Understanding Embryo Transfer Procedure for IVF
Although it may seem obvious that the correct identification of patients and embryos is vital, communication errors do happen and can lead to a catastrophic error, especially if there are patients with similar names undergoing treatment at the same time.
Electronic identity/witnessing systems are now available to confirm identities of a doctor, nurse, embryologist and patient, but if such a system is not available, a routine discipline of identification should be followed to ensure that there is no possibility of mistaken identity:
- IVF laboratory ensures that medical notes always accompany a patient who is being prepared for embryo transfer procedure.
- Name and medical numbers on medical notes and patient identity should be checked by a few people, i.e., the doctor in charge of the procedure and the assisting nurse.
- The doctor should also check the name and number verbally with the patient, and doctor, nurse and patient may sign an appropriate form confirming that the details are correct.
- The duty embryologist should check the same details with the embryology records, and also sign the same form in the presence of the doctor.
Preparation of Embryos for Transfer
The rate of multiple gestation resulting from IVF/ET is unacceptably high, and legislation in Ukraine now prohibits the transfer of more than two embryos in a treatment cycle for certain patient groups. Elective single embryo transfer (eSET) is recommended for selected patients with a good prognosis, i.e., young age, tubal infertility only, first attempt or previous history of pregnancy and/or delivery.
Implantation is a complex and multistep process that requires successful interplay between several factors: not only a competent embryo and receptive endometrium, but also a competent embryologist as well as the personnel carrying out the transfer procedure. Although the technique of embryo transfer procedure may appear to be a simple and straightforward procedure, its correct management is absolutely critical in safe delivery of the embryos to the site of their potential implantation.
Evidence repeatedly shows that pregnancy rates can vary in the hands of different operators and with the use of different embryo transfer catheters. In an evidence of embryo transfer procedure under ultrasound-guided control, researchers observed guiding cannula and transfer catheter placement in relation to the endometrial surface and uterine fundus during embryo transfer procedure. Their results indicated that tactile assessment of the embryo transfer catheter was unreliable, in that the cannula and the catheter could be seen to abut the fundal endometrium, and indent or embed in the endometrium in a significant number of cases.
Endometrial movement due to sub-endometrial myometrial contraction was obvious in 36% of cases, and this movement was associated with a reduced pregnancy rate. Their studies highlight the fact that “blind” embryo transfer procedure may often lead to an unsatisfactory outcome, and they recommend the use of ultrasound guidance as a routine during embryo transfer procedure.
In view of the complex and elegant biochemistry and physiology involved in the development of a competent oocyte that will fertilize and develop successfully in vitro, as well as the delicate balance that must be required within each contributing component and compartment, it seems miraculous indeed that the application of essentially ill-defined strategies has led to the successful birth of so many children.
Although success rates have improved significantly over the past two decades, there continues to be a wastage of embryos that fail to implant. A great deal more research is required to identify and define factors involved in the development of competent oocytes and viable embryos, and new data from the application of current research using the latest advances in molecular biology and culture technology are awaited.
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