Training Providers in Embryo Transfer: the Identification of a Learning Curve Among Reproductive Endocrinology Fellows

Abstract

Objective: Embryo transfer represents one of the most critical procedures in the practice of assisted reproduction. The provider is one of the most important variables at embryo transfer. The objective of this study was to assess each individual provider’s performance as measured by clinical pregnancy rates and to identify the minimum number of embryo transfers required to train providers in this technique. Design: Observational study of pregnancy outcome following embryo transfer for five fellow trainees. Materials and Methods: Trainees in the Combined Federal Fellowship Program were instructed in embryo transfer methods. All trainees performed a minimum of 30 practice uterine insertions with the Wallace catheter during mock transfers or for intrauterine inseminations remote from assisted reproduction cycles. From January 1996 to March 2000 information regarding clinical pregnancy rate, patient age, embryo quality and number, the presence of blood or mucus in the catheter, retained embryos, and degree of difficulty of the transfer were obtained. All patients undergoing embryo transfer received a mock transfer remote from the cycle of stimulation. All transfers were performed under ultrasound guidance with a full bladder. The number of embryos transferred conformed to ASRM guidelines. Results: Annual pregnancy rates for the program did not differ significantly during the study period. Five fellow trainees performed a total of 206 embryo transfers for a combined pregnancy rate of 48.2% per embryo transfer. In comparison the program pregnancy rate per transfer was 47.4% (560/1179). When pregnancy results were serially recorded, pregnancy rates were initially low for 4 of the 5 fellows. By thirty-five transfers, the trainees average clinical pregnancy rates were comparable to the mean program rate. Conclusion: Thirty-five transfers were sufficient to train providers in the method of embryo transfer. This information also makes it possible to identify providers with pregnancy rates that are significantly different from their peers and provides an opportunity for additional remedial training.