Embryo Transfer by Reproductive Endocrinology Fellows Versus Attending Physicians

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Significant heterogeneity exists among the various methods used for training reproductive endocrinology and infertility (REI) fellows to perform embryo transfer (ET) for in vitro fertilization (IVF). The findings of a recent survey of current REI fellows and recent fellowship graduates indicated that almost half of them did not perform ET while in training. Many programs do not allow fellows to perform ET and restrict its performance to attending physicians largely because of fear that pregnancy rates will be compromised. There is no evidence supporting this restriction. In a recent study, ET pregnancy rates were comparable between fellows and attending physicians both before and after the institution of a mandatory minimal intrauterine insemination policy. The aim of this retrospective cohort study was to compare live birth rates following ultrasound-guided ET performed by REI fellows versus attending physicians. The study was conducted at a single academic institution between 2005 and 2011. All participants underwent first day-3, fresh, nondonor ET. Day 3 embryos with 8 cells, less than 10% fragmentation, and no asymmetry were deemed to be high quality. Fellows performed ET under direct ultrasound guidance by the attending physician, using the afterload method. The χ2 test was used to evaluate categorical variables and Student t test for continuous variables. The relationship between ET trainee status and live birth rate was assessed with multivariate logistic regression, adjusting for potential confounders. A total of 760 ETs were performed by attending physicians and 104 by fellows. Baseline patient characteristics were similar in the 2 groups. There was no difference in the live birth rate between groups: 31% following ET by an attending physician versus 34% following ET by a fellow; the odds ratio was 0.99, with a 95% confidence interval of 0.63 to 1.55. Adjusting for potential confounders did not affect the results. These findings show no significant difference in live birth rates following ultrasound-guided ET by fellows or attending physicians at a single institution. The data suggest that fellows can be trained to perform ET using the afterload method and ultrasound guidance without compromising success rates.