The position of the euploid blastocyst in the uterine cavity influences implantation

Bayram, A; Munck, Neelke De; Elkhatib, Ibrahim; Arnanz, Ana; El-Damen, Ahmed; Abdala, Andrea; Coughlan, Carol; Garrido, Nicolás; Vidales, Laura Melado; Lawrenz, Barbara; Fatemi, Human M.

doi:10.1016/j.rbmo.2021.02.008

Cited by 7 publications

(13 citation statements)

References 47 publications

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“…The results were also logically in line with the studies suggesting an embryo position closer to the fundal myometrium–endometrial interface results in a better chance of pregnancy 15 , 38 , 39 . More recently, Bayram et al further confirmed the negative association between the transfer depth and implantation in a cohort of euploid blastocyst transfer cycles 18 .…”

Section: Discussionmentioning

confidence: 85%

“…Given the evidence from the randomized trials remained limited 11 , cohort studies in large populations may contribute to verify the conclusions drawn from the meta-analysis. However, one factor that limited some of the studies examining the role of transfer depth is estimating the effect on pregnancy through simple bivariate analyses, without controlling for confounding effects by other important parameters 12 , 13 , while several other studies controlled for different sets of confounding factors 16 – 18 . Many of the important parameters identified in the recent studies that have shown to be associated with the chance of pregnancy, such as endometrial thickness 19 , quality of embryos transferred 18 , number of oocytes retrieved 20 , and progesterone elevation before transfer 21 , were not included in the analyses in many previous studies, even though the multivariate analyses were used.…”

Section: Introductionmentioning

confidence: 99%

“…However, one factor that limited some of the studies examining the role of transfer depth is estimating the effect on pregnancy through simple bivariate analyses, without controlling for confounding effects by other important parameters 12 , 13 , while several other studies controlled for different sets of confounding factors 16 – 18 . Many of the important parameters identified in the recent studies that have shown to be associated with the chance of pregnancy, such as endometrial thickness 19 , quality of embryos transferred 18 , number of oocytes retrieved 20 , and progesterone elevation before transfer 21 , were not included in the analyses in many previous studies, even though the multivariate analyses were used. Moreover, some of these confounders, such as progesterone levels 22 , endometrial thickness 23 , and the day of transfer 24 , are not only predictors of implantation but may also affect the frequency and the direction of uterine contraction.…”

Section: Introductionmentioning

confidence: 99%

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Uterine factors modify the association between embryo transfer depth and clinical pregnancy

Sun

Cai

Liu

et al. 2022

Sci Rep

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The embryo transfer depth may affect the chance of pregnancy. However, embryo dislodging caused by uterine contraction may occur after the transfer. The aim of the retrospective study was to investigate whether the factors associated with uterine contractilities, such as endometrial thickness and progesterone elevation, affect the association between transfer depth and implantation. A total of 7849 fresh transfer cycles on conventional stimulation in a single in vitro fertilization (IVF) center during the period 2013–2015 was reviewed. Patients were categorized according to quartiles of embryo transfer depth (≤ 9 mm, n = 1735, 9.1–11 mm, n = 2557, 11.1–14 mm, n = 1933, ≥ 1.4 mm, n = 1624, respectively). Adjusted for confounding factors, the adjusted odds ratio (aOR) (95% confidence interval, CI) for clinical pregnancy was 0.90 (0.79–1.02), 0.86 (0.74–0.99), and 0.70 (0.60–0.82) respectively in quartiles 2 through 4, comparing with quartile 1. However, the aORs were significantly increased when the endometrial thickness was < 8 mm. In comparison with that in the cycles with a normal endometrial thickness (8–11 mm), the aORs comparing quartiles 2 through 4 with quartile 1 in the cycles with an endometrial thickness < 8 mm increased from 0.78 (95% CI 0.65–0.93), 0.79 (95% CI 0.65–0.97), and 0.64 (95% CI 0.51–0.81) to 1.73 (95% CI 1.21–2.47), 1.04 (95% CI 0.69–1.56), and 1.45 (95% CI 0.91–2.31), respectively. In the cycles with elevated progesterone and blastocyst stage transfer, the aORs comparing quartiles 4 with quartile 1 decreased from 0.73 (95% CI 0.62–0.87) and 0.74 (95% CI 0.63–0.87) to 0.58 (95% CI 0.40–0.84) and 0.42 (95% CI 0.25–0.73) than those in the cycles without. However, only blastocyst transfer showed a significant interaction with transfer depth (p = 0.043). Our data suggested that endometrial thickness and blastocyst transfer significantly affect the association between embryo transfer depth and clinical pregnancy.

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Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Uterine factors modify the association between embryo transfer depth and clinical pregnancy

Sun

Cai

Liu

et al. 2022

Sci Rep

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“…When the inner catheter tip is placed 1.5–2 cm from the fundal endometrium, a best performance is expected ( Cenksoy et al , 2014 ). In a more recent retrospective study, it was shown that the probability of pregnancy, clinical pregnancy and ongoing pregnancy decreases as the distance from the fundus (DFF) to the air bubble (SD: 10.27 ± 3.0 mm) increases ( Bayram et al , 2021 ). When all variables remained constant, an increase of 1 mm of DFF changed the odds of pregnancy by 0.882; of clinical pregnancy by 0.891 and of ongoing pregnancy by 0.925.…”

Section: Recommendationsmentioning

confidence: 99%

Evidence and consensus on technical aspects of embryo transfer

D’Angelo

Panayotidis²,

Alteri

et al. 2022

Human Reproduction Open

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BACKGROUND Ultrasound-guided embryo transfer (US-GET) is a widely performed procedure, but standards for the best practice are not available. OBJECTIVE AND RATIONALE This document aims to provide an overview of technical aspects of US-GET after considering the published data and including the preparation for the embryo transfer (ET) procedure, the actual procedure, the post-procedure care, associated pathologies, complications and risks, quality assurance and practitioners’ performance. SEARCH METHODS A literature search for evidence on key aspects of the ET procedure was carried out from database inception to November 2021. Selected papers (n = 359) relevant to the topic were analysed by the authors. The following key points were considered in the papers: whether ultrasound (US) practice standards were explained, to what extent the ET technique was described and whether complications or incidents and how to prevent such events were reported. In the end, 89 papers could be used to support the recommendations in this document, which focused on transabdominal US-GET. OUTCOMES The relevant papers found in the literature search were included in the current document and described according to the topic in three main sections: requirements and preparations prior to ET, the ET procedure, and training and competence for ET. Recommendations are provided on preparations prior to ET, equipment and materials, ET technique, possible risks and complications, training and competence. Specific aspects of the laboratory procedures are covered, in particular the different loading techniques and their potential impact on the final outcomes. Potential future developments and research priorities regarding the ET technique are also outlined. LIMITATIONS, REASONS FOR CAUTION Many topics were not covered in the literature review and some recommendations were based on expert opinions and are not necessarily evidence based. WIDER IMPLICATIONS ET is the last procedural step in an ART treatment and is a crucial step toward achieving a pregnancy and live birth. The current paper set out to bring together the recent developments considering all aspects of ET, especially emphasizing US quality imaging. There are still many questions needing answers, and these can be subject of future research. STUDY FUNDING/COMPETING INTEREST(S) No funding. ADA has received royalties from CRC Press and personal honorarium from Cook, Ferring and Cooper Surgical. The other co-authors have no conflicts of interest to declare that are relevant to the content of this article.

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“…Many factors are involved that results in affecting high implantation potential are, embryo transfer catheter type, catheter loading technique, embryo transfer site, uterine receptivity and endometrial thickness. 1 Ultrasound guided embryo transfer allows to visualize the exact position of the catheter tip along with the inclusion of air bubbles loaded in the catheter. Air bubbles were known to be a predictor on the pregnancy rates.…”

Section: Introductionmentioning

confidence: 99%

Influence of endometrial thickness and embryo placement distance from fundus in in-vitro fertilization treatment

Selvamani

Gurumoortthy

Anandaraj

et al. 2022

Int J Reprod Contracept Obstet Gynecol

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Background: In-vitro fertilization–embryo transfer (IVF-ET) has become progressively popular as a treatment for different type of infertility issues. Implantation of the embryo is an essential step and depends on various factors that play pivotal role in influencing the pregnancy outcomes in IVF cycle. It directly impacts on the efficiency of embryo transfer procedure, site of embryo deposition, catheter loading technique, embryo placement distance from the fundus and thickness of endometrium.Methods: In the present retrospective study, data from IVF-ET treatment cycles conducted at Srushti Fertility Centre and Women’s Hospital, Chennai, for a period between October 2021 and February 2022 were analysed. Women were divided into four groups according to embryo placement distance from fundus post embryo transfer group 1: <10 mm, group 2: >10 to <15 mm, group 3: >15 to <20 mm and group 4: >20 mm. According to endometrial thickness they were divided into two groups, group A: 6-10 mm and group B: 10-14 mm. Clinical pregnancy were assessed between the groups.Results: Clinical pregnancy rates were higher in groups 2 and 3 when compared to embryo placement distance from fundus 62.3% and 82.2%, distance of 10 mm and 20 mm and endometrial thickness of more than 10 mm (group B) had higher clinical pregnancy rates 66.3% than (group A) 43.5%.Conclusion: Ideal ET depth and optimum endometrial thickness were found to influence the clinical pregnancy rates. Embryo placement at 10-20 mm from fundus and endometrial thickness of more than 10 mm is recommended for optimal clinical pregnancy outcomes.

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The position of the euploid blastocyst in the uterine cavity influences implantation

Cited by 7 publications

References 47 publications

Uterine factors modify the association between embryo transfer depth and clinical pregnancy

Uterine factors modify the association between embryo transfer depth and clinical pregnancy

Evidence and consensus on technical aspects of embryo transfer

Influence of endometrial thickness and embryo placement distance from fundus in in-vitro fertilization treatment

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