Standardization of transvaginal ultrasound guided embryo transfer post fellowship: a case control study

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Introduction: There is a void in clinical training of embryo transfer during Reproductive Endocrinology fellowships. Due to the inherent nature of these programs, experience is often limited to observation. However, developing a protocol utilizing mock transfers with the assistance of a transvaginal ultrasound may prevent compromising pregnancy rates immediately post fellowship.Purpose: To compare pregnancy rates post fellowship to those of an experienced operator subsequent to initiating a meticulous protocol.Methods: After a short period of observation, Dr A rehearsed embryo transfers with a Softpass catheter and transvaginal ultrasound during intrauterine inseminations. After competency was established with inseminations, the technique was applied to embryo transfer. A mock transfer was performed (by Doctor A) at the time of egg retrieval and then again just prior to transfer on day 3 or day 5. Doctor B, who has 15 years of experience, performed mock transfers during the stimulation phase with a Jones Catheter. After several transfers were supervised (by Doctor B) and pregnancies were established, this protocol was adhered to during the first 95 fresh and frozen transfers during practice. Pregnancy rates were then compared. Statistical analyses were performed using the Chi-Square test.Results: Table 1Fresh ≤ 37Fresh ≥ 38FrozenDoctor A57.4% (35/61)42.0% (8/19)53.3% (8/15)Doctor B54.5% (36/66)36.7% (18/49)60.0% (36/60)∗ P > 0.05Table 1 is a summary comparing the first 95 transfers post fellowship, which include fresh non donor and frozen including donor and non-donor cycles from December 2002 through October 2003. Open table in a new tab Discussion: According to this case control investigation there is no significant difference in pregnancy rates when a rigorous and conscientious embryo transfer protocol is implemented post fellowship. The use of echo tip catheters and ultrasound are essential in establishing the location of embryo transfer placement. Whereas the transabdominal ultrasound may be limited in specific clinical scenarios, the transvaginal ultrasound is persistently effective in obese women and women with a retroverted uterus. Moreover, it is of interest to note that mock transfers performed close to the actual day of embryo transfer does not appear to disturb the endometrium and affect pregnancy rates when compared to mock transfers performed considerably earlier in the treatment cycle.Conclusion: Despite the lack of training of embryo transfers during fellowship, a meticulous protocol utilizing mock transfers and transvaginal ultrasound can prevent impaired pregnancy rates during the first year in practice. Introduction: There is a void in clinical training of embryo transfer during Reproductive Endocrinology fellowships. Due to the inherent nature of these programs, experience is often limited to observation. However, developing a protocol utilizing mock transfers with the assistance of a transvaginal ultrasound may prevent compromising pregnancy rates immediately post fellowship. Purpose: To compare pregnancy rates post fellowship to those of an experienced operator subsequent to initiating a meticulous protocol. Methods: After a short period of observation, Dr A rehearsed embryo transfers with a Softpass catheter and transvaginal ultrasound during intrauterine inseminations. After competency was established with inseminations, the technique was applied to embryo transfer. A mock transfer was performed (by Doctor A) at the time of egg retrieval and then again just prior to transfer on day 3 or day 5. Doctor B, who has 15 years of experience, performed mock transfers during the stimulation phase with a Jones Catheter. After several transfers were supervised (by Doctor B) and pregnancies were established, this protocol was adhered to during the first 95 fresh and frozen transfers during practice. Pregnancy rates were then compared. Statistical analyses were performed using the Chi-Square test. Results: ∗ P > 0.05 Table 1 is a summary comparing the first 95 transfers post fellowship, which include fresh non donor and frozen including donor and non-donor cycles from December 2002 through October 2003. Discussion: According to this case control investigation there is no significant difference in pregnancy rates when a rigorous and conscientious embryo transfer protocol is implemented post fellowship. The use of echo tip catheters and ultrasound are essential in establishing the location of embryo transfer placement. Whereas the transabdominal ultrasound may be limited in specific clinical scenarios, the transvaginal ultrasound is persistently effective in obese women and women with a retroverted uterus. Moreover, it is of interest to note that mock transfers performed close to the actual day of embryo transfer does not appear to disturb the endometrium and affect pregnancy rates when compared to mock transfers performed considerably earlier in the treatment cycle. Conclusion: Despite the lack of training of embryo transfers during fellowship, a meticulous protocol utilizing mock transfers and transvaginal ultrasound can prevent impaired pregnancy rates during the first year in practice.