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Performing the embryo transfer: a guideline
Practice Committee of the American Society for Reproductive Medicine American Society for Reproductive Medicine, Birmingham, Alabama
A systematic review of the literature was conducted which examined each of the major steps of embryo transfer. Recommendations made for improving pregnancy rates are based on interventions demonstrated to be either beneficial or not beneficial. (Fertil SterilÒ 2017;107:882–96. Ó2017 by American Society for Reproductive Medicine.)
Discuss: You can discuss this article with its authors and with other ASRM members at https://www.fertstertdialog.com/users/ 16110-fertility-and-sterility/posts/14713-23759
One of the most critical steps in the process of in vitro fertiliza- tion (IVF) is the embryo transfer. Studies have consistently demonstrated that embryo transfer pregnancy rates differ depending upon the clinician per- forming the procedure (1–3). In addition, data are accumulating that demonstrate a paucity of training in current fellowship programs or for practitioners who may have embryo transfer success rates consistently below the mean. A recent survey of Society for Assisted Reproductive Technology (SART) medical directors demonstrates that essentially all practitioners are allowed to perform embryo transfer if they desire, no matter what their skill (4). Half of the programs allow clinicians to perform embryo transfer using their personal ‘‘procedure’’ rather than having a standard protocol for all clinicians to follow. The results of that comprehensive survey demonstrate the breakdown of responses for 84 questions. From that survey, steps were identified for which the majority of practitioners demonstrated concor- dance, others were found to have nearly equal discordance, and, for most, a few outliers were identified. From those data a Common Practice Protocol was
developed (4). The purpose of this guideline for performing embryo transfer is to examine the various steps of the Common Practice Protocol by a systematic review of the literature to determine which of the steps, if any, are supported by sufficient data.
METHODS
This clinical practice guideline was based on a systematic review of the literature. A systematic literature search of relevant articles was per- formed in the electronic database MED- LINE through PubMed in December 2016, with a filter for human subject research. No limit or filter was used for time period or English language, but articles were subsequently culled for English language. A combination of the following medical subject head- ings or text words/keywords were used: acupuncture; acupuncture ther- apy; afterloading; ambulation; anal- gesia; analgesic; analgesics; anesthesia; anti anxiety; antibacterial hand soaps; antibiotic; antibiotics; antibiotic prophylaxis; bed rest; bed- rest; birth; bleeding; blastocyst trans- fer; blood; catheter; catheter remains; catheter remnants; catheterization;
catheterization/adverse effects; cathe- terization/methods; cervix; Chinese medicine; cleanse; cleanser; cleansing; deposition; disinfection; duration; ejection; embryo retention; embryo transfer; embryo transfer catheter; em- bryo transfer/instrumentation; embryo transfer/methods; embryo transfer pro- tocol; embryo transfer techniques; endometrial; endometrial cavity; endo- metrium; expel; expulsion; flushing; gloves; hand disinfection; hand hy- giene; hand washing; hand washing/ behavior; hand washing/behaviors; hand disinfectant; hand disinfectants; hand washing/glove; implantation; in- jection; in vitro fertilization; IVF; load; loading; massage; medicine, Chinese traditional relaxant; mucus; mucous; physician; physician's role; placement; plunge; plunger; pregnancy; pressure; recumbency; recumbent; recumbent position; recumbent posture; release; replacement; rest; retained embryos; sedation; simulation; skin scrub; speed; stiletto; stylet; stylette; success; success rate; supine; surgical gloves; surgical scrub; time; time factors; time interval; transcutaneous electrical acupoint stimulation; transcutaneous electrical nerve stimulation; transfer techniques; ultrasound; ultrasound guidance; ul- trasound guided embryo transfer; uteri; uterus; vaginal flush; vaginal preparation.
Initially, titles and abstracts of potentially relevant articles were screened and reviewed for inclusion/
VOL. 107 NO. 4 / APRIL 2017
Received January 25, 2017; accepted January 27, 2017.
Reprint requests: Practice Committee, American Society for Reproductive Medicine, 1209 Montgom-
ery Hwy, Birmingham, Alabama 35216 (E-mail: ASRM@asrm.org).
Fertility and Sterility® Vol. 107, No. 4, April 2017 0015-0282/$36.00
Copyright ©2017 American Society for Reproductive Medicine, Published by Elsevier Inc. http://dx.doi.org/10.1016/j.fertnstert.2017.01.025
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