Training fellows to perform embryo transfers: a standard protocol giving excellent live birth rates

Abstract

Embryo transfer (ET) technique plays a critical role in determining the success of an IVF cycle and should be an important component of fellow training. Yet, many REI fellows graduate performing few or no ETs. We have developed a standard protocol for fellows to perform ETs. The purpose of this study was to determine if live birth rates differ between attending physicians and fellows using a standard protocol. Retrospective analysis IVF cycles performed at an academic medical center between 7/1/2005 and 12/31/2015 were identified. Cycles without a documented pregnancy outcome or ET physician were excluded. All fellow transfers were done with a Wallace catheter using the afterload technique while the attending physician performed abdominal probe ultrasound to ensure proper embryo placement. Data were analyzed by attending physician versus fellow status. All outcomes were evaluated using t-tests, chi squared or regression analysis. A total of 2,477 cycles meeting criteria were identified. Attending physicians performed 2,001 transfers, while fellows performed 476. Attending physicians transferred a larger proportion of grade 1 embryos (62% vs. 56%, p= 0.013), while fellows transferred a larger proportion of grade 2 embryos (37% vs. 30%, p= 0.009). There were otherwise no differences in cycle characteristics between attending physicians and fellows (Table 1). Additionally, there were no differences in per cycle live birth rates between attending physicians and fellows (30% vs. 28%, p= 0.422); this relationship remained true even after adjusting for differences in morphology grading. When data were analyzed by fellowship year, there remained no differences in live birth rates between groups. In particular, the per cycle live birth rate among first year fellows was 30% compared to 32% among attending physicians (p= 0.653). Our data show that there are no differences in live birth rates associated with embryo transfers performed by attending physicians versus fellows. Furthermore, mastery of proper embryo transfer technique is a skill that can be effectively learned during one’s first year of fellowship training. We therefore demonstrate that our decade long practice of training fellows to perform embryo transfers does not compromise pregnancy or live birth rates.Tabled 1Patient Cycle CharacteristicsAttending PhysiciansFellowsAge3636BMI2423Stimulation days1010Oocytes retrieved1212Embryos transferred2.12D5 transfers14%16%Clinical Pregnancy40%42%Miscarriage8%7%Live birth30%28% Open table in a new tab