Evaluation of the effect of the adoption of ultrasound guidance for embryo replacement on the pregnancy outcome for multiple providers

Objective: To evaluate the clinical effects of adopting the policy of transabdominal ultrasound–assisted embryo transfer on outcomes of in vitro fertilization–embryo transfer (IVF-ET) in comparison to the "clinical touch" method of transcervical embryo transfer by 3 different providers.
Design: A cohort study in a university-based IVF practice.
Materials and methods(s): Four hundred sixty-two sequential patients who underwent transcervical transfer of fresh embryos 1-year before (group I) and 1-year after (group II) the adoption of US guidance were included. The clinical touch and the US guided embryo transfers were performed by 3 experienced physicians. On selected days, at time of embryo transfer, transabdominal ultrasound was performed to guide catheter placement depth approximately 1.5 cm from the uterine fundus. The presence of at least one gestational sac on ultrasound was compared in the two study groups. Additionally, the clinical pregnancy rate (presence of fetal cardiac activity observed on ultrasound), and the implantation rate (number of gestational sacs identified on ultrasound per number of embryos transferred) between groups was evaluated. Characteristics of the two cohorts were analyzed to verify similarities between the treatment and control groups, including age of recipient, and difficulty of transfer, the use of a tenaculum, and the quality and number of embryos transferred.
Result(s): US guidance did not reduce the time of the ET procedure. In addition, it did not reduce the percentage of bloody catheters at the end of the procedure. More importantly, no statistical difference was seen in the presence or number of gestational sacs following embryo transfer either before or after the adoption of the transabdominal ultrasound guidance for all 3 providers.
Conclusion(s): Providers' performance has not improved by the adoption of US guidance. There is no other additional advantage for using transabdominal ultrasound to perform embryo transfer. Although there is a trend towards a higher pregnancy if US guidance is adopted, in experienced hands, the "clinical touch" method of embryo transfer yields equivalent results to transabdominal ultrasound–guided embryo placement.