Document Type : original article
Authors
1 Tehran University of Medical Sciences, Tehran, Iran
2 Birjand University of Medical Sciences,Birjand,Iran
3 Department of obstetrics and Gynecology , Pregnancy Health Research Center,Zahedan University of Medical Sciencese , Zahedan,Iran
4 Department of obstetrics and gynecology,school of medicine Shariati hospital, Tehran university of medical sciences
Abstract
Background: This study is conducted to compare the pregnancy rate among patients with embryo transfer using the conventional experimental method with those using measurement of uterine length with transvaginal ultrasound before transfer in freeze ART cycles.
Methods: In this cohort study, all participants were subjected to the cycle of ovulation stimulation according to the antagonist protocol; consequently, after oocyte recovery, the embryos were frozen following the next cycles. If they were ready, they were subjected to the cycle of endometrial preparation with estradiol protocol. In case of having one to three embryos of good quality (based on the patients’ selection), they were placed in two groups of embryo transfer using the conventional method (clinical touch) or embryo transfer after measuring the length of the uterus with transvaginal ultrasound. Then, all patients were treated with vaginal progesterone and oral estradiol; two weeks later, a pregnancy test was performed, and if it was positive, they were followed up for ultrasound and pregnancy outcomes. Statistical analysis was performed using Student's t-test and Chi-square or Fisher's exact test in SPSS 16 software. A significance level of less than 0.05 was considered.
Results: There are no statistically significant differences between the two groups in variables such as the type of stimulation, the type of gonadotropin, the number of retrieved eggs, the number of transferred embryos, the thickness of the endometrium, the length of the uterus, and easy or difficult transfer. Although the pregnancy rate was higher in the group of ET with measuring the length of the uterus (38.5% versus 34.0%), this difference was not statistically significant (p=0.681).
Conclusion: The use of the embryo transfer method using transfer guidelines which were guided by transvaginal ultrasound and determining the location of the embryo deposition by experienced doctors does not increase the fertility rate in ART cycles compared to using the traditional and blind method in Iran. At the same time, it is necessary to examine other advantages of using this method.
Keywords
- Vander Borght M, Wyns C. Fertility and infertility: Definition and epidemiology. Clinical biochemistry. 2018; 62:2-10.
- 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. Fertility and sterility. 2002; 77(4):769-75.
- Mohamed Hassan S, Ramadan W, Elsharkawy M, Ali Bayoumi Y. The Role of Transvaginal Ultrasound Guided Embryo Transfer to Improve Pregnancy Rate in Obese Patients Undergoing Intracytoplasmic Sperm Injection. International journal of women's health. 2021; 13:861-7.
- Simopoulou M, Sfakianoudis K, Antoniou N, Maziotis E, Rapani A, Bakas P, Anifandis G, Kalampokas T, Bolaris S, Pantou A, Pantos K, Koutsilieris M. Making IVF more effective through the evolution of prediction models: is prognosis the missing piece of the puzzle? Systems Biology in Reproductive Medicine. 2018; 64(5):305-23.
- Saharkhiz N, Nikbakht R, Salehpour S. Comparison between Conventional Blind Embryo Transfer and Embryo Transfer Based on Previously Measured Uterine Length. Int J Fertil Steril. 2014; 8(3):249-54.
- 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. Human Reproduction. 2007; 22(5):1327-34.
- 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.
- Aflatounian a, Asgharnia m. Factors affecting the successful embryo transfer. International journal of reproductive biomedicine (Iranian journal of reproductive medicine). 2006; 4(2):-.
- Mackens S, Santos-Ribeiro S, van de Vijver A, Racca A, Van Landuyt L, Tournaye H, Blockeel C. Frozen embryo transfer: a review on the optimal endometrial preparation and timing. Human reproduction (Oxford, England). 2017; 32(11):2234-42.
- Tomás C, Tikkinen K, Tuomivaara L, Tapanainen JS, Martikainen H. The degree of difficulty of embryo transfer is an independent factor for predicting pregnancy. Human reproduction (Oxford, England). 2002; 17(10):2632-5.
- Mains L, Van Voorhis BJ. Optimizing the technique of embryo transfer. Fertility and sterility. 2010; 94(3):785-90.
- Morroll D. Textbook of assisted reproductive techniques: Laboratory and clinical perspectives (second edition). Human Fertility. 2006; 9(1):63-.
- Tang OS, Ng EHY, So WWK, Ho PC. Ultrasound-guided embryo transfer: a prospective randomized controlled trial. Human Reproduction. 2001; 16(11):2310-5.
- 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 in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2016; 48(3):289-95.
- Bakas P, Simopoulou M, Giner M, Tzanakaki D, Deligeoroglou E. Accuracy and efficacy of embryo transfer based on the previous measurement of cervical length and total uterine length. Archives of gynecology and obstetrics. 2019; 299(2):565-70.
- Rovei V, Dalmasso P, Gennarelli G, Lantieri T, Basso G, Benedetto C, Revelli A. 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. Reproductive Biology and Endocrinology. 2013; 11(1):114.
- Tanksale SJ NP, Nadkarni AA, P. S. Where is the best site for embryo transfer? A study of relation of embryo fundal distance with pregnancy rate in ICSI-ET cycle. Int J Reprod Contracept Obstet Gynecol. 2016; 5:2661–5.
- Pacchiarotti A, Mohamed MA, Micara G, Tranquilli D, Linari A, Espinola SMB, Aragona C. The impact of the depth of embryo replacement on IVF outcome. J Assist Reprod Genet. 2007; 24(5):189-93.
- 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. Fertility and sterility. 2005; 84(4):1046-8.
- Mitchell JD, Wardle PG, Foster PA, Hull MG. Effect of bladder filling on embryo transfer. Journal of in vitro fertilization and embryo transfer: IVF. 1989; 6(4):263-5.
- Schoolcraft WB, Surrey ES, Gardner DK. Embryo transfer: techniques and variables affecting success. Fertility and sterility. 2001; 76(5):863-70.
- Cozzolino M, Vitagliano A, Troiano G, Giovanni M, Laganà AS, Vitale SG, Blaganje M, Starič KD, Borut K, Patrelli TS, Noventa M. Ultrasound-guided embryo transfer: summary of the evidence and new perspectives. A systematic review and meta-analysis. Reproductive BioMedicine Online. 2018; 36.
)