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study of 712 women evaluated the effect of powdered gloves on clinical pregnancy rate in IVF (37.6%) in comparison with unpowdered gloves (37.4%) and did not find a difference in pregnancy rate with the use of powdered gloves (P1⁄41.0) (30). These investigators concluded that as long as direct con- tact is avoided, powdered gloves can safely be used in embryo transfer. There are no studies assessing glove use and live- birth rates. Therefore, although some physicians may opt to avoid non-sterile, latex, or powdered gloves in hopes of mini- mizing embryo toxicity, no data support the usage of a partic- ular type of glove to optimize pregnancy rate.
Summary statement:
There is fair evidence based on one, single-center RCT that powdered gloves worn during embryo transfer do not have an adverse effect on pregnancy rates. (Grade B). No specific type of glove is recommended for embryo transfer.
Does Routine Use of Abdominal Ultrasound for Guidance during Embryo Transfer Improve Pregnancy and Live-birth Rates?
There are 35 RCTs and cohort studies among other published data that examine the use of abdominal ultrasound guidance
during embryo transfer. Ultrasound was introduced with the hope that it would diminish the likelihood that the embryo transfer catheter would traumatize the endometrium as compared with a blind approach or touch technique.
With regard to the transfer of fresh embryos in eight RCTs and four cohort studies, transabdominal (TA) ultrasound—guided embryo transfer was found to improve the implantation rate and/or pregnancy rate (31–40), clinical or ongoing clinical pregnancy rates, and/or live- birth rate (33, 36, 41–43). These findings were supported by five meta-analyses or systematic reviews (44–48). A recent review found that ultrasound-guided embryo transfer was associated with improved clinical pregnancy rate (OR 1.31, 1.17–1.45; 20 trials; N1⁄46,711 women) and live-birth rate/ ongoing pregnancy rate (OR 1.47, 1.30–1.65; 13 trials; N1⁄45,859 women), compared with clinical touch (Fig. 2) (48). Studies have also shown improved outcomes using ultra- sound guidance with frozen embryo transfer and pro- grammed recipient cycles using donor eggs (32, 49).
In contrast to the preponderance of studies that have shown improved IVF outcome with the use of TA ultrasound guidance, a few studies have not been able to replicate these findings. One RCT of 374 patients found a similar pregnancy rate between ultrasound-guided and blind transfers (50). Likewise, an RCT of day-3 embryo transfers that included
FIGURE 2
Comparison of live-birth and ongoing pregnancy rates between ultrasound-guided embryo transfer and clinical touch embryo transfer. Used with permission from Brown 2016, the Cochrane Collection (48).
ASRM. Embryo transfer guideline. Fertil Steril 2017.
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