Embryo transfer techniques: an American Society for Reproductive Medicine survey of current Society for Assisted Reproductive Technology practices

• Published in: Fertility and sterility Vol. 107; no. 4; pp. 1003 - 1011
• Main Authors: Toth, Thomas L., M.D, Lee, Malinda S., M.D., M.B.A, Bendikson, Kristin A., M.D, Reindollar, Richard H., M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2017
• Subjects: Adult; Clinical Competence; Cross-Sectional Studies; Embryo transfer; Embryo Transfer - adverse effects; Embryo Transfer - standards; Embryo Transfer - trends; Female; Fertility; Fertilization in Vitro; Health Care Surveys; Healthcare Disparities - standards; Healthcare Disparities - trends; Humans; Infertility - diagnosis; Infertility - physiopathology; Infertility - therapy; Internal Medicine; in vitro fertilization; Learning Curve; Middle Aged; Obstetrics and Gynecology; Practice Patterns, Physicians' - standards; Practice Patterns, Physicians' - trends; Pregnancy; survey; Treatment Outcome; United States; Embryo transfer; in vitro fertilization; survey
• ISSN: 0015-0282; 1556-5653
• DOI: 10.1016/j.fertnstert.2016.10.040

Objective To better understand practice patterns and opportunities for standardization of ET. Design Cross-sectional survey. Setting Not applicable. Patient(s) Not applicable. Intervention(s) An anonymous 82-question survey was emailed to the medical directors of 286 Society for Assisted Reproductive Technology member IVF practices. A follow-up survey composed of three questions specific to ET technique was emailed to the same medical directors. Descriptive statistics of the results were compiled. Main Outcome Measure(s) The survey assessed policies, protocols, restrictions, and specifics pertinent to the technique of ET. Result(s) There were 117 (41%) responses; 32% practice in academic settings and 68% in private practice. Responders were experienced clinicians, half of whom had performed <10 procedures during training. Ninety-eight percent of practices allowed all practitioners to perform ET; half did not follow a standardized ET technique. Multiple steps in the ET process were identified as “highly conserved;” others demonstrated discordance. ET technique is divided among [1] trial transfer followed immediately with ET (40%); [2] afterload transfer (30%); and [3] direct transfer without prior trial or afterload (27%). Embryos are discharged in the upper (66%) and middle thirds (29%) of the endometrial cavity and not closer than 1–1.5 cm from fundus (87%). Details of each step were reported and allowed the development of a “common” practice ET procedure. Conclusion(s) ET training and practices vary widely. Improved training and standardization based on outcomes data and best practices are warranted. A common practice procedure is suggested for validation by a systematic literature review.