofmann, GE, Warikoo, P, Jacobs, W. Ultrasound detection of pyometra at the time of embryo transfer after ovum retrieval for in vitro fertilization. Fertil Steril 2003;80:637–8.CrossRefGoogle ScholarPubMed
Quintero, RB, Sharara, FI, Milki, AA. Successful pregnancies in the setting of exaggerated endometrial thickness. Fertil Steril 2004;82:215–17.CrossRefGoogle ScholarPubMed
Jarvela, 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;26:765–9.CrossRefGoogle ScholarPubMed
Zollner, U, Zollner, KP, Specketer, MT, et al. Endometrial volume as assessed by three-dimensional ultrasound is a predictor of pregnancy outcome after in vitro fertilization and embryo transfer. Fertil Steril 2003;80:1515–17.CrossRefGoogle ScholarPubMed
Zaidi, J, Campbell, S, Pittrof, R, Tan, SL. Endometrial thickness, morphology, vascular penetration and velocimetry in predicting implantation in an in vitro fertilization program. Ultrasound Obstet Gynecol 1995;6:191–8.CrossRefGoogle Scholar
Kupesic, S, Bekavac, I, Bjelos, D, Kurjak, A. Assessment of endometrial receptivity by transvaginal color Doppler and three-dimensional power Doppler ultrasonography in patients undergoing in vitro fertilization procedures. J Ultrasound Med 2001; 20:125–34.CrossRefGoogle ScholarPubMed
Chien, LW, Lee, WS, Au, HK, Tzeng, CR. Assessment of changes in utero-ovarian arterial impedance during the peri-implantation period by Doppler sonography in women undergoing assisted reproduction. Ultrasound Obstet Gynecol 2004;23:496–500.CrossRefGoogle ScholarPubMed
Ng, EH, Chan, CC, Tang, OS, Yeung, WS, Ho, PC. Endometrial and subendometrial vascularity is higher in pregnant patients with livebirth following ART than in those who suffer a miscarriage. Hum Reprod 2006.Google ScholarPubMed
Ng, EH, Chan, CC, Tang, OS, Yeung, WS, Ho, PC. The role of endometrial and subendometrial blood flows measured by three-dimensional power Doppler ultrasound in the prediction of pregnancy during IVF treatment. Hum Reprod 2006;21:164–70.CrossRefGoogle ScholarPubMed
Chien, LW, Au, HK, Chen, PL, Xiao, J, Tzeng, CR. Assessment of uterine receptivity by the endometrial-subendometrial blood flow distribution pattern in women undergoing in vitro fertilization-embryo transfer. Fertil Steril 2002;78:245–51.CrossRefGoogle ScholarPubMed
Maugey-Laulom, B, Commenges-Ducos, M, Jullien, V, Papaxanthos-Roche, A, Scotet, V, Commenges, D. Endometrial vascularity and ongoing pregnancy after IVF. Eur J Obstet Gynecol Reprod Biol 2002;104:137–43.CrossRefGoogle ScholarPubMed
Lewin, A, Schenker, JG, Avrech, O, et al. The role of uterine straightening by passive bladder distension before embryo transfer in IVF cycles. J Assist Reprod Genet 1997;14:32–4.CrossRefGoogle ScholarPubMed
Lorusso, F, Depalo, R, Bettocchi, S, Vacca, M, Vimercati, A, Selvaggi, L. Outcome of in vitro fertilization after transabdominal ultrasound-assisted embryo transfer with a full or empty bladder. Fertil Steril 2005;84:1046–8.CrossRefGoogle ScholarPubMed
MacNamee P. Vigorous flushing the cervical canal with culture medium prior to embryo transfer. Paper presented at the World Congress of IVF, Sydney 1999.
Sallam, HN, Farrag, F, Ezzeldin, A, Agameya, A, Sallam, AN. The importance of flushing the cervical canal with culture medium prior to embryo transfer. Fertil Steril 2000;3 (Suppl. 1):64–5.CrossRefGoogle Scholar
Berkkanoglu, M, Isikoglu, M, Seleker, M, Ozgur, K. Flushing the endometrium prior to the embryo transfer does not affect the pregnancy rate. Reprod Biomed Online 2006;13:268–71.CrossRefGoogle Scholar
Hearns-Stokes, RM, Miller, BT, Scott, L, et al. Pregnancy rates after embryo transfer depend on the provider at embryo transfer. Fertil Steril 2000;74:80–6.CrossRefGoogle ScholarPubMed
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;23:329–32.CrossRefGoogle Scholar
Barber, D, Egan, D, Ross, C, et al. Nurses performing embryo transfer: successful outcome of in-vitro fertilization. Hum Reprod 1996;11:105–8.CrossRefGoogle ScholarPubMed
Sinclair, L, Morgan, C, Lashen, H, et al. Nurses performing embryo transfer: the development and results of the Birmingham experience. Hum Reprod 1998;13:699–702.CrossRefGoogle ScholarPubMed
Bjuresten, K, Hreinsson, JG, Fridstrom, M, et al. Embryo transfer by midwife or gynecologist: a prospective randomized study. Acta Obstet Gynecol Scand 2003;82:462–6.CrossRefGoogle ScholarPubMed
Papageorgiou, TC, Hearns-Stokes, RM, Leondires, MP, Miller, BT, Chakraborty, P, Cruess, D, Segars, J. Training of providers in embryo transfer: what is the minimum number of transfers required for proficiency?Hum Reprod 2001;16:1415–19.CrossRefGoogle ScholarPubMed
Englert, Y, Puissant, F, Camus, M, Hoeck, J, Leroy, F. Clinical study on embryo transfer after human in vitro fertilization. J In Vitro Fert Embryo Transf 1986;3:243–6.CrossRefGoogle ScholarPubMed
Ribic-Pucelj, M, Tomazevic, T, Vogler, A, Meden-Vrtovec, H. Risk factors for ectopic pregnancy after in vitro fertilization and embryo transfer. J Assist Reprod Genet 1995;12:594–8.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Sallam, HN, Agameya, AF, Rahman, AF, et al. 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;20:135–42.CrossRefGoogle ScholarPubMed
Goudas, VT, Hammitt, DG, Damario, MA, et al. Blood on the embryo transfer catheter is associated with decreased rates of embryo implantation and clinical pregnancy with the use of in vitro fertilization-embryo transfer. Fertil Steril 1998;70:878–82.CrossRefGoogle ScholarPubMed
Tomas, C, Tikkinen, K, Tuomivaara, L, Tapanainen, JS, Martikainen, H. The degree of difficulty of embryo transfer is an independent factor for predicting pregnancy. Hum Reprod 2002;17:2632–5.CrossRefGoogle ScholarPubMed
Silberstein, T, Weitzen, S, Frankfurter, D, et al. Cannulation of a resistant internal os with the malleable outer sheath of a coaxial soft embryo transfer catheter does not affect in vitro fertilization-embryo transfer outcome. Fertil Steril 2004;82:1402–6.CrossRefGoogle Scholar
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;13:523–7.CrossRefGoogle ScholarPubMed
Marconi, G, Vilela, M, Bello, J, et al. Endometrial lesions caused by catheters used for embryo transfers: a preliminary report. Fertil Steril 2003;80:363–7.CrossRefGoogle ScholarPubMed
Murray, AS, Healy, DL, Rombauts, L. Embryo transfer: hysteroscopic assessment of transfer catheter effects on the endometrium. Reprod Biomed Online 2003;7:583–6.CrossRefGoogle ScholarPubMed
Fanchin, R, Righini, C, Ziegler, D, et al. Effects of vaginal progesterone administration on uterine contractility at the time of embryo transfer. Fertil Steril 2001;75:1136–40.CrossRefGoogle ScholarPubMed
Baruffi, R, Mauri, AL, Petersen, CG, et al. Effects of vaginal progesterone administration starting on the day of oocyte retrieval on pregnancy rates. J Assist Reprod Genet 2003;20:517–20.CrossRefGoogle ScholarPubMed
Shaker, AG, Fleming, R, Jamieson, ME, Yates, RW, Coutts, JR. Assessments of embryo transfer after in-vitro fertilization: effects of glyceryl trinitrate. Hum Reprod 1993;8:1426–8.CrossRefGoogle ScholarPubMed
Moon, HS, Park, SH, Lee, JO, Kim, KS, Joo, BS. Treatment with piroxicam before embryo transfer increases the pregnancy rate after in vitro fertilization and embryo transfer. Fertil Steril 2004;82:816–20.CrossRefGoogle ScholarPubMed
Ven, H, Diedrich, K, Al-Hasani, S, Pless, V, Krebs, D. The effect of general anaesthesia on the success of embryo transfer following human in-vitro fertilization. Hum Reprod 1988;3 (Suppl. 2):81–3.Google ScholarPubMed
Paulus, WE, Zhang, M, Strehler, E, El-Danasouri, I, Sterzik, K. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertil Steril 2002;77:721–4.CrossRefGoogle ScholarPubMed
Westergaard, LG, Mao, Q, Krogslund, M, Sandrini, S, Lenz, S, Grinsted, J. Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial. Fertil Steril 2006;85:1341–6.CrossRefGoogle ScholarPubMed
Smith, C, Coyle, M, Norman, RJ. Influence of acupuncture stimulation on pregnancy rates for women undergoing embryo transfer. Fertil Steril 2006;85:1352–8.CrossRefGoogle ScholarPubMed
Levitas, E, Parmet, A, Lunenfeld, E, Bentov, Y, Burstein, E, Friger, M, Potashnik, G. Impact of hypnosis during embryo transfer on the outcome of in vitro fertilization-embryo transfer: a case-control study. Fertil Steril 2006;85:1404–8.CrossRefGoogle ScholarPubMed
Strickler, RC, Christianson, C, Crane, JP, et al. Ultrasound guidance for human embryo transfer. Fertil Steril 1985;43:54–61.CrossRefGoogle ScholarPubMed
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;21:1809–15.CrossRefGoogle Scholar
Letterie, GS, Marshall, L, Angle, M. A new coaxial catheter system with an echodense tip for ultrasonographically guided embryo transfer. Fertil Steril 1999;72:266–8.Google ScholarPubMed
Sallam, HN, Sadek, SS. Ultrasound-guided embryo transfer: a meta-analysis of randomized controlled trials. Fertil Steril 2003;80:1042–6.CrossRefGoogle ScholarPubMed
Buckett, WM. A meta-analysis of ultrasound-guided versus clinical touch embryo transfer. Fertil Steril 2003;80:1037–41.CrossRefGoogle ScholarPubMed
Woolcott, R, Stanger, J. Potentially important variables identified by transvaginal ultrasound-guided embryo transfer. Hum Reprod 1997;12:963–6.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Letterie, GS. Three-dimensional ultrasound-guided embryo transfer: a preliminary study. Am J Obstet Gynecol 2005;192:1983–7; discussion 1987–8.CrossRefGoogle ScholarPubMed
Gergely, RZ, DeUgarte, CM, Danzer, H, Surrey, M, Hill, D, DeCherney, AH. Three dimensional/four dimensional ultrasound-guided embryo transfer using the maximal implantation potential point. Fertil Steril 2005;84:500–3.CrossRefGoogle ScholarPubMed
Baba, K, Ishihara, O, Hayashi, N, Saitoh, M, Taya, J, Kinoshita, K. Where does the embryo implant after embryo transfer in humans?Fertil Steril 2000;73:123–5.CrossRefGoogle ScholarPubMed
Krampl, E, Zegermacher, G, Eichler, C, Obruca, A, Strohmer, H, Feichtinger, W. Air in the uterine cavity after embryo transfer. Fertil Steril 1995;63:366–70.CrossRefGoogle ScholarPubMed
Moreno, V, Balasch, J, Vidal, E, et al. Air in the transfer catheter does not affect the success of embryo transfer. Fertil Steril 2004; 81:1366–70.CrossRefGoogle Scholar
Eytan, O, Elad, D, Zaretsky, U, Jaffa, AJ. A glance into the uterus during in vitro simulation of embryo transfer. Hum Reprod 2004;19:562–9.CrossRefGoogle ScholarPubMed
Matorras, R, Mendoza, R, Exposito, A, Rodriguez-Escudero, FJ. Influence of the time interval between embryo catheter loading and discharging on the success of IVF. Hum Reprod 2004;19:2027–30.CrossRefGoogle ScholarPubMed
Coroleu, B, Barri, PN, Carreras, O, et al. 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.CrossRefGoogle ScholarPubMed
Pope, CS, Cook, EK, Arny, M, et al. Influence of embryo transfer depth on in vitro fertilization and embryo transfer outcomes. Fertil Steril 2004;81:51–8.CrossRefGoogle ScholarPubMed
Frankfurter, D, Silva, CP, Mota, F, et al. The transfer point is a novel measure of embryo placement. Fertil Steril 2003;79:1416–21.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Franco, JG Jr, Martins, AM, Baruffi, RL, et al. Best site for embryo transfer: the upper or lower half of endometrial cavity?Hum Reprod 2004;19:1785–90.CrossRefGoogle ScholarPubMed
Oliveira, JB, Martins, AM, Baruffi, RL, et al. Increased implantation and pregnancy rates obtained by placing the tip of the transfer catheter in the central area of the endometrial cavity. Reprod Biomed Online 2004;9:435–41.CrossRefGoogle ScholarPubMed
Cavagna, M, Contart, P, Petersen, CG, Mauri, AL, Martins, AM, Baruffi, RL, Oliveira, JB, Franco, JG Jr. Implantation sites after embryo transfer into the central area of the uterine cavity. Reprod Biomed Online 2006;13:541–6.CrossRefGoogle ScholarPubMed
Silberstein, T, Trimarchi, JR, Shackelton, R, Weitzen, S, Frankfurter, D, Plosker, S. Ultrasound-guided miduterine cavity embryo transfer is associated with a decreased incidence of retained embryos in the transfer catheter. Fertil Steril 2005;84:1510–12.CrossRefGoogle ScholarPubMed
Nazari, A, Askari, HA, Check, JH, O'Shaughnessy, A. Embryo transfer technique as a cause of ectopic pregnancy in in vitro fertilization. Fertil Steril 1993;60:919–21.CrossRefGoogle ScholarPubMed
Dorn, C, Reinsberg, J, Schlebusch, H, et al. Serum oxytocin concentration during embryo transfer procedure. Eur J Obstet Gynecol Reprod Biol 1999;87:77–80.CrossRefGoogle ScholarPubMed
Lesny, P, Killick, SR, Robinson, J, et al. Junctional zone contractions and embryo transfer: is it safe to use a tenaculum?Hum Reprod 1999;14:2367–70.CrossRefGoogle ScholarPubMed
Fanchin, R, Righini, C, Ayoubi, JM, et al. [Uterine contractions at the time of embryo transfer: a hindrance to implantation?] [Article in French]. Contracept Fertil Sex 1998;26:498–505.Google Scholar
Martinez, F, Coroleu, B, Parriego, M, et al. Ultrasound-guided embryo transfer: immediate withdrawal of the catheter versus a 30 second wait. Hum Reprod 2001;16:871–4.CrossRefGoogle ScholarPubMed
Mansour, R. Minimizing embryo expulsion after embryo transfer: a randomized controlled study. Hum Reprod 2005;20:170–4.CrossRefGoogle ScholarPubMed
Visser, DS, Fourie, FL, Kruger, HF. Multiple attempts at embryo transfer: effect on pregnancy outcome in an in vitro fertilization and embryo transfer program. J Assist Reprod Genet 1993;10:37–43.CrossRefGoogle Scholar
Lee, HC, Seifer, DB, Shelden, RM. Impact of retained embryos on the outcome of assisted reproductive technologies. Fertil Steril 2004;82:334–7.CrossRefGoogle ScholarPubMed
Abramovici, H, Dirnfeld, M, Weisman, Z, et al. Pregnancies following the interval double-transfer technique in an in vitro fertilization-embryo transfer program. J In Vitro Fert Embryo Transf 1988;5:175–6.CrossRefGoogle Scholar
Phillips, SJ, Dean, NL, Buckett, WM, Tan, SL. Consecutive transfer of day 3 embryos and of day 5-6 blastocysts increases overall pregnancy rates associated with blastocyst culture. J Assist Reprod Genet 2003;20:461–4.CrossRefGoogle ScholarPubMed
Loutradis, D, Drakakis, P, Dallianidis, K, et al. A double embryo transfer on days 2 and 4 or 5 improves pregnancy outcome in patients with good embryos but repeated failures in IVF or ICSI. Clin Exp Obstet Gynecol 2004;31:63–6.Google ScholarPubMed
Goto, S, Shiotani, M, Kitagawa, M, Kadowaki, T, Noda, Y. Effectiveness of two-step (consecutive) embryo transfer in patients who have two embryos on day 2: comparison with cleavage-stage embryo transfer. Fertil Steril 2005;83:721–3.CrossRefGoogle ScholarPubMed
Machtinger, R, Dor, J, Margolin, M, et al. Sequential transfer of day 3 embryos and blastocysts after previous IVF failures despite adequate ovarian response. Reprod Biomed Online 2006;13:376–9.CrossRefGoogle ScholarPubMed
Bar-Hava, I, Kerner, R, Yoeli, R, Ashkenazi, J, Shalev, Y, Orvieto, R. Immediate ambulation after embryo transfer: a prospective study. Fertil Steril 2005;83:594–7.CrossRefGoogle ScholarPubMed
Amarin, ZO, Obeidat, BR. Bed rest versus free mobilisation following embryo transfer: a prospective randomised study. BJOG 2004;111:1273–6.CrossRefGoogle ScholarPubMed
Tremellen, KP, Valbuena, D, Landeras, J, et al. The effect of intercourse on pregnancy rates during assisted human reproduction. Hum Reprod 2000;15:2653–8.CrossRefGoogle ScholarPubMed
Waldenstrom, U, Hellberg, D, Nilsson, S. Low-dose aspirin in a short regimen as standard treatment in in vitro fertilization: a randomized, prospective study. Fertil Steril 2004;81:1560–4.CrossRefGoogle Scholar
Pakkila, M, Rasanen, J, Heinonen, S, et al. Low-dose aspirin does not improve ovarian responsiveness or pregnancy rate in IVF and ICSI patients: a randomized, placebo-controlled double-blind study. Hum Reprod 2005;20:2211–14.CrossRefGoogle ScholarPubMed
Duvan, CI, Ozmen, B, Satiroglu, H, Atabekoglu, CS, Berker, B. Does addition of low-dose aspirin and/or steroid as a standard treatment in nonselected intracytoplasmic sperm injection cycles improve in vitro fertilization success? A randomized, prospective, placebo-controlled study. J Assist Reprod Genet 2006;23:15–21.CrossRefGoogle ScholarPubMed
Check, JH, Graziano, V, Lee, G, et al. Neither sildenafil nor vaginal estradiol improves endometrial thickness in women with thin endometria after taking oral estradiol in graduating dosages. Clin Exp Obstet Gynecol 2004;31:99–102.Google ScholarPubMed
Egbase, PE, al-Sharhan, M, al-Othman, S, et al. Incidence of microbial growth from the tip of the embryo transfer catheter after embryo transfer in relation to clinical pregnancy rate following in-vitro fertilization and embryo transfer. Hum Reprod 1996;11:1687–9.CrossRefGoogle ScholarPubMed
Moore, , Soules, MR, Klein, NA, Fujimoto, , et al. Bacteria in the transfer catheter tip influence the live-birth rate after in vitro fertilization. Fertil Steril 2000;74:1118–24.CrossRefGoogle ScholarPubMed
Wittemer, C, Bettahar-Lebugle, K, Ohl, J, et al. [Abnormal bacterial colonisation of the vagina and implantation during assisted reproduction]. [Article in French]. Gynecol Obstet Fertil 2004;32:135–9.CrossRefGoogle Scholar
Egbase, PE, Udo, EE, Al-Sharhan, M, Grudzinskas, JG. Prophylactic antibiotics and endocervical microbial inoculation of the endometrium at embryo transfer. Lancet 1999;354:651–2.CrossRefGoogle ScholarPubMed
Lenz, S, Leeton, J, Rogers, P, Trounson, A. Transfundal transfer of embryos using ultrasound. J In Vitro Fert Embryo Transf 1987; 4:13–17.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Biervliet, FP, Lesny, P, Maguiness, SD, Robinson, J, Killick, SR. Transmyometrial embryo transfer and junctional zone contractions. Hum Reprod 2002;17:347–50.CrossRefGoogle ScholarPubMed
Kato, O, Takatsuka, R, Asch, RH. Transvaginal-transmyometrial embryo transfer: the Towako method; experiences of 104 cases. Fertil Steril 1993;59:51–3.CrossRefGoogle ScholarPubMed
Sharif, K, Afnan, M, Lenton, W, Bilalis, D, Hunjan, M, Khalaf, Y. Transmyometrial embryo transfer after difficult immediate mock transcervical transfer. Fertil Steril 1996;65:1071–4.CrossRefGoogle ScholarPubMed
Lai, TH, Wu, MH, Hung, KH, Cheng, YC, Chang, FM. Successful pregnancy by transmyometrial and transtubal embryo transfer after IVF in a patient with congenital cervical atresia who underwent uterovaginal canalization during Caesarean section: case report. Hum Reprod 2001;16:268–71.CrossRefGoogle Scholar
Abusheikha, N, Lass, A, Akagbosu, F, Brinsden, P. How useful is cervical dilatation in patients with cervical stenosis who are participating in an in vitro fertilization-embryo transfer program?The Bourn Hall experience. Fertil Steril 1999;72:610–12.CrossRefGoogle Scholar
Prapas, N, Prapas, Y, Panagiotidis, Y, Prapa, S, Vanderzwalmen, P, Makedos, G. Cervical dilatation has a positive impact on the outcome of IVF in randomly assigned cases having two previous difficult embryo transfers. Hum Reprod 2004;19:1791–5.CrossRefGoogle Scholar
Groutz, A, Lessing, JB, Wolf, Y, Yovel, I, Azem, F, Amit, A. Cervical dilatation during ovum pick-up in patients with cervical stenosis: effect on pregnancy outcome in an in vitro fertilization-embryo transfer program. Fertil Steril 1997;67:909–11.CrossRefGoogle Scholar
Noyes, N, Licciardi, F, Grifo, J, Krey, L, Berkeley, A. In vitro fertilization outcome relative to embryo transfer difficulty: a novel approach to the forbidding cervix. Fertil Steril 1999;72:261–5.CrossRefGoogle ScholarPubMed
Pabuccu, R, Ceyhan, ST, Onalan, G, Goktolga, U, Ercan, CM, Selam, B. Successful treatment of cervical stenosis with hysteroscopic canalization before embryo transfer in patients undergoing IVF: a case series. J Minim Invasive Gynecol 2005;12:436–8.CrossRefGoogle ScholarPubMed
Glatstein, IZ, Pang, SC, McShane, PM. Successful pregnancies with the use of laminaria tents before embryo transfer for refractory cervical stenosis. Fertil Steril 1997;67:1172–4.CrossRefGoogle ScholarPubMed
Serhal, P, Ranieri, DM, Khadum, I, Wakim, RA. Cervical dilatation with hygroscopic rods prior to ovarian stimulation facilitates embryo transfer. Hum Reprod 2003;18:2618–20.CrossRefGoogle ScholarPubMed
El Danasouri, I, Milki, A. A new cervical introducer for embryo transfer with soft open-end catheters. Fertil Steril 1992;57:939–41.CrossRefGoogle ScholarPubMed
Patton, PE, Stoelk, EM. Difficult embryo transfer managed with a coaxial catheter system. Fertil Steril 1993;60:182–3.CrossRefGoogle ScholarPubMed
Sallam, HN. Embryo transfer: factors involved in optimizing the success. Curr Opin Obstet Gynecol 2005;17:289–98.CrossRefGoogle ScholarPubMed

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