Objective Given the importance of ET technique during assisted reproductive technology
Objective Given the importance of ET technique during assisted reproductive technology cycles, we evaluated the effect of embryo afterloading subsequent to placement of the ET catheter on pregnancy rates vs. using the afterloading technique was higher than in the direct ET group (52.4% vs. 34.9%). Conclusion(s) There was a trend toward an increase in pregnancy rate when an embryo afterloading technique was used. A prospective randomized trial is needed to examine this issue. Keywords: Embryo transfer, technique, IVF-ET, pregnancy rate Over the past 10-15 years there have been increasing success rates with assisted reproductive technologies (ART) in all age groups. The Society for Assisted Reproductive Technology reported an increase in live birth rates from 28% in 1996 to IL10RB antibody 32% in 2002 (1). This increase has been attributed to multiple factors including improved stimulation protocols (2-4), advances in embryology laboratory techniques (5), and improvement in ET techniques (6, 7). Embryo transfer is universally accepted as a crucial last step in any ART cycle. The importance of this step has been emphasized by the fact that different providers at the same institution may have disparate pregnancy rates after ET (8, 9). Other variables affecting pregnancy include the ease of ET (7, 10, 11), presence or absence of blood on the transfer catheter (12), type of catheter used (13), technique used to perform the transfer (14-16), and experience of the physician (17). In the early 1990s, studies were first published on the use of a mock or dummy ET before the start of an IVF cycle (11, 18). A mock ET allows the physician to choose the appropriate transfer catheter, measure the depth of the endometrial Spliceostatin A manufacture cavity, and anticipate potential problems at ET. However, a mock transfer remote from the actual ET is done under different circumstances and may not be reflective of actual conditions encountered on the day of ET. Sharif et al. (19) proposed to circumvent this problem by performing a mock ET immediately before the actual ET. To avoid additional trauma by the passage of two separate catheters, we began transferring embryos by an afterload technique, in which an empty catheter is placed at, or just past, the internal cervical os. The inner sheath is withdrawn, and a second inner sheath containing the embryos is passed. This gives the provider the benefit of an immediate mock transfer while minimizing manipulation of embryos and possibly reducing trauma to the endometrium. We performed a retrospective analysis of 127 ETs done during a 1-year period of time to determine whether there were differences in pregnancy rates based on the transfer method used. MATERIALS AND METHODS Under an approved protocol reviewed by the Department of Clinical Investigation, Spliceostatin A manufacture we performed a retrospective analysis of patients undergoing a day 3 ET at the Walter Reed Army Medical Center ART program from July 2001 to July 2002 by a single provider. Information regarding patient age, day 3 FSH level, number of embryos transferred, method of ET, and clinical pregnancy rates were collected. The ET method used was at the discretion of the provider performing the procedure, and the number of women receiving the afterload technique was proportional throughout the study. Transfers of blastocysts, cryopreserved embryos, and donor Spliceostatin A manufacture oocytes were not included in the analysis. Patients were excluded from analysis if they were greater than 43 years of age or had an FSH level >14 mIU/L on cycle day 3 (or on cycle day 3 or 10 after a clomiphene citrate challenge test). A total of 127 patients met criteria for study. All patients had undergone controlled ovarian stimulation by using a combination of long-term gonadotropin-releasing hormone (GnRH) agonist (Lupron, Spliceostatin A manufacture 1.0 mg/day; TAP Pharmaceuticals, Deerfield, IL) or microdose flare GnRH agonist (40 g twice daily and gonadotropins Gonal-F (Serono, Rockland, MA) or a combination of Gonal-F and Repronex (Ferring Pharmaceuticals, Suffern, NY) as described elsewhere (20). The dose of gonadotropins was individualized based on the patients age, history, and response to medication. Cycles were monitored using serial transvaginal ultrasounds to chronicle follicular growth and the measurement of serum E2 levels. Administration of hCG occurred when follicular size and E2 levels were.