Embryo transfer quality and provider-specific pregnancy rates in IVF-ET

Abstract

Objective: Mounting evidence suggests that embryo transfer (et) technique is a significant variable affecting treatment success in ivf-et. using a transfer grading system developed at our institution, physician-specific scoring of embryo transfer procedures was performed to determine if this approach is meaningful and consistent enough to serve as a quality control method for et procedures in ivf-et. Design: Prospective study. Materials and methods: Over a period of 10 consecutive months, all embryo transfers performed by our four physicians were graded at time of the procedure by the attending embryologists using an 8-category scoring system. zero to four points were given for the presence or absence of mucus and blood in or/and around the catheter tip, the type of catheter used, the degree of ultrasound visualisation of the transfer catheter during the transfer, the presence or absence of uterine cramping, the number of times embryos are retained, the number of reloads necessary, as well as the length of the procedure. the transfer grade was based on the total points scored, with grade 1 indicating the best possible technique (0 points scored) and grade 5 the worst (>10 points scored). Pregnancy rates/et, mean embryo quality score, mean number of embryos transferred/et, distribution of day 3 vs day 5/6 et’s, and name of attending embryologists were recorded for the individual physicians (a,b,c,d). fisher’s exact test and anova were used for statistical analysis where appropriate. Results: A total of 291 et’s were performed during the observation period. There was no difference in the mean embryo grade per et, mean number of embryos transferred, d3 vs d5/d6, fresh vs frozen transfers and the distribution of embryologists among physicians. mean embryo transfer grades by physician were 1.4 (a), 1.7 (b), 1.9 (c), 2.0 (d), (p values a: d ∗∗∗<0.001, a: c ∗< 0.05, a: b/b: c /b: d/c: d n.s.). individual pregnancy rates were 62.3% (a), 45.7% (b), 44.4% (c), 47.8% (d) (p values a: d < 0.05, a: c/a: b/c: d/b: d/b: c n.s.). a statistically significant difference in individual mean et grades and mean pregnancy rates/et is limited to the physicians with the lowest and the highest et-score, but these preliminary results demonstrate a trend towards a higher pregnancy rate if the individual physician’s et-score is lower. Conclusion: Further study is needed to analyse the individual components generating a physician’s average et-score. Although preliminary and weakened by small study populations, these data provide encouragement towards continuing efforts to monitor, and ultimately adjust, embryo transfer techniques in an attempt to improve outcome in ivf-et without risking multiple pregnancies.