National Survey Highlights the Urgent Need for Standardisation of Embryo Transfer Techniques in the UK.

Lewis Nancarrow,Dharani K Hapangama,Roy Homburg,Nicola Tempest,Andrew J Drakeley,Richard Russell

doi:10.3390/jcm10132839

Abstract

Embryo transfer (ET) is one of the vital steps in the in vitro fertilisation (IVF) process, yet there is wide variation in ET technique throughout the UK, without a nationally approved standardised approach. The aim of this study was to gain contemporaneous information regarding the current clinical ET practice in the UK. Method: A 38-question electronic survey was distributed to the 79 UK Human Fertilisation and Embryology Authority (HFEA) registered clinics performing ETs. Results: In total, 59% (47/79) of units responded, 83% (39/47) performing ultrasound-guided transfers, with 42% (20/47) of units using a tenaculum; 22% (10/45) would proceed with transfer regardless of fluid in the endometrial cavity. In 91% (43/47) of units, embryos were deposited in the upper/middle portion of the uterine cavity, but interpretation of this area ranged from 0.5 to >2 cm from the fundus, with 68% (32/47) allowing patients to mobilise immediately after transfer. In 60% (27/45) of clinics, success rates were based on clinical pregnancy rates (CPR). Conclusion: Within the UK there is a wide range of variability in ET techniques, with >70% of discordance in survey-responses between clinics. Whilst there are areas of good practice, some disadvantageous techniques continue to persist. This survey emphasises the importance of developing a standardised, evidence-based approach to improve ET success rates.

Highlights

IntroductionTransferring a good quality embryo in to an appropriately prepared uterine cavity is an integral part of the in vitro fertilisation (IVF) process and a fundamental step in conception [1]
The initial survey questions were formulated in August 2018 after reviewing current embryo transfer (ET) techniques and by considering the practice pertinent to individual practitioners
The initial 33 question survey was subsequently modified after being peer reviewed by five other fertility specialists who were directly contacted by the authors, from in vitro fertilisation (IVF) units around the country, before a final

Summary

Introduction

Transferring a good quality embryo in to an appropriately prepared uterine cavity is an integral part of the in vitro fertilisation (IVF) process and a fundamental step in conception [1]. Reproductive medicine as a speciality, and the IVF process in particular, have seen significant changes over the past 40 years, with many developments in both clinical practice and laboratory procedures [2]. During this time, there has been little change in the embryo transfer (ET) technique originally developed by Steptoe et al [3,4]

Objectives

Methods

Results

Discussion

Conclusion