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Nancarrow L, Tempest N, Lane S, Homburg R, Russell R, Hapangama DK. Four-dimensional ultrasound guided embryo transfers improve live birth rates when compared to the clinical touch technique: a randomised controlled trial. Sci Rep 2023; 13:14875. [PMID: 37684296 PMCID: PMC10491625 DOI: 10.1038/s41598-023-41313-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Most aspects of in-vitro fertilisation (IVF) have changed dramatically since introduction, but embryo transfer (ET) technique remains largely unaltered. We aimed to determine whether four-dimensional ultrasound guided embryo transfers (4D UGET) could improve pregnancy rates when compared with clinical touch technique (CTT). This was a single centre open labelled randomised controlled trial in a tertiary fertility centre in the UK. 320 women were randomised on the day of single ET. The primary outcome was clinical pregnancy rate (CPR), secondary outcomes included live birth rate (LBR), biochemical pregnancy rate (BPR), miscarriage, pregnancy of unknown location (PUL) and ectopic pregnancy. 4D-UGET resulted in significantly higher CPR [50% vs 36% p = 0.02, OR 1.78 (1.12-2.84)] and LBR [41% vs 28%, p = 0.02, OR 1.77 (1.09-2.87)] when compared to CTT technique. Miscarriage (p = 0.49), PUL (p = 0.14) and ectopic pregnancy (p = 0.96) were similar between the two groups. LBR, from this trial, are significantly higher than the current UK average (41% vs 24%). 4D UGET allows for superior imaging of the uterine cavity, whilst tailoring the embryo deposition point specifically to the patient. Further RCTs are required to determine if these results can be replicated in other units and whether 4D UGET is superior to 2D UGET.
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Affiliation(s)
- L Nancarrow
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, Centre for Women's Health Research, Member of Liverpool Health Partners, University of Liverpool, Liverpool, L8 7SS, UK
- Hewitt Centre for Reproductive Medicine, Liverpool Women's NHS Foundation Trust, Liverpool, L8 7SS, UK
| | - Nicola Tempest
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, Centre for Women's Health Research, Member of Liverpool Health Partners, University of Liverpool, Liverpool, L8 7SS, UK.
- Hewitt Centre for Reproductive Medicine, Liverpool Women's NHS Foundation Trust, Liverpool, L8 7SS, UK.
- Liverpool Women's NHS Foundation Trust, Member of Liverpool Health Partners, Liverpool, L8 7SS, UK.
| | - S Lane
- Department of Biostatistics, Institute of Life Course and Medical Sciences, Member of Liverpool Health Partners, University of Liverpool, Liverpool, UK
| | - R Homburg
- Hewitt Centre for Reproductive Medicine, Liverpool Women's NHS Foundation Trust, Liverpool, L8 7SS, UK
| | - R Russell
- Hewitt Centre for Reproductive Medicine, Liverpool Women's NHS Foundation Trust, Liverpool, L8 7SS, UK
- Liverpool Women's NHS Foundation Trust, Member of Liverpool Health Partners, Liverpool, L8 7SS, UK
| | - D K Hapangama
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, Centre for Women's Health Research, Member of Liverpool Health Partners, University of Liverpool, Liverpool, L8 7SS, UK
- Liverpool Women's NHS Foundation Trust, Member of Liverpool Health Partners, Liverpool, L8 7SS, UK
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Tyler B, Walford H, Tamblyn J, Keay SD, Mavrelos D, Yasmin E, Al Wattar BH. Interventions to optimize embryo transfer in women undergoing assisted conception: a comprehensive systematic review and meta-analyses. Hum Reprod Update 2022; 28:480-500. [PMID: 35325124 PMCID: PMC9631462 DOI: 10.1093/humupd/dmac009] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/02/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Several interventions and techniques are suggested to improve the outcome of embryo transfer (ET) in assisted conception. However, there remains no consensus on the optimal practice, with high variations among fertility specialists. OBJECTIVE AND RATIONALE We conducted a comprehensive systematic review and meta-analyses of randomized controlled trials (RCTs) aiming to identify effective interventions that could be introduced around the time of ET to improve reproductive outcomes. SEARCH METHODS We searched the electronic databases (MEDLINE, EMBASE and Cochrane CENTRAL) from inception until March 2021 using a multi-stage search strategy of MeSH terms and keywords, and included all RCTs that evaluated an intervention in the 24-h period before/after ET in women undergoing IVF/ICSI. Our primary outcome was clinical pregnancy rate post-ET confirmed as viable pregnancy on ultrasound scan. We assessed the risk of bias in included trials and extracted data in duplicate. We pooled data using a random-effect meta-analysis and reported using risk ratio (RR) with 95% CI. We explored publication bias and effect modifiers using subgroup analyses. OUTCOMES Our search yielded 3685 citations of which we included 188 RCTs (38 interventions, 59 530 participants) with a median sample size of 200 (range 26-1761). The quality of included RCTs was moderate with most showing a low risk of bias for randomization (118/188, 62.8%) and attrition (105/188, 55.8%) but there was a significant risk of publication bias (Egger's test P = 0.001). Performing ET with ultrasound guidance versus clinical touch (n = 24, RR 1.265, 95% CI 1.151-1.391, I2 = 38.53%), hyaluronic acid versus routine care (n = 9, RR 1.457, 95% CI 1.197-1.261, I2 = 46.48%) and the use of a soft versus hard catheter (n = 27, RR 1.122, 95% CI 1.028-1.224, I2 = 57.66%) led to higher clinical pregnancy rates. Other pharmacological add-ons also showed a beneficial effect including granulocyte colony-stimulating factor (G-CSF: n = 4, RR 1.774, 95% CI 1.252-2.512, I2 = 0), Atosiban (n = 7, RR 1.493, 95% CI 1.184-1.882, I2 = 68.27%) and hCG (n = 17, RR 1.232, 95% CI 1.099-1.382, I2 = 57.76%). Bed rest following ET was associated with a reduction in clinical pregnancy (n = 6, RR 0.857, 95% CI 0.741-0.991, I2 = 0.01%). Other commonly used interventions, such as non-steroidal anti-inflammatory drugs, prophylactic antibiotics, acupuncture and cervical mucus removal, did not show a significant benefit on reproductive outcomes. Our effect estimates for other important outcomes, including miscarriage and live birth, were limited by the varied reporting across included RCTs. WIDER IMPLICATIONS Using ultrasound guidance, soft catheters and hyaluronic acid at the time of ET appears to increase clinical pregnancy rates. The use of Atosiban, G-CSF and hCG showed a trend towards increased clinical pregnancy rate, but larger trials are required before adopting these interventions in clinical practice. Bed rest post-ET was associated with a reduction in clinical pregnancy and should not be recommended.
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Affiliation(s)
- Bede Tyler
- UCL Institute for Women's Health, University College London, London, UK
| | - Hugo Walford
- UCL Institute for Women's Health, University College London, London, UK
| | - Jennifer Tamblyn
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham, UK
| | - Stephen D Keay
- Centre for Reproductive Medicine, University Hospital of Coventry & Warwickshire, Coventry, UK
| | - Dimitrios Mavrelos
- UCL Institute for Women's Health, University College London, London, UK,Reproductive Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals, London, UK
| | - Ephia Yasmin
- UCL Institute for Women's Health, University College London, London, UK,Reproductive Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals, London, UK
| | - Bassel H Al Wattar
- Correspondence address. Reproductive Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals, London, UK, WC1E 6DB. E-mail:
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Conto ED, Schuster AK, Genro VK, Chapon R, da Silva DS, Cunha-Filho JS. A prospective study comparing two embryo-transfer soft catheters. JBRA Assist Reprod 2017; 21:70-72. [PMID: 28609270 PMCID: PMC5473696 DOI: 10.5935/1518-0557.20170018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 01/16/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To compare reproductive outcomes using two different soft catheters i.e. Set TDT® and Cook® Sydney IVF. The primary outcome was defined as a positive β-human chorionic gonadotropin (β-hCG) test. METHODS Our prospective study recruited 68 patients undergoing in vitro fertilization cycles in a private fertility clinic in Porto Alegre, Brazil, between January 2014 and April 2016. They were divided into two groups according to the catheter that would be used for the embryo transfer, and the groups were matched by age. The total number of patients in each group was: 34 for the TDT and 34 for the Cook Sydney. All the patients were submitted to a β-hCG test 12 days after the embryo transfer for pregnancy outcome evaluation. RESULTS Ten out of 34 patients from the TDT group had a positive outcome for pregnancy, corresponding to 29.4%. The Cook Sydney group had 9 patients out of 34 with positive outcomes, corresponding to 26.5%. Comparing the efficacy of both catheters for the primary outcome, there was no significant difference (p>0.05) between the TDT and the Cook Sydney catheters. CONCLUSION The TDT and the Cook Sydney catheters efficacies were similar for embryo transfer during assisted reproductive technology cycles.
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Affiliation(s)
- Emily De Conto
- Federal University of Rio Grande do Sul - UFRGS - Porto
Alegre - Brazil
| | - Artur K Schuster
- Federal University of Rio Grande do Sul - UFRGS - Porto
Alegre - Brazil
| | - Vanessa K Genro
- Federal University of Rio Grande do Sul - UFRGS - Porto
Alegre - Brazil
| | - Rita Chapon
- Federal University of Rio Grande do Sul - UFRGS - Porto
Alegre - Brazil
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Performing the embryo transfer: a guideline. Fertil Steril 2017; 107:882-896. [DOI: 10.1016/j.fertnstert.2017.01.025] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 01/27/2017] [Indexed: 11/17/2022]
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Boone WR, Higdon HL, Johnson JE. Quality Management Issues in the Assisted Reproduction Laboratory. ACTA ACUST UNITED AC 2010. [DOI: 10.1177/205891581000100103] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the United States, the Clinical Laboratory Improvement Act (CLIA) of 1988 describes requirements and guidelines for implementing a quality control/quality assurance (QC/QA) program for moderate and high complexity laboratories. These requirements and guidelines apply to Assisted Reproductive Technology (ART) laboratories as well. The general topic of QC and QA as it pertains to in vitro fertilization (IVF) and embryo transfer (ET) is extensively reviewed. This review summarizes many of the QC and QA events that contribute to the advancement of knowledge in this biotechnological field. These events include control of the culture environment inside and outside of the incubator, as well as factors that affect culture media. This review also discusses, in considerable detail, the QC and the QA that pertain to equipment used within the laboratory and how to control for potential contaminants, which reside within the laboratory. This review provides evidence to indicate the need for laboratory personnel to monitor quality improvement issues on a continuous basis. Personnel must be willing to change as improvements in technology occur in order to meet the ever-evolving demands of a more difficult patient population. Suggestions for meeting these demands are offered.
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Affiliation(s)
- William R. Boone
- Greenville Hospital System University Medical Center, Greenville, South Carolina Department of Obstetrics and Gynecology
| | - H. Lee Higdon
- Greenville Hospital System University Medical Center, Greenville, South Carolina Department of Obstetrics and Gynecology
| | - Jane E. Johnson
- Greenville Hospital System University Medical Center, Greenville, South Carolina Department of Obstetrics and Gynecology
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Yao Z, Vansteelandt S, Van der Elst J, Coetsier T, Dhont M, De Sutter P. The efficacy of the embryo transfer catheter in IVF and ICSI is operator-dependent: a randomized clinical trial. Hum Reprod 2008; 24:880-7. [PMID: 19095665 DOI: 10.1093/humrep/den453] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Zhan Yao
- Department of Obstetrics and Gynaecology, Ghent University, De Pintelaan 185, B-9000 Gent, Belgium
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Ata B, Isiklar A, Balaban B, Urman B. Prospective randomized comparison of Wallace and Labotect embryo transfer catheters. Reprod Biomed Online 2007; 14:471-6. [PMID: 17425830 DOI: 10.1016/s1472-6483(10)60895-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to compare the clinical performance of Wallace and Labotect embryo transfer catheters in a single assisted reproduction centre. A total of 260 women undergoing embryo transfer were randomized between Wallace and Labotect catheters. When both catheters failed to negotiate the cervical canal, the transfer was accomplished with a stiff catheter. Intention to treat analysis revealed that Wallace and Labotect embryo transfer catheters yielded statistically similar clinical pregnancy (44.6 versus 34.6%), implantation (23.2 versus 18.9%) and ongoing pregnancy (38.5 versus 27.7%) rates. As treated analysis revealed clinical pregnancy rates of 42.5 versus 35.4%, implantation rates of 22.3 versus 20.6% and ongoing pregnancy rates of 36.8 versus 28.3% with Wallace and Labotect catheters respectively. Catheter change due to unsuccessful negotiation of the internal cervical os was significantly more frequently necessary when embryo transfer was first intended with the Wallace than the Labotect catheter (P < 0.001; 33 and 2% respectively). Although not being statistically significant, the observed differences may be regarded as clinically important and may reach statistical significance in larger trials. More trials are necessary before reaching a definitive conclusion regarding the performance of the Labotect embryo transfer catheter.
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Affiliation(s)
- Baris Ata
- The Assisted Reproduction Unit, American Hospital of Istanbul, Turkey
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8
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Rhodes TL, Higdon HL, Boone WR. Comparison of pregnancy rates for two embryo-transfer catheters. Fertil Steril 2007; 87:411-6. [PMID: 17094973 DOI: 10.1016/j.fertnstert.2006.06.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Revised: 06/08/2006] [Accepted: 06/08/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare two flexible catheters and determine whether pregnancy rates (PRs) differed. DESIGN Prospective, randomized pilot study. SETTING Tertiary-care infertility practice. PATIENT(S) The subjects for this study were 100 women undergoing assisted reproductive technology (ART) cycles between September 2003 and October 2005. INTERVENTION(S) None. MAIN OUTCOME MEASURE Clinical PR for Edwards-Wallace (Cooper Surgical, Shelton, CT) and Cook World (Cook Urological, Spencer, IN) embryo-transfer (ET) catheters. RESULT(S) The outcomes of pregnancy between the Edwards-Wallace and Cook World ET catheters were not significantly different. Use of the flare stimulation protocol resulted in a significantly lower PR compared to long luteal and antagonist protocols. No other variable affected PR. CONCLUSION(S) A 5% difference in PR was demonstrated between ET catheters; however, this study does not have the power to detect a significant difference in clinical PR between the two catheter groups. The pilot study demonstrates good design due to the lack of significant differences between the variables when stratifed by cather as well as pregnancy status. In a larger study, the flare protocol should be excluded.
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Affiliation(s)
- Tiffany L Rhodes
- Upstate Obstetrics and Gynecology, Greenville Hospital System University Medical Group, Greenville, South Carolina 29605-5601, USA
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9
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Abou-Setta AM. Firm embryo transfer catheters for assisted reproduction: a systematic review and meta-analysis using direct and adjusted indirect comparisons. Reprod Biomed Online 2006; 12:191-8. [PMID: 16478584 DOI: 10.1016/s1472-6483(10)60860-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A systematic review of published evidence on firm embryo transfer catheters is presented. Extensive searches were conducted for full-text manuscripts, abstracts, ongoing and unpublished trials. Direct and adjusted indirect comparisons were undertaken, where appropriate. Twenty-six randomized controlled trials comparing embryo transfer catheters were identified. Only two trials (314 transfers) compared different firm embryo catheters. Using direct comparison, both the Tom Cat and Tefcat catheters demonstrated statistically significant increased chances of clinical pregnancy compared with the Tight Difficult Transfer (TDT) catheter (P=0.007; OR=3.67, 95% CI=1.48-9.10 and P<0.0001; OR=4.71, 95% CI=2.34-9.48 respectively). The implantation rates were also higher with the Tom Cat and Tefcat catheters than the TDT catheter (P=0.005; OR=3.67, 95% CI=1.48-9.10 and P<0.00001; OR=4.29, 95% CI=2.45-7.50 respectively). Using adjusted indirect comparison, Tom Cat and Tefcat catheters were compared, and shown to have similar pregnancy and implantation rates (OR=0.99; 95% CI=-0.87-1.79 and OR=0.86; 95% CI=-0.77-1.35). In conclusion, both Tom Cat and Tefcat catheters give better outcomes than the TDT catheter, but are similar to each other.
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Affiliation(s)
- Ahmed M Abou-Setta
- The Egyptian IVF-ET Centre, 3, Street 161, Hadayek El Maadi, Cairo 11431, Egypt.
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Buckett WM. A review and meta-analysis of prospective trials comparing different catheters used for embryo transfer. Fertil Steril 2006; 85:728-34. [PMID: 16500345 DOI: 10.1016/j.fertnstert.2005.08.031] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2005] [Revised: 08/14/2005] [Accepted: 08/14/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the relative efficacy of different types of embryo transfer (ET) catheters. DESIGN Systematic review and meta-analysis of prospective randomized, controlled trials comparing at least two different ET catheters. SETTING Infertility centers providing treatment with in vitro fertilization/embryo transfer (IVF-ET). PATIENT(S) Women undergoing ET. INTERVENTION(S) Embryo transfer with soft or hard catheters. MAIN OUTCOME MEASURE(S) Clinical pregnancy rate. RESULT(S) A total of seven prospective trials were identified that compared soft (Cook or Wallace) catheters with hard (TDT, Frydman, Tomcat, Rocket) catheters. The meta-analysis demonstrated an increased chance of clinical pregnancy when soft ET catheters were used. The TDT catheter was compared against both soft catheters and other hard catheters, showing decreased chance of clinical pregnancy when the TDT catheter was used. Six more prospective trials were identified comparing the Cook and Wallace soft catheters, and the meta-analysis of these data showed no demonstrable difference in clinical pregnancy rates. CONCLUSION(S) An increased chance of clinical pregnancy is achieved when soft ET catheters are used. There appears to be little difference between the Cook and Wallace soft catheters.
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Affiliation(s)
- William M Buckett
- Department of Obstetrics and Gynecology, McGill University, Royal Victoria Hospital, Montreal, Quebec, Canada.
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McIlveen M, Lok FD, Pritchard J, Lashen H. Modern embryo transfer catheters and pregnancy outcome: a prospective randomized trial. Fertil Steril 2005; 84:996-1000. [PMID: 16213855 DOI: 10.1016/j.fertnstert.2005.06.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2004] [Revised: 01/10/2005] [Accepted: 01/10/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Embryo transfer (ET) is the final crucial step in IVF treatment. The type of catheter used can affect the pregnancy rate (PR). In this prospective, randomized trial we compared the clinical PR between the Wallace and the Cook K-Jet embryo transfer catheters. DESIGN Prospective, randomized clinical trial. SETTING A National Health Service Assisted Reproduction Unit. PATIENT(S) One hundred fifty women undergoing a fresh ET. Age more than 40 years, a high basal FSH, a previous difficult ET, or more than six previous ETs were the exclusion criteria. INTERVENTION(S) Women undergoing a fresh ET were randomized at the time of ET to either the Cook K-Jet or Wallace embryo transfer catheter. The randomization was stratified according to age and the number of previous ETs. MAIN OUTCOME MEASURE(S) Clinical PR. RESULT(S) There was no significant difference in the clinical PR between the Wallace and the Cook catheters (22/75 [29.3%] and 23/75 [30.6%], relative risk [RR]: 0.96 [95% confidence interval 0.58-1.58]). CONCLUSION(S) There is no significant difference in the PRs achieved by modern, soft, double-lumen ET catheters.
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Affiliation(s)
- Myvanwy McIlveen
- The Jessop Wing, University of Sheffield, Sheffield, United Kingdom
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12
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Rhodes TL, McCoy TP, Higdon HL, Boone WR. Factors affecting assisted reproductive technology (ART) pregnancy rates: a multivariate analysis. J Assist Reprod Genet 2005; 22:335-46. [PMID: 16247715 DOI: 10.1007/s10815-005-6794-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Accepted: 05/10/2005] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To determine factors instrumental in achieving a clinical pregnancy in assisted reproductive technology (ART) patients. METHODS This study included 205 women undergoing their first ART cycle. Univariate and multivariate analyses were performed for patient demographics, in vitro production data, and factors associated with embryo transfer. Odds ratios (OR) were performed where appropriate. RESULTS Our analyses indicated that age (OR: 0.879), specific year in which the cycle was performed (OR: 2.959), and use of intracytoplasmic sperm injection (OR: 2.867) altered potential pregnancy rate. In addition, percent fertilization (OR: 1.028), number of embryos transferred (OR: 1.842), type of catheter used to transfer the embryos (OR: 0.377), presence of blood on the catheter (OR .414), and embryologist (OR: 2.338) also altered pregnancy rate. CONCLUSIONS Our data indicate patients' age, use of the Cook catheter, and presence of blood on the catheter reduce pregnancy rates. Performing ART in 1999, using ICSI, increasing fertilization rate, increasing number of embryos transferred (albeit less desirable when the chance of multiple gestation may occur), and transferring embryos via a particular embryologist, improve pregnancy rates.
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Affiliation(s)
- Tiffany L Rhodes
- Department of Obstetrics and Gynecology, Greenville Hospital System, South Carolina 29605, USA
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13
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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. [PMID: 16040620 DOI: 10.1093/humrep/dei198] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The true impact of the embryo transfer catheter choice on an IVF programme has not been fully examined. We therefore decided to systematically review the evidence provided in the literature so that we may evaluate a single variable in relation to a successful transfer, the firmness of the embryo transfer catheter. METHODS An extensive computerized search was conducted for all relevant articles published as full text, or abstracts, and critically appraised. In addition, a hand search was undertaken to locate any further trials. RESULTS A total of 23 randomized controlled trials (RCT) evaluating the types of embryo transfer catheters were identified. Only ten of these trials, including 4141 embryo transfers, compared soft versus firm embryo catheters. Pooling of the results demonstrated a statistically significantly increased chance of clinical pregnancy following embryo transfer using the soft (643/2109) versus firm (488/2032) catheters [P = 0.01; odds ratio (OR) = 1.39, 95% confidence interval (CI) = 1.08-1.79]. When only the truly RCT were analysed, the results were again still in favour of using the soft embryo transfer catheters [soft (432/1403) versus firm (330/1402)], but with a greater significance (P < 0.00001; OR = 1.49, 95% CI = 1.26-1.77). CONCLUSION Using soft embryo transfer catheters for embryo transfer results in a significantly higher pregnancy rate as compared to firm catheters.
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Affiliation(s)
- Ahmed M Abou-Setta
- The Egyptian IVF-ET Center, 3, Street 161, Hadayek El Maadi, Cairo 11431, Egypt.
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14
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Boone WR, Crane MM, Johnson JE, Higdon HL, Blackhurst DW. Changes in the freezing protocol for human zygotes alter embryonic development and pregnancy rates. Fertil Steril 2005; 83:182-8. [PMID: 15652905 DOI: 10.1016/j.fertnstert.2004.06.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2004] [Revised: 06/08/2004] [Accepted: 06/08/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine the effect of various freezing protocols on postthaw development and pregnancy rates resulting from transfer of human zygotes. DESIGN Prospective study. SETTING Tertiary care center. PATIENT(S) Couples undergoing assisted reproductive technology (ART) procedures who wished to have their excess zygotes cryopreserved. INTERVENTION(S) We cryopreserved zygotes with one of three protocols. MAIN OUTCOME MEASURE(S) Post-thaw survival and development of the zygotes as well as pregnancy rate after transfer of these zygotes. RESULT(S) A 3-minute hold time after seeding, followed by a final preplunging temperature of -180 degrees C, resulted in a clinical pregnancy rate of 28.6%. In contrast, a 15-minute postseed hold time and a -30 degrees C final chamber temperature resulted in a 37.3% clinical pregnancy rate. When we combined the protocols to provide a 15-minute postseed holding time and a -180 degrees C before plunging into liquid nitrogen, we achieved a 69.6% clinical pregnancy rate. CONCLUSION(S) By increasing the postseeding hold time and decreasing the temperature of the freezing chamber before plunging the zygotes into liquid nitrogen, significant improvements can be made in postthaw development and pregnancy rates.
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Affiliation(s)
- William R Boone
- Department of Obstetrics and Gynecology, Greenville Hospital System, South Carolina 29605-5601, USA.
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15
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McDonald JA, Norman RJ. A randomized controlled trial of a soft double lumen embryo transfer catheter versus a firm single lumen catheter: significant improvements in pregnancy rates. Hum Reprod 2002; 17:1502-6. [PMID: 12042268 DOI: 10.1093/humrep/17.6.1502] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Embryo transfer has changed little since originally described in 1978. Clinicians rate the type of catheter used as the third most important variable in embryo transfer, but there are no adequately powered randomized trials. We compared the clinical pregnancy rates with the single lumen catheter (TCC) and the double lumen catheter (CC) in a randomized single blind trial. METHODS A total of 650 cycles of women from the Adelaide University reproductive medicine units in Australia were included in this trial. Patients were <40 years of age undertaking IVF and embryo transfer. Exclusion criteria were: known uterine abnormality, day 3 FSH >10 IU/l, previous difficult embryo transfer and pre-implantation genetic diagnosis. Cycles were randomized from numbered sealed envelopes immediately prior to embryo transfer with stratification for fresh or frozen cycles. RESULTS There was a significantly higher pregnancy rate in the group treated with the CC compared with the TCC catheter [29.6 versus 20.5% per embryo transfer, odds ratio (OR) = 1.63 (95% confidence interval: 1.14-2.30), P = 0.0076]. The point estimate for the OR was similar for fresh and frozen cycles. CONCLUSIONS The pregnancy rate was increased by 50% and this justifies the increased cost of the soft double lumen catheter and the training of clinical staff required.
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Affiliation(s)
- Janelle A McDonald
- Suite 14, John James Medical Centre, 175 Strickland Crescent, Deakin, ACT 2600, Australia.
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Nichols JE, Higdon HL, Crane MM, Boone WR. Comparison of implantation and pregnancy rates in African American and white women in an assisted reproductive technology practice. Fertil Steril 2001; 76:80-4. [PMID: 11438323 DOI: 10.1016/s0015-0282(01)01853-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare IVF outcomes between infertile African American and white women. DESIGN Retrospective cohort study. SETTING Hospital-based IVF practice. PATIENT(S) Women undergoing IVF procedures between November 1996 and June 2000. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Implantation and pregnancy rates. RESULT(S) There were 24 African American and 273 white women < or =40 years of age who underwent 25 and 333 IVF cycles, respectively. African American women were more likely to have had tubal factor as a primary diagnosis, to have had a child, and to have undergone fewer previous assisted reproductive technology (ART) cycles as compared to white women. No differences between the two groups for clinical variables were noted with the exception of body mass index (BMI [kg/m(2)], 27.1 in African Americans vs. 24.8 in whites). Implantation rates were higher in African American than in white women (35% vs. 23%, respectively). Pregnancy rates were 71% in African Americans and 48% in whites. After adjustment for tubal factor, BMI, and parity, the odds ratio for pregnancy in African American women versus white women increased from 2.6 to 3.3. CONCLUSION(S) This is the first study to demonstrate a significantly higher clinical pregnancy rate in African American women as compared to white women undergoing ART. These data strongly contradict a recent study comparing the same two groups of women undergoing ART. We urge other ART centers to report their data pertaining to race.
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Affiliation(s)
- J E Nichols
- Department of Obstetrics and Gynecology, Greenville Hospital System, Greenville, South Carolina, USA
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