A comparative study of transabdominal and transvaginal ultrasound guidance on consequences of embryo transfer at Mahdiyeh hospital of Tehran in 2020: An RCT

Abstract

Background: Infertility is an important problem that affects many couples worldwide. Assisted reproductive technology (ART) helps infertile couples to have offspring. One of the critical parts of ART is embryo transfer (ET).


Objective: To compare the effect of transvaginal and transabdominal ultrasonographyguided ET on ART outcomes.


Materials and Methods: In this randomized clinical trial study, 90 women who were candidates for in vitro fertilization (IVF) referred to Mahdiyeh hospital of Tehran during the yr 2020 were randomly divided into two groups (n = 45/each) of transvaginal and transabdominal ultrasonography-guided ET. The embryos were transferred two-three days after oocyte retrieval. The patient pain, duration and difficulty of the procedure, three-dimensional vision quality and successful pregnancy rate were measured.


Results: In this study, 63.2% of the 45 women who underwent IVF under the guidance of the transvaginal guidance and 36.8% of the 45 women who underwent IVF under the transabdominal guidance had a successful pregnancy, which was not significantly different (p = 0.19). Also, based on other results there was no difference between the two groups in terms of patient pain (p = 0.53), duration (p ≥ 0.50), difficulty of procedures (p ≥ 0.50) and ultrasonography vision; however, the threedimensional vision quality in the transvaginal ultrasonography was better than that in the transabdominal ultrasonography (p < 0.01).


Conclusion: Overall, the ART outcomes in the transvaginal and transabdominal ultrasonography-guided ET were similar, so we suggest that physicians evaluate the patient’s situation, the hospital equipment, and their ability before selecting the type of ultrasonography.


Key words: Transvaginal, Transabdominal, Ultrasound, Embryo transfer, Pregnancy.

References
[1] Miyamoto T, Minase G, Shin T, Ueda H, Okada H, Sengoku K. Human male infertility and its genetic causes. Reprod Med Biol 2017; 16: 81–88.

[2] Nosrati R, Graham PJ, Zhang B, Riordon J, Lagunov A, Hannam TG, et al. Microfluidics for sperm analysis and selection. Nat Rev Urol 2017; 14: 707–730.

[3] Yildirim G, Turkgeldi LS, Koroglu N, Guler S, Talmac M. Predictive factors for pregnancy outcome following controlled ovarian stimulation and intrauterine insemination. J Pak Med Assoc 2017; 67: 422–427.

[4] Kleijkers SHM, Mantikou E, Slappendel E, Consten D, van Echten-Arends J, Wetzels AM, et al. Influence of embryo culture medium (G5 and HTF) on pregnancy and perinatal outcome after IVF: A multicenter RCT. Hum Reprod 2016; 31: 2219–2230.

[5] Saldeen P, Källen K, Sundström P. The probability of successful IVF outcome after poor ovarian response. Acta Obstet Gynecol Scand 2007; 86: 457–461.

[6] Larue L, Keromnes G, Massari A, Roche C, Moulin J, Gronier H, et al. Transvaginal ultrasound-guided embryo transfer in IVF. J Gynecol Obstet Hum Reprod 2017; 46: 411–416.

[7] Uyar A, Bener A, Ciray HN, Bahceci M. Physician experience in performing embryo transfers may affect outcome. Fertil Steril 2011; 95: 1860–1862.

[8] Abou-Setta AM, Al-Inany HG, Mansour RT, Serour GI, Aboulghar MA. Soft versus firm embryo transfer catheters for assisted reproduction: A systematic review and metaanalysis. Hum Reprod 2005; 20: 3114–3121.

[9] Rovei V, Dalmasso P, Gennarelli G, Lantieri T, Basso G, Benedetto C, et al. IVF outcome is optimized when embryos are replaced between 5 and 15 mm from the fundal endometrial surface: A prospective analysis on 1184 IVF cycles. Reprod Biol Endocrinol 2013; 11: 114.

[10] Matorras R, Mendoza R, Exposito A, Rodriguez-Escudero F. Influence of the time interval between embryo catheter loading and discharging on the success of IVF. Hum Reprod 2004; 19: 2027–2030.

[11] Tiras B, Korucuoglu U, Polat M, Saltik A, Zeyneloglu HB, Yarali H. Effect of blood and mucus on the success rates of embryo transfers. Eur J Obstet Gynecol Reprod Biol 2012; 165: 239–242.

[12] Ghanem ME, Ragab AE, Alboghdady LA, Helal AS, Bedairy MH, Bahlol IA, et al. Difficult embryo transfer (ET) components and cycle outcome. Which is more harmful? Middle East Fertil Soc J 2016; 21: 114–119.

[13] Cozzolino M, Vitagliano A, Di Giovanni MV, Laganà AS, Vitale SG, Blaganje M, et al. Ultrasound-guided embryo transfer: Summary of the evidence and new perspectives: A systematic review and meta-analysis. Reprod Biomed Online 2018; 36: 524–542.

[14] Saravelos SH, Wong AW, Kong GW, Huang J, Klitzman R, Li TC. Pain during embryo transfer is independently associated with clinical pregnancy in fresh/frozen assisted reproductive technology cycles. J Obstet Gynaecol Res 2016; 42: 684–693.

[15] Brown J, Buckingham K, Buckett W, Abou-Setta AM. Ultrasound versus ’clinical touch’ for catheter guidance during embryo transfer in women. Cochrane Database Syst Rev 2016; 3: CD006107.

[16] Mansour RT, Aboulghar MA. Optimizing the embryo transfer technique. Hum Reprod 2002; 17: 1149–1153.

[17] Gergeley RZ. Sonography guided embryo transfer for in vitro fertilization. Google Patents; 2014. Available at: https://patents.google.com/patent/US20140163313A1/en.

[18] Revelli A, Rovei V, Dalmasso P, Gennarelli G, Racca C, Evangelista F, et al. Large randomized trial comparing transabdominal ultrasound-guided embryo transfer with a technique based on uterine length measurement before embryo transfer. Ultrasound Obstet Gynecol 2016; 48: 289–295.

[19] Teixeira DM, Dassunção LA, Vieira CVR, Barbosa MAP, Coelho Neto MA, Nastri CO, et al. Ultrasound guidance during embryo transfer: A systematic review and metaanalysis of randomized controlled trials. Ultrasound Obstet Gynecol 2015; 45: 139–148.

[20] Woolcott R, Stanger J. Potentially important variables identified by transvaginal ultrasound-guided embryo transfer. Hum Reprod 1997; 12: 963–966.

[21] Hurley VA, Osborn JC, Leoni MA, Leeton J. Ultrasoundguided embryo transfer: A controlled trial. Fertil Steril 1991; 55: 559–562.

[22] Anderson RE, Nugent NL, Gregg AT, Nunn SL, Behr BR. Transvaginal ultrasound-guided embryo transfer improves outcome in patients with previous failed in vitro fertilization cycles. Fertil Steril 2002; 77: 769–775.

[23] Revelli A, Tur-Kaspa T, Confino E. Ultrasound guidance in embryo transfer. In: Stadtmauer LA, Tur-Kaspa I. Ultrasound imaging in reproductive medicine. United States: Springer; 2019. 335–343.

[24] Karavani G, Ben-Meir A, Shufaro Y, Hyman JH, Revel A. Transvaginal ultrasound to guide embryo transfer: A randomized controlled trial. Fertil Steril 2017; 107: 1159– 1165.

[25] Bodri D, Colodrón M, García D, Obradors A, Vernaeve V, Coll O. Transvaginal versus transabdominal ultrasound guidance for embryo transfer in donor oocyte recipients: A randomized clinical trial. Fertil Steril 2011; 95: 2263–2268.

[26] Samy AA, El-Kassar YS, Gaafar SS, Hamza HA, Menshawi SS. Comparison between transvaginal and transabdominal ultrasound-guided embryo transfer: A randomized, prospective trial. Menoufia Med J 2020; 33: 419–426.

[27] Porat N, Boehnlein LM, Schouweiler CM, Kang J, Lindheim SR. Interim analysis of a randomized clinical trial comparing abdominal versus transvaginal ultrasoundguided embryo transfer. J Obstet Gynaecol Res 2010; 36: 384–392.