P12.14: 4D/3D ultrasound‐guided embryo transfer

Abstract

Despite many developments in ART, implantation and pregnancy rates remain low and almost 85% of transferred embryos do not implant, mostly because of embryo transfer (ET) which is the least successful step in IVF procedures. To improve ET technique is considered essential to determine IVF failure or success. We report on the use of 4D/3D US-guided ET to improve implantation/pregnancy rate. 45 ETs were performed by use 4D/3D US to locate the catheter tip within the uterine cavity in the presence of a half-full bladder. A GE 730 Voluson machine with a transabdominal volume probe was used. Frydman catheters were used. ETs were successful in all cases with a lowering in endometrial bleeding and an increasing of 15% of our implantation/pregnancy rate. The use of atraumatic soft catheter during ET without touching the endometrium and the uterine fundus improve IVF outcome. Unlikely blind “clinical touch” catheter placement has been associated with uterine contractility and relocation of embryos towards the cervix, whereas US-guided ET allows the catheter tip to be accurately positioned within the uterine cavity documenting at the meantime that embryos were properly deposited by observing the movement of the embryo-associated air bubbles as well as the dept of embryo replacement into the uterine cavity, positively influencing by this way IVF outcome. To date the all US-guided ET reports but one have been regarded 2D US, and to the best of our knowledge it is the first report on 4D/3D real-time US-guided ET The rationale for 4D/3D US-guided ET includes real-time tracking of the catheter tip and more predictable embryo placement in the lumen of the endometrial cavity. 4D/3D US guidance may represent an important tool in ET as it allows a real-time reconstruction of the uterine cavity in its three planes significantly lowering the incidence of difficult transfers as well as the incidence of bleeding, improving implantation/pregnancy rates.