SlideShare a Scribd company logo

Embryo Transfer

Dr Sujoy Dasgupta delivered an invited talk on "Embryo Transfer" in "Ultrasound Workshop" on 8 December 2023 at Milan, 2023, the conference of all the Obstetric and Gynaecological Societies of West Bengal. This conference was organized by Kalyani Obstetric and Gynaecological Society (KOGS).

1 of 37
Download to read offline
Dr Sujoy Dasgupta
MBBS (Gold Medalist, Hons)
MS (OBGY- Gold Medalist)
DNB (New Delhi)
MRCOG (London)
Advanced ART Course for Clinicians (NUHS, Singapore)
M Sc, Sexual and Reproductive Medicine (South Wales, UK)
Clinical Director, Genome Fertility Centre, Kolkata
Managing Committee Member, BOGS, 2023-24
Executive Committee Member, ISAR Bengal, 2022-24
Clinical Examiner, MRCOG Part 3 Examination
Winner, Prof Geoffrey Chamberlain Award, RCOG World
Congress, London, 2019
Embryo Transfer
“Just” putting embryos inside the
womb !!!
Embryo Transfer
• Many recommendations are NOT necessarily evidence
based.
• Success of the ET procedure depends on many factors,
several of which are difficult to standardize and
hence to investigate.
• To improve pregnancy and live birth rates, and to
minimize exposure of women to unnecessary or
harmful interventions.
• To avoid multiple treatment cycles, and the high
expenses especially in developing countries.
• To reduce the physical and psychological burden after
failed cycles
Common steps
Step 1: Patient Education
•Short and simple procedure
•Mostly painless
•Positive attitude → reduces anxiety →
reduces uterine contraction (Fanchin et al, 2000)
•For apprehensive/ difficult cases- Sedation/
GA (D’Angelo et al., 2019)
Step 2: Check documents
• Consent form
• Clinical data
• Difficulties during previous transfer/ IUI
• WHO surgical checklist
• Double check patient’s identity

Recommended

ENDOMETRIAL PREPARATION IN FROZEN EMBRYO TRANSFER CYCLES
ENDOMETRIAL PREPARATION IN FROZEN EMBRYO TRANSFER CYCLESENDOMETRIAL PREPARATION IN FROZEN EMBRYO TRANSFER CYCLES
ENDOMETRIAL PREPARATION IN FROZEN EMBRYO TRANSFER CYCLESAboubakr Elnashar
 
CURRENT EVIDENCE ON MEDICAL ADD-ONS IN IVF
CURRENT EVIDENCE ON MEDICAL ADD-ONS IN IVFCURRENT EVIDENCE ON MEDICAL ADD-ONS IN IVF
CURRENT EVIDENCE ON MEDICAL ADD-ONS IN IVFAboubakr Elnashar
 
NICE Guidelines 2013, in relation to IUI & IVF Dr. Jyoti Agarwal,Dr. Sharda J...
NICE Guidelines 2013, in relation to IUI & IVF Dr. Jyoti Agarwal,Dr. Sharda J...NICE Guidelines 2013, in relation to IUI & IVF Dr. Jyoti Agarwal,Dr. Sharda J...
NICE Guidelines 2013, in relation to IUI & IVF Dr. Jyoti Agarwal,Dr. Sharda J...Lifecare Centre
 
Intrauterine Insemination UPDATE 2018
Intrauterine Insemination UPDATE 2018 Intrauterine Insemination UPDATE 2018
Intrauterine Insemination UPDATE 2018 Lifecare Centre
 
Progestin-primed ovarian stimulation (PPOS) is a NEW DAW...
Progestin-primed ovarian stimulation (PPOS)                      is a NEW DAW...Progestin-primed ovarian stimulation (PPOS)                      is a NEW DAW...
Progestin-primed ovarian stimulation (PPOS) is a NEW DAW...Lifecare Centre
 
CLEAVAGE OR BLASTOCYST EMBRYO TRANSFER
CLEAVAGE OR BLASTOCYST EMBRYO TRANSFERCLEAVAGE OR BLASTOCYST EMBRYO TRANSFER
CLEAVAGE OR BLASTOCYST EMBRYO TRANSFERKaberi Banerjee
 

More Related Content

What's hot

Recurrant Implantation Failure in IVF
Recurrant Implantation Failure in IVFRecurrant Implantation Failure in IVF
Recurrant Implantation Failure in IVFKaberi Banerjee
 
How to stimulate your patient for IVF / ICSI
How to stimulate your patient for IVF / ICSIHow to stimulate your patient for IVF / ICSI
How to stimulate your patient for IVF / ICSIHesham Al-Inany
 
Management of thin endometrium isar 2019
Management of thin endometrium isar 2019Management of thin endometrium isar 2019
Management of thin endometrium isar 2019Poonam Loomba
 
Luteal phase support in IUI and ART | Dr. Laxmi Shrikhande | ShrikhandeIVF
Luteal phase support in IUI and ART | Dr. Laxmi Shrikhande | ShrikhandeIVFLuteal phase support in IUI and ART | Dr. Laxmi Shrikhande | ShrikhandeIVF
Luteal phase support in IUI and ART | Dr. Laxmi Shrikhande | ShrikhandeIVFDr.Laxmi Agrawal Shrikhande
 
OVARIAN RESERVE DIAGNOSIS & MANAGEMENT DR Sharda Jain
OVARIAN RESERVE DIAGNOSIS & MANAGEMENT DR Sharda Jain OVARIAN RESERVE DIAGNOSIS & MANAGEMENT DR Sharda Jain
OVARIAN RESERVE DIAGNOSIS & MANAGEMENT DR Sharda Jain Lifecare Centre
 
Fertility Enhancing Laparoscopic Surgeries Panel Discussion
Fertility Enhancing Laparoscopic Surgeries Panel DiscussionFertility Enhancing Laparoscopic Surgeries Panel Discussion
Fertility Enhancing Laparoscopic Surgeries Panel DiscussionRajesh Gajbhiye
 
AZOOSPERMIA Management Made Simple : “Stepwise approach”
AZOOSPERMIAManagement  Made  Simple : “Stepwise approach” AZOOSPERMIAManagement  Made  Simple : “Stepwise approach”
AZOOSPERMIA Management Made Simple : “Stepwise approach” Lifecare Centre
 
Ovulation Induction - Simplified - Dr Dhorepatil Bharati
Ovulation Induction - Simplified - Dr Dhorepatil BharatiOvulation Induction - Simplified - Dr Dhorepatil Bharati
Ovulation Induction - Simplified - Dr Dhorepatil BharatiBharati Dhorepatil
 
EVIDENCE BASED PRACTICAL TIPS FOR LUTEAL PHASE SUPPORT BY DR SHASHWAT JANI
EVIDENCE BASED PRACTICAL TIPS FOR LUTEAL PHASE SUPPORT BY DR SHASHWAT JANIEVIDENCE BASED PRACTICAL TIPS FOR LUTEAL PHASE SUPPORT BY DR SHASHWAT JANI
EVIDENCE BASED PRACTICAL TIPS FOR LUTEAL PHASE SUPPORT BY DR SHASHWAT JANIDR SHASHWAT JANI
 
Management of Infertility With Endometriosis Clinical Practice Guidelines +...
Management of Infertility With Endometriosis   Clinical Practice Guidelines +...Management of Infertility With Endometriosis   Clinical Practice Guidelines +...
Management of Infertility With Endometriosis Clinical Practice Guidelines +...Lifecare Centre
 
Optimal endometrial preparation for frozen embryo transfer cycles
Optimal endometrial preparation for frozen embryo transfer cyclesOptimal endometrial preparation for frozen embryo transfer cycles
Optimal endometrial preparation for frozen embryo transfer cyclesnermine amin
 
10 secrets of success of iui dr. sharda Jain
10 secrets of success of iui dr. sharda Jain10 secrets of success of iui dr. sharda Jain
10 secrets of success of iui dr. sharda JainLifecare Centre
 
Repeated Implantation failure
Repeated Implantation failureRepeated Implantation failure
Repeated Implantation failureAhmad Saber
 
Ovulation Stimulation Protocols for IUI - Dr Dhorepatil Bharati
Ovulation Stimulation Protocols for IUI - Dr Dhorepatil BharatiOvulation Stimulation Protocols for IUI - Dr Dhorepatil Bharati
Ovulation Stimulation Protocols for IUI - Dr Dhorepatil BharatiBharati Dhorepatil
 
INDIVIDUALISED OVARIAN STIMULATION PROTOCOLS
INDIVIDUALISED OVARIAN STIMULATION PROTOCOLSINDIVIDUALISED OVARIAN STIMULATION PROTOCOLS
INDIVIDUALISED OVARIAN STIMULATION PROTOCOLSG K hospital Indore
 
Ovulation Induction in I.U.I. Dr. Sharda Jain Dr. Jyoti Agarwal Dr. Jyoti Bh...
Ovulation Induction in I.U.I. Dr. Sharda Jain Dr. Jyoti Agarwal  Dr. Jyoti Bh...Ovulation Induction in I.U.I. Dr. Sharda Jain Dr. Jyoti Agarwal  Dr. Jyoti Bh...
Ovulation Induction in I.U.I. Dr. Sharda Jain Dr. Jyoti Agarwal Dr. Jyoti Bh...Lifecare Centre
 

What's hot (20)

Recurrant Implantation Failure in IVF
Recurrant Implantation Failure in IVFRecurrant Implantation Failure in IVF
Recurrant Implantation Failure in IVF
 
How to stimulate your patient for IVF / ICSI
How to stimulate your patient for IVF / ICSIHow to stimulate your patient for IVF / ICSI
How to stimulate your patient for IVF / ICSI
 
Management of thin endometrium isar 2019
Management of thin endometrium isar 2019Management of thin endometrium isar 2019
Management of thin endometrium isar 2019
 
Icsi preparation
Icsi preparationIcsi preparation
Icsi preparation
 
Luteal phase support in IUI and ART | Dr. Laxmi Shrikhande | ShrikhandeIVF
Luteal phase support in IUI and ART | Dr. Laxmi Shrikhande | ShrikhandeIVFLuteal phase support in IUI and ART | Dr. Laxmi Shrikhande | ShrikhandeIVF
Luteal phase support in IUI and ART | Dr. Laxmi Shrikhande | ShrikhandeIVF
 
OVARIAN RESERVE DIAGNOSIS & MANAGEMENT DR Sharda Jain
OVARIAN RESERVE DIAGNOSIS & MANAGEMENT DR Sharda Jain OVARIAN RESERVE DIAGNOSIS & MANAGEMENT DR Sharda Jain
OVARIAN RESERVE DIAGNOSIS & MANAGEMENT DR Sharda Jain
 
Endometriosis and art
Endometriosis and artEndometriosis and art
Endometriosis and art
 
Endometriosis in IVF
Endometriosis in IVFEndometriosis in IVF
Endometriosis in IVF
 
Fertility Enhancing Laparoscopic Surgeries Panel Discussion
Fertility Enhancing Laparoscopic Surgeries Panel DiscussionFertility Enhancing Laparoscopic Surgeries Panel Discussion
Fertility Enhancing Laparoscopic Surgeries Panel Discussion
 
AZOOSPERMIA Management Made Simple : “Stepwise approach”
AZOOSPERMIAManagement  Made  Simple : “Stepwise approach” AZOOSPERMIAManagement  Made  Simple : “Stepwise approach”
AZOOSPERMIA Management Made Simple : “Stepwise approach”
 
Ovulation Induction - Simplified - Dr Dhorepatil Bharati
Ovulation Induction - Simplified - Dr Dhorepatil BharatiOvulation Induction - Simplified - Dr Dhorepatil Bharati
Ovulation Induction - Simplified - Dr Dhorepatil Bharati
 
EVIDENCE BASED PRACTICAL TIPS FOR LUTEAL PHASE SUPPORT BY DR SHASHWAT JANI
EVIDENCE BASED PRACTICAL TIPS FOR LUTEAL PHASE SUPPORT BY DR SHASHWAT JANIEVIDENCE BASED PRACTICAL TIPS FOR LUTEAL PHASE SUPPORT BY DR SHASHWAT JANI
EVIDENCE BASED PRACTICAL TIPS FOR LUTEAL PHASE SUPPORT BY DR SHASHWAT JANI
 
Management of Infertility With Endometriosis Clinical Practice Guidelines +...
Management of Infertility With Endometriosis   Clinical Practice Guidelines +...Management of Infertility With Endometriosis   Clinical Practice Guidelines +...
Management of Infertility With Endometriosis Clinical Practice Guidelines +...
 
Optimal endometrial preparation for frozen embryo transfer cycles
Optimal endometrial preparation for frozen embryo transfer cyclesOptimal endometrial preparation for frozen embryo transfer cycles
Optimal endometrial preparation for frozen embryo transfer cycles
 
10 secrets of success of iui dr. sharda Jain
10 secrets of success of iui dr. sharda Jain10 secrets of success of iui dr. sharda Jain
10 secrets of success of iui dr. sharda Jain
 
Repeated Implantation failure
Repeated Implantation failureRepeated Implantation failure
Repeated Implantation failure
 
oocyte pickup ESHRE2019
oocyte pickup ESHRE2019oocyte pickup ESHRE2019
oocyte pickup ESHRE2019
 
Ovulation Stimulation Protocols for IUI - Dr Dhorepatil Bharati
Ovulation Stimulation Protocols for IUI - Dr Dhorepatil BharatiOvulation Stimulation Protocols for IUI - Dr Dhorepatil Bharati
Ovulation Stimulation Protocols for IUI - Dr Dhorepatil Bharati
 
INDIVIDUALISED OVARIAN STIMULATION PROTOCOLS
INDIVIDUALISED OVARIAN STIMULATION PROTOCOLSINDIVIDUALISED OVARIAN STIMULATION PROTOCOLS
INDIVIDUALISED OVARIAN STIMULATION PROTOCOLS
 
Ovulation Induction in I.U.I. Dr. Sharda Jain Dr. Jyoti Agarwal Dr. Jyoti Bh...
Ovulation Induction in I.U.I. Dr. Sharda Jain Dr. Jyoti Agarwal  Dr. Jyoti Bh...Ovulation Induction in I.U.I. Dr. Sharda Jain Dr. Jyoti Agarwal  Dr. Jyoti Bh...
Ovulation Induction in I.U.I. Dr. Sharda Jain Dr. Jyoti Agarwal Dr. Jyoti Bh...
 

Similar to Embryo Transfer

Embryo Transfer (ET) . Lifecare Centre Dr Sharda Jain Dr. Jyoti Agarwal Dr. ...
Embryo Transfer (ET) . Lifecare Centre Dr Sharda Jain Dr. Jyoti Agarwal  Dr. ...Embryo Transfer (ET) . Lifecare Centre Dr Sharda Jain Dr. Jyoti Agarwal  Dr. ...
Embryo Transfer (ET) . Lifecare Centre Dr Sharda Jain Dr. Jyoti Agarwal Dr. ...Lifecare Centre
 
Embryo transfer: Aboubakr Elnashar
Embryo transfer: Aboubakr ElnasharEmbryo transfer: Aboubakr Elnashar
Embryo transfer: Aboubakr ElnasharAboubakr Elnashar
 
Embryo loading & Transfer , Lifecare IVF Dr. Aruna Saxena
Embryo loading & Transfer , Lifecare IVF  Dr. Aruna Saxena Embryo loading & Transfer , Lifecare IVF  Dr. Aruna Saxena
Embryo loading & Transfer , Lifecare IVF Dr. Aruna Saxena Lifecare Centre
 
Embryo Transfer- Tips and Tricks to improve success
Embryo Transfer- Tips and Tricks to improve successEmbryo Transfer- Tips and Tricks to improve success
Embryo Transfer- Tips and Tricks to improve successKaberi Banerjee
 
Fertility Management: Synergy between Endoscopists and Fertility Specialists
Fertility Management: Synergy between Endoscopists and Fertility SpecialistsFertility Management: Synergy between Endoscopists and Fertility Specialists
Fertility Management: Synergy between Endoscopists and Fertility SpecialistsSujoy Dasgupta
 
Amniotomy by dr alka mukherjee dr apurva mukherjee nagpur m.s. india
Amniotomy by dr alka mukherjee dr apurva mukherjee nagpur m.s. india Amniotomy by dr alka mukherjee dr apurva mukherjee nagpur m.s. india
Amniotomy by dr alka mukherjee dr apurva mukherjee nagpur m.s. india alka mukherjee
 
Reproductive imaging
Reproductive imagingReproductive imaging
Reproductive imaginghood ibanda
 
DIAGNOSIS MODALITIES OF PREGNANCY.pptx
DIAGNOSIS MODALITIES OF PREGNANCY.pptxDIAGNOSIS MODALITIES OF PREGNANCY.pptx
DIAGNOSIS MODALITIES OF PREGNANCY.pptxRameeThj
 
Uterine balloon tamponade in Postpartum Hemorrhage (PPH)
Uterine balloon tamponade in Postpartum Hemorrhage (PPH)Uterine balloon tamponade in Postpartum Hemorrhage (PPH)
Uterine balloon tamponade in Postpartum Hemorrhage (PPH)Mahantesh Karoshi
 
Induction of labour (2)
Induction of labour (2)Induction of labour (2)
Induction of labour (2)drmcbansal
 
Ovarian cyst aspiration
Ovarian cyst aspiration Ovarian cyst aspiration
Ovarian cyst aspiration Mohammad Emam
 
Efficacy of laparoscopically assisted high ligation of patent processus vagin...
Efficacy of laparoscopically assisted high ligation of patent processus vagin...Efficacy of laparoscopically assisted high ligation of patent processus vagin...
Efficacy of laparoscopically assisted high ligation of patent processus vagin...Hisham Ahmed,M.D,PhD,MRCS
 
clinical-skills-net-work (1).ppt
clinical-skills-net-work (1).pptclinical-skills-net-work (1).ppt
clinical-skills-net-work (1).pptOmarKhaled354545
 

Similar to Embryo Transfer (20)

Embryo Transfer (ET) . Lifecare Centre Dr Sharda Jain Dr. Jyoti Agarwal Dr. ...
Embryo Transfer (ET) . Lifecare Centre Dr Sharda Jain Dr. Jyoti Agarwal  Dr. ...Embryo Transfer (ET) . Lifecare Centre Dr Sharda Jain Dr. Jyoti Agarwal  Dr. ...
Embryo Transfer (ET) . Lifecare Centre Dr Sharda Jain Dr. Jyoti Agarwal Dr. ...
 
Embryo transfer: Aboubakr Elnashar
Embryo transfer: Aboubakr ElnasharEmbryo transfer: Aboubakr Elnashar
Embryo transfer: Aboubakr Elnashar
 
Embryo loading & Transfer , Lifecare IVF Dr. Aruna Saxena
Embryo loading & Transfer , Lifecare IVF  Dr. Aruna Saxena Embryo loading & Transfer , Lifecare IVF  Dr. Aruna Saxena
Embryo loading & Transfer , Lifecare IVF Dr. Aruna Saxena
 
Embryo Transfer- Tips and Tricks to improve success
Embryo Transfer- Tips and Tricks to improve successEmbryo Transfer- Tips and Tricks to improve success
Embryo Transfer- Tips and Tricks to improve success
 
Hysterectomy
HysterectomyHysterectomy
Hysterectomy
 
Fertility Management: Synergy between Endoscopists and Fertility Specialists
Fertility Management: Synergy between Endoscopists and Fertility SpecialistsFertility Management: Synergy between Endoscopists and Fertility Specialists
Fertility Management: Synergy between Endoscopists and Fertility Specialists
 
Embryo transfer
Embryo transfer Embryo transfer
Embryo transfer
 
Embryo transfer
Embryo transferEmbryo transfer
Embryo transfer
 
Amniotomy by dr alka mukherjee dr apurva mukherjee nagpur m.s. india
Amniotomy by dr alka mukherjee dr apurva mukherjee nagpur m.s. india Amniotomy by dr alka mukherjee dr apurva mukherjee nagpur m.s. india
Amniotomy by dr alka mukherjee dr apurva mukherjee nagpur m.s. india
 
PPPP00P
PPPP00PPPPP00P
PPPP00P
 
Reproductive imaging
Reproductive imagingReproductive imaging
Reproductive imaging
 
DIAGNOSIS MODALITIES OF PREGNANCY.pptx
DIAGNOSIS MODALITIES OF PREGNANCY.pptxDIAGNOSIS MODALITIES OF PREGNANCY.pptx
DIAGNOSIS MODALITIES OF PREGNANCY.pptx
 
Cervical stitches
Cervical stitchesCervical stitches
Cervical stitches
 
Uterine balloon tamponade in Postpartum Hemorrhage (PPH)
Uterine balloon tamponade in Postpartum Hemorrhage (PPH)Uterine balloon tamponade in Postpartum Hemorrhage (PPH)
Uterine balloon tamponade in Postpartum Hemorrhage (PPH)
 
Difficult c section
Difficult c sectionDifficult c section
Difficult c section
 
Induction of labour (2)
Induction of labour (2)Induction of labour (2)
Induction of labour (2)
 
Ovarian cyst aspiration
Ovarian cyst aspiration Ovarian cyst aspiration
Ovarian cyst aspiration
 
Efficacy of laparoscopically assisted high ligation of patent processus vagin...
Efficacy of laparoscopically assisted high ligation of patent processus vagin...Efficacy of laparoscopically assisted high ligation of patent processus vagin...
Efficacy of laparoscopically assisted high ligation of patent processus vagin...
 
clinical-skills-net-work (1).ppt
clinical-skills-net-work (1).pptclinical-skills-net-work (1).ppt
clinical-skills-net-work (1).ppt
 
Cervical Incompetence
Cervical IncompetenceCervical Incompetence
Cervical Incompetence
 

More from Sujoy Dasgupta

Azoospermia- Evaluation and Management
Azoospermia- Evaluation and ManagementAzoospermia- Evaluation and Management
Azoospermia- Evaluation and ManagementSujoy Dasgupta
 
Are we giving much importance to AMH in infertility practice?
Are we giving much importance to AMH in infertility practice?Are we giving much importance to AMH in infertility practice?
Are we giving much importance to AMH in infertility practice?Sujoy Dasgupta
 
Male Infertility- How a Gynaecologist can Manage?
Male Infertility-How a Gynaecologist can Manage?Male Infertility-How a Gynaecologist can Manage?
Male Infertility- How a Gynaecologist can Manage?Sujoy Dasgupta
 
Endometriosis and Subfertility, Primium non nocere
Endometriosis and Subfertility, Primium non nocereEndometriosis and Subfertility, Primium non nocere
Endometriosis and Subfertility, Primium non nocereSujoy Dasgupta
 
Investigating Infertile Male
Investigating Infertile MaleInvestigating Infertile Male
Investigating Infertile MaleSujoy Dasgupta
 
Rational Investigations and Management of Male Infertility
Rational Investigations and Management of Male InfertilityRational Investigations and Management of Male Infertility
Rational Investigations and Management of Male InfertilitySujoy Dasgupta
 
Rational Investigations and Management of Male Infertility
Rational Investigations and Management of Male InfertilityRational Investigations and Management of Male Infertility
Rational Investigations and Management of Male InfertilitySujoy Dasgupta
 
Endometriosis and Subfertility - What to do?
Endometriosis and Subfertility - What to do?Endometriosis and Subfertility - What to do?
Endometriosis and Subfertility - What to do?Sujoy Dasgupta
 
IVF- How it changed the perspective of Male Infertility
IVF- How it changed the perspective of Male InfertilityIVF- How it changed the perspective of Male Infertility
IVF- How it changed the perspective of Male InfertilitySujoy Dasgupta
 
Male Infertility- How Gynaecologists can manage?
Male Infertility- How Gynaecologists can manage?Male Infertility- How Gynaecologists can manage?
Male Infertility- How Gynaecologists can manage?Sujoy Dasgupta
 
Role of Multivitamins & Antioxidants in Managing Male Infertility
Role of Multivitamins & Antioxidants in Managing Male Infertility Role of Multivitamins & Antioxidants in Managing Male Infertility
Role of Multivitamins & Antioxidants in Managing Male Infertility Sujoy Dasgupta
 
Troubleshooting in Male Subfertility
Troubleshooting in Male Subfertility Troubleshooting in Male Subfertility
Troubleshooting in Male Subfertility Sujoy Dasgupta
 
ESHRE Guideline on Recurrent Pregnancy Loss (RPL)
ESHRE Guideline on Recurrent Pregnancy Loss (RPL)ESHRE Guideline on Recurrent Pregnancy Loss (RPL)
ESHRE Guideline on Recurrent Pregnancy Loss (RPL)Sujoy Dasgupta
 
Abnormal Semen- What next?
Abnormal Semen- What next?Abnormal Semen- What next?
Abnormal Semen- What next?Sujoy Dasgupta
 
Low AMH- Is it linked to Infertility?
Low AMH- Is it linked to Infertility?Low AMH- Is it linked to Infertility?
Low AMH- Is it linked to Infertility?Sujoy Dasgupta
 
Diagnosis and Management of Poor Ovarian Reserve : Evidence & Practice
Diagnosis and Management of Poor Ovarian Reserve : Evidence & Practice Diagnosis and Management of Poor Ovarian Reserve : Evidence & Practice
Diagnosis and Management of Poor Ovarian Reserve : Evidence & Practice Sujoy Dasgupta
 
Difficult Cases in IUI
Difficult Cases in IUIDifficult Cases in IUI
Difficult Cases in IUISujoy Dasgupta
 
Day3 versus Day5 Embryo Transfer
Day3 versus Day5 Embryo TransferDay3 versus Day5 Embryo Transfer
Day3 versus Day5 Embryo TransferSujoy Dasgupta
 

More from Sujoy Dasgupta (20)

Azoospermia- Evaluation and Management
Azoospermia- Evaluation and ManagementAzoospermia- Evaluation and Management
Azoospermia- Evaluation and Management
 
Are we giving much importance to AMH in infertility practice?
Are we giving much importance to AMH in infertility practice?Are we giving much importance to AMH in infertility practice?
Are we giving much importance to AMH in infertility practice?
 
Male Infertility- How a Gynaecologist can Manage?
Male Infertility-How a Gynaecologist can Manage?Male Infertility-How a Gynaecologist can Manage?
Male Infertility- How a Gynaecologist can Manage?
 
Endometriosis and Subfertility, Primium non nocere
Endometriosis and Subfertility, Primium non nocereEndometriosis and Subfertility, Primium non nocere
Endometriosis and Subfertility, Primium non nocere
 
Investigating Infertile Male
Investigating Infertile MaleInvestigating Infertile Male
Investigating Infertile Male
 
Rational Investigations and Management of Male Infertility
Rational Investigations and Management of Male InfertilityRational Investigations and Management of Male Infertility
Rational Investigations and Management of Male Infertility
 
Rational Investigations and Management of Male Infertility
Rational Investigations and Management of Male InfertilityRational Investigations and Management of Male Infertility
Rational Investigations and Management of Male Infertility
 
Endometriosis and Subfertility - What to do?
Endometriosis and Subfertility - What to do?Endometriosis and Subfertility - What to do?
Endometriosis and Subfertility - What to do?
 
IVF- How it changed the perspective of Male Infertility
IVF- How it changed the perspective of Male InfertilityIVF- How it changed the perspective of Male Infertility
IVF- How it changed the perspective of Male Infertility
 
Male Infertility- How Gynaecologists can manage?
Male Infertility- How Gynaecologists can manage?Male Infertility- How Gynaecologists can manage?
Male Infertility- How Gynaecologists can manage?
 
Role of Multivitamins & Antioxidants in Managing Male Infertility
Role of Multivitamins & Antioxidants in Managing Male Infertility Role of Multivitamins & Antioxidants in Managing Male Infertility
Role of Multivitamins & Antioxidants in Managing Male Infertility
 
Troubleshooting in Male Subfertility
Troubleshooting in Male Subfertility Troubleshooting in Male Subfertility
Troubleshooting in Male Subfertility
 
ESHRE Guideline on Recurrent Pregnancy Loss (RPL)
ESHRE Guideline on Recurrent Pregnancy Loss (RPL)ESHRE Guideline on Recurrent Pregnancy Loss (RPL)
ESHRE Guideline on Recurrent Pregnancy Loss (RPL)
 
Abnormal Semen- What next?
Abnormal Semen- What next?Abnormal Semen- What next?
Abnormal Semen- What next?
 
Low AMH- Is it linked to Infertility?
Low AMH- Is it linked to Infertility?Low AMH- Is it linked to Infertility?
Low AMH- Is it linked to Infertility?
 
Diagnosis and Management of Poor Ovarian Reserve : Evidence & Practice
Diagnosis and Management of Poor Ovarian Reserve : Evidence & Practice Diagnosis and Management of Poor Ovarian Reserve : Evidence & Practice
Diagnosis and Management of Poor Ovarian Reserve : Evidence & Practice
 
Subfertility
SubfertilitySubfertility
Subfertility
 
Difficult Cases in IUI
Difficult Cases in IUIDifficult Cases in IUI
Difficult Cases in IUI
 
Case Scenarios in ART
Case Scenarios in ARTCase Scenarios in ART
Case Scenarios in ART
 
Day3 versus Day5 Embryo Transfer
Day3 versus Day5 Embryo TransferDay3 versus Day5 Embryo Transfer
Day3 versus Day5 Embryo Transfer
 

Recently uploaded

Typhoid.pptx Department of Physiotherapy, SHUATS, Prayagraj
Typhoid.pptx Department of Physiotherapy, SHUATS, PrayagrajTyphoid.pptx Department of Physiotherapy, SHUATS, Prayagraj
Typhoid.pptx Department of Physiotherapy, SHUATS, PrayagrajSurabhi Srivastava
 
Malaria Disease.pptx Department of Physiotherapy, SHUATS, Prayagraj
Malaria Disease.pptx Department of Physiotherapy, SHUATS, PrayagrajMalaria Disease.pptx Department of Physiotherapy, SHUATS, Prayagraj
Malaria Disease.pptx Department of Physiotherapy, SHUATS, PrayagrajSurabhi Srivastava
 
Psychedelic Treatment Planning: Opportunities in Integrated Care
Psychedelic Treatment Planning: Opportunities in Integrated CarePsychedelic Treatment Planning: Opportunities in Integrated Care
Psychedelic Treatment Planning: Opportunities in Integrated CareBrian Peacock
 
Role of vitamin D supplements in prevention of hungry bone syndrome for prima...
Role of vitamin D supplements in prevention of hungry bone syndrome for prima...Role of vitamin D supplements in prevention of hungry bone syndrome for prima...
Role of vitamin D supplements in prevention of hungry bone syndrome for prima...Nguyễn đình Đức
 
Analyzing Performance of the Twist Exome with CNV Backbone at Various Probe D...
Analyzing Performance of the Twist Exome with CNV Backbone at Various Probe D...Analyzing Performance of the Twist Exome with CNV Backbone at Various Probe D...
Analyzing Performance of the Twist Exome with CNV Backbone at Various Probe D...Golden Helix
 
Anesthesia Implications in cannabis Users.pptx
Anesthesia Implications in cannabis Users.pptxAnesthesia Implications in cannabis Users.pptx
Anesthesia Implications in cannabis Users.pptxhrowshan
 
RADIATION THERAPY IN BILIARY TRACT CANCER
RADIATION THERAPY IN BILIARY TRACT CANCERRADIATION THERAPY IN BILIARY TRACT CANCER
RADIATION THERAPY IN BILIARY TRACT CANCERKanhu Charan
 
Measles.pptx Department of Physiotherapy, SHUATS, Prayagraj
Measles.pptx Department of Physiotherapy, SHUATS, PrayagrajMeasles.pptx Department of Physiotherapy, SHUATS, Prayagraj
Measles.pptx Department of Physiotherapy, SHUATS, PrayagrajSurabhi Srivastava
 
1. GP Chi trên hay lạ khó cần xem nhiều.pdf
1. GP Chi trên hay lạ khó cần xem nhiều.pdf1. GP Chi trên hay lạ khó cần xem nhiều.pdf
1. GP Chi trên hay lạ khó cần xem nhiều.pdfHongBiThi1
 
Circulatory shock Cardiogenic Shock Hypovolemic Shock Sepsis, Septic Shock an...
Circulatory shock Cardiogenic Shock Hypovolemic Shock Sepsis, Septic Shock an...Circulatory shock Cardiogenic Shock Hypovolemic Shock Sepsis, Septic Shock an...
Circulatory shock Cardiogenic Shock Hypovolemic Shock Sepsis, Septic Shock an...Abhinav S
 
The Musculo- Skeletal System by M. Thiru Murugan
The Musculo- Skeletal System by M. Thiru MuruganThe Musculo- Skeletal System by M. Thiru Murugan
The Musculo- Skeletal System by M. Thiru Muruganthiru murugan
 
Dasha vidha Pareeksha.pptx Dr Akshay Shetty
Dasha vidha Pareeksha.pptx Dr Akshay ShettyDasha vidha Pareeksha.pptx Dr Akshay Shetty
Dasha vidha Pareeksha.pptx Dr Akshay ShettyAkshay Shetty
 
KOSHTA CONCEPT IN AYURVEDA BY VIJAY R K
KOSHTA CONCEPT IN AYURVEDA  BY  VIJAY R KKOSHTA CONCEPT IN AYURVEDA  BY  VIJAY R K
KOSHTA CONCEPT IN AYURVEDA BY VIJAY R Kvinaykumarrkumabar
 
Health powerpoint for catch -up fridays.
Health powerpoint for catch -up fridays.Health powerpoint for catch -up fridays.
Health powerpoint for catch -up fridays.JohnMarckySeoTeriomp
 
(DENGUE).pptx Department of Physiotherapy, SHUATS, Prayagraj
(DENGUE).pptx Department of Physiotherapy, SHUATS, Prayagraj(DENGUE).pptx Department of Physiotherapy, SHUATS, Prayagraj
(DENGUE).pptx Department of Physiotherapy, SHUATS, PrayagrajSurabhi Srivastava
 
How to be a successful physician intrapreneur
How to be a successful physician intrapreneurHow to be a successful physician intrapreneur
How to be a successful physician intrapreneurArlen Meyers, MD, MBA
 
GERIATRIC PHARMACOLOGY Geriatric pharmacology is a specialized field focusing...
GERIATRIC PHARMACOLOGY Geriatric pharmacology is a specialized field focusing...GERIATRIC PHARMACOLOGY Geriatric pharmacology is a specialized field focusing...
GERIATRIC PHARMACOLOGY Geriatric pharmacology is a specialized field focusing...Abhinav S
 
Biochemistry of Carbohydrates for MBBS, BDS, Lab Med 2024.pptx
Biochemistry of Carbohydrates for MBBS, BDS, Lab Med 2024.pptxBiochemistry of Carbohydrates for MBBS, BDS, Lab Med 2024.pptx
Biochemistry of Carbohydrates for MBBS, BDS, Lab Med 2024.pptxRajendra Dev Bhatt
 
Bursitis is inflammation or irritation of a bursa sac. Bursae are small fluid...
Bursitis is inflammation or irritation of a bursa sac. Bursae are small fluid...Bursitis is inflammation or irritation of a bursa sac. Bursae are small fluid...
Bursitis is inflammation or irritation of a bursa sac. Bursae are small fluid...leejalashrestha2
 
Best neurologist in jalandhar Punjab India
Best neurologist in jalandhar Punjab IndiaBest neurologist in jalandhar Punjab India
Best neurologist in jalandhar Punjab IndiaNHS Hospital
 

Recently uploaded (20)

Typhoid.pptx Department of Physiotherapy, SHUATS, Prayagraj
Typhoid.pptx Department of Physiotherapy, SHUATS, PrayagrajTyphoid.pptx Department of Physiotherapy, SHUATS, Prayagraj
Typhoid.pptx Department of Physiotherapy, SHUATS, Prayagraj
 
Malaria Disease.pptx Department of Physiotherapy, SHUATS, Prayagraj
Malaria Disease.pptx Department of Physiotherapy, SHUATS, PrayagrajMalaria Disease.pptx Department of Physiotherapy, SHUATS, Prayagraj
Malaria Disease.pptx Department of Physiotherapy, SHUATS, Prayagraj
 
Psychedelic Treatment Planning: Opportunities in Integrated Care
Psychedelic Treatment Planning: Opportunities in Integrated CarePsychedelic Treatment Planning: Opportunities in Integrated Care
Psychedelic Treatment Planning: Opportunities in Integrated Care
 
Role of vitamin D supplements in prevention of hungry bone syndrome for prima...
Role of vitamin D supplements in prevention of hungry bone syndrome for prima...Role of vitamin D supplements in prevention of hungry bone syndrome for prima...
Role of vitamin D supplements in prevention of hungry bone syndrome for prima...
 
Analyzing Performance of the Twist Exome with CNV Backbone at Various Probe D...
Analyzing Performance of the Twist Exome with CNV Backbone at Various Probe D...Analyzing Performance of the Twist Exome with CNV Backbone at Various Probe D...
Analyzing Performance of the Twist Exome with CNV Backbone at Various Probe D...
 
Anesthesia Implications in cannabis Users.pptx
Anesthesia Implications in cannabis Users.pptxAnesthesia Implications in cannabis Users.pptx
Anesthesia Implications in cannabis Users.pptx
 
RADIATION THERAPY IN BILIARY TRACT CANCER
RADIATION THERAPY IN BILIARY TRACT CANCERRADIATION THERAPY IN BILIARY TRACT CANCER
RADIATION THERAPY IN BILIARY TRACT CANCER
 
Measles.pptx Department of Physiotherapy, SHUATS, Prayagraj
Measles.pptx Department of Physiotherapy, SHUATS, PrayagrajMeasles.pptx Department of Physiotherapy, SHUATS, Prayagraj
Measles.pptx Department of Physiotherapy, SHUATS, Prayagraj
 
1. GP Chi trên hay lạ khó cần xem nhiều.pdf
1. GP Chi trên hay lạ khó cần xem nhiều.pdf1. GP Chi trên hay lạ khó cần xem nhiều.pdf
1. GP Chi trên hay lạ khó cần xem nhiều.pdf
 
Circulatory shock Cardiogenic Shock Hypovolemic Shock Sepsis, Septic Shock an...
Circulatory shock Cardiogenic Shock Hypovolemic Shock Sepsis, Septic Shock an...Circulatory shock Cardiogenic Shock Hypovolemic Shock Sepsis, Septic Shock an...
Circulatory shock Cardiogenic Shock Hypovolemic Shock Sepsis, Septic Shock an...
 
The Musculo- Skeletal System by M. Thiru Murugan
The Musculo- Skeletal System by M. Thiru MuruganThe Musculo- Skeletal System by M. Thiru Murugan
The Musculo- Skeletal System by M. Thiru Murugan
 
Dasha vidha Pareeksha.pptx Dr Akshay Shetty
Dasha vidha Pareeksha.pptx Dr Akshay ShettyDasha vidha Pareeksha.pptx Dr Akshay Shetty
Dasha vidha Pareeksha.pptx Dr Akshay Shetty
 
KOSHTA CONCEPT IN AYURVEDA BY VIJAY R K
KOSHTA CONCEPT IN AYURVEDA  BY  VIJAY R KKOSHTA CONCEPT IN AYURVEDA  BY  VIJAY R K
KOSHTA CONCEPT IN AYURVEDA BY VIJAY R K
 
Health powerpoint for catch -up fridays.
Health powerpoint for catch -up fridays.Health powerpoint for catch -up fridays.
Health powerpoint for catch -up fridays.
 
(DENGUE).pptx Department of Physiotherapy, SHUATS, Prayagraj
(DENGUE).pptx Department of Physiotherapy, SHUATS, Prayagraj(DENGUE).pptx Department of Physiotherapy, SHUATS, Prayagraj
(DENGUE).pptx Department of Physiotherapy, SHUATS, Prayagraj
 
How to be a successful physician intrapreneur
How to be a successful physician intrapreneurHow to be a successful physician intrapreneur
How to be a successful physician intrapreneur
 
GERIATRIC PHARMACOLOGY Geriatric pharmacology is a specialized field focusing...
GERIATRIC PHARMACOLOGY Geriatric pharmacology is a specialized field focusing...GERIATRIC PHARMACOLOGY Geriatric pharmacology is a specialized field focusing...
GERIATRIC PHARMACOLOGY Geriatric pharmacology is a specialized field focusing...
 
Biochemistry of Carbohydrates for MBBS, BDS, Lab Med 2024.pptx
Biochemistry of Carbohydrates for MBBS, BDS, Lab Med 2024.pptxBiochemistry of Carbohydrates for MBBS, BDS, Lab Med 2024.pptx
Biochemistry of Carbohydrates for MBBS, BDS, Lab Med 2024.pptx
 
Bursitis is inflammation or irritation of a bursa sac. Bursae are small fluid...
Bursitis is inflammation or irritation of a bursa sac. Bursae are small fluid...Bursitis is inflammation or irritation of a bursa sac. Bursae are small fluid...
Bursitis is inflammation or irritation of a bursa sac. Bursae are small fluid...
 
Best neurologist in jalandhar Punjab India
Best neurologist in jalandhar Punjab IndiaBest neurologist in jalandhar Punjab India
Best neurologist in jalandhar Punjab India
 

Embryo Transfer

  • 1. Dr Sujoy Dasgupta MBBS (Gold Medalist, Hons) MS (OBGY- Gold Medalist) DNB (New Delhi) MRCOG (London) Advanced ART Course for Clinicians (NUHS, Singapore) M Sc, Sexual and Reproductive Medicine (South Wales, UK) Clinical Director, Genome Fertility Centre, Kolkata Managing Committee Member, BOGS, 2023-24 Executive Committee Member, ISAR Bengal, 2022-24 Clinical Examiner, MRCOG Part 3 Examination Winner, Prof Geoffrey Chamberlain Award, RCOG World Congress, London, 2019 Embryo Transfer
  • 2. “Just” putting embryos inside the womb !!!
  • 4. • Many recommendations are NOT necessarily evidence based. • Success of the ET procedure depends on many factors, several of which are difficult to standardize and hence to investigate. • To improve pregnancy and live birth rates, and to minimize exposure of women to unnecessary or harmful interventions. • To avoid multiple treatment cycles, and the high expenses especially in developing countries. • To reduce the physical and psychological burden after failed cycles
  • 5. Common steps Step 1: Patient Education •Short and simple procedure •Mostly painless •Positive attitude → reduces anxiety → reduces uterine contraction (Fanchin et al, 2000) •For apprehensive/ difficult cases- Sedation/ GA (D’Angelo et al., 2019)
  • 6. Step 2: Check documents • Consent form • Clinical data • Difficulties during previous transfer/ IUI • WHO surgical checklist • Double check patient’s identity
  • 7. Step 3: Full Bladder
  • 8. Advantages of Full Bladder • Systematic review- full bladder improves pregnancy rate (Abou-Setta. 2007) • Cochrane review- full bladder does not improve pregnancy rate (Derks et al., 2009) • A difference in fluid intake instructions : 250 ml (Lorusso et al., 2005) to 1000 ml (Lewin et al., 1997) • Full bladder- better visualization of catheter tip during TAS- can improve pregnancy rate (Buckett, 2003; Mirkin et al., 2003; Salim et al., 2002)
  • 9. Over-distension of bladder • Discomfort • Increases uterine contraction • The assistant may not be able to produce the best US images • Retroverted uterus, a full bladder makes the uterine-cervical angle will be more pronounced
  • 10. Optimum bladder distension • When patient feels the urge to urinate. • Drink 500-1000 ml fluid 1 hr prior to ET (after emptying bladder completely). • Minimize waiting time • If necessary, the patient can be instructed to drink an additional 1-2cups of water • Optimal positioning of the patient • Gynaecological couches- Lithotomy position, bottom and back tilting with fully optimizable leg support
  • 11. Step 4: Theatre & Equipments • The preferred temperature of the ET room is 22– 23°C (D’Angelo et al., 2019). • Maintain temperature and pH while transporting embryos (De los Santos et al., 2016). • Cusco’s speculum of different sizes (and other types of speculum) • Tenaculum, dilators, sponge holder, cotton swabs, cotton buds for cervical mucus, forceps and a cleaning set including saline/cleaning solution. • Specialized gynaecological chairs with full mobility
  • 12. Step 5: Infection Control • Standard asepsis in theatre • Cleansing of the vagina/cervix using sterile water or saline. • Cleaning delicately in order to avoid bleeding. • Routine vaginal screening- ??? • No prophylactic antibiotic (Ameratunga D, Cochrane Database Syst Rev, 2023)
  • 13. Step 6: Visualization and cleaning of cervix Gentle introduction of speculum • Avoid uterine contraction • Evaluate the external appearance of the cervix to rule out cervical polyps, ectropion/ inflammation Removing mucus from the cervical canal with a cotton swab or insulin syringe 1. facilitates the insertion of an ET catheter 2. avoid a clogged catheter tip 3. prevents relocation of mucus within the uterine cavity, • Evidences- inconclusive (Moini et al., 2011; Eskandar et al., 2007; Craciunas et al., 2014; Derks et al., 2009). • Avoid uterine contraction
  • 14. Step 7: Ultrasound vs Clinical Touch Brown et al., 2016
  • 15. Ultrasound setting • No studies investigating the association between the US system quality and ET outcomes. • Adjust the field of view, depth and zoom, gain, contrast (D’Angelo et al., 2019).
  • 16. Improve ultrasound image • Uterine length measurement before ET- not helpful (Revelli et al., 2016; Lambers et al., 2006; Chun et al., 2010). • Doppler- not much difference (Saravelos et al., 2016) • 3D- and 4D- US- 80% accuracy of the embryo(s) positioning (Baba et al., 2000).
  • 17. Step 8: Catheter selection •Pregnancy rates improved when soft catheters compared to rigid catheters (ASRM, 2017) 1. Less traumatic 2. Length, tip diameter 3. Lumen opening at the tip for the embryo(s) passage 4. Cost 5. Echogenicity of the body and tip 6. Overall, their consistency 7. Easy to manipulate.
  • 18. Step 9: Catheter Loading
  • 19. Loading technique Air-fluid loading 1. Prevents retention in catheter 2. Protects from Cx mucus and accidental dislodgement before entering cavity 3. Improves US visibility • Meta-analysis - insufficient evidence to suggest the superiority any loading method (Abou-Setta et al., 2007) Volume of medium • 10–30 µl is highly recommended. • >60 µl- chance of dislocation of embryo(s) into the cervix or Fallopian tubes • Contradictory findings (Ebner et al., 2001; Montag et al., 2002; Omidi et al., 2015; Sigalos et al., 2018)
  • 20. Step 10: Catheter Insertion Single step • Use of a loaded catheter • Internal cervical/uterine trauma is avoided • Difficulties can be encountered in passing through the cervical canal Double step • A rigid double catheter is passed through the cervical canal up to the top end of the cervix. • Then remove the inner part and replace it with the softer catheter containing the embryo(s). • May increase the risk of cervical/internal trauma and patient discomfort • More reassuring for the operator to successfully pass and complete the ET
  • 21. Where to place the embryos Maximum implantation potential (MIP)
  • 22. Transfer distance from fundus (TDF) • Lower area- higher miscarriage rate (Cavagna et al., 2006). • Too close (<1 cm) to fundus- decreases pregnancy rate (Singh et al., 2017). • Best result 1.5-2 cm from fundal endometrium (Cenkov et al., 2014). • An increase of 1 mm of TDF changed the odds of pregnancy by 0.882; of clinical pregnancy by 0.891 and of ongoing pregnancy by 0.925 (Bayram et al., 2021).
  • 23. Avoid uterine micro-contraction • Try to pass the catheter as smoothly as possible in an axial trajectory without bending or irritating endometrium • Better IVF outcome with a less irritated uterus (Sammali et al., 2018; Blank et al., 2020). • Tocolysis- Insufficient evidence (Buddhabunyakan et al., 2021).
  • 24. Other considerations Pressure in the piston • No consensus • If the catheter end is in the proximity of the fundal end, apply the lowest pressure possible to maintain the embryo(s) in the MIP area. Withdrawing the catheter • Slow/ fast? • Inner and outer together/ separately? The duration of the ET procedure • Time taken for: the embryologist to prepare the loaded catheter; catheter transport to operator hands; the catheterization (one step or two steps), passing through the cervix and moving the catheter tip to the targeted point within the endometrial cavity; the injection; and catheter withdrawal. • Duration >120 s having a negative effect (Matorras et al. 2004; Cetin et al., 2010)
  • 25. Step 11: Recheck the inner catheter tip by the Embryologist • Immediately re-transfer the retained embryo(s) (ASRM, 2017)
  • 26. TAS or TVS? • No need for a full bladder • No need for trained assistant • A far better image • Takes more time for preparation than a standard ET • Unclear what could be done in case of a difficult ET • Success rate ?? (Bodri et al., 2011, Cozzolino et al., 2018; Hassan et al., 2021; Nakano et al., 2022)
  • 28. Difficult Embryo Transfer • Only 3-4% 1. Discomfort to the patient 2. Presence of blood at the end of the catheter (Muhaidat M et al., 2023) 3. Requires the use of specific tools such as catheters with sheaths and rigid mandrels (stylet). 4. Retained embryo • Effect on pregnancy rate? (Arora & Mishra, 2018; Philips et al., 2013).
  • 29. Identify women at risk • Vaginismus- sedation, counseling • Severe endometriosis- fixed RV uterus- small speculum, sedation, mock ET • Fibroids- low lying fibroids- pushes Cx anteriorly- examine and mock ET • Cx surgery- mock ET, rigid catheter, then EUA, then hysteroscopy and dilatation under GA, transmyometrial transfer • Most common cause- abnormal crypts and tortuosity inside the Cx canal • Review previous HSG/ IUI/ ET notes
  • 30. Mock Transfer • During OPU, before starting stimulation or just before actual ET- no advantage (Derks, Cochrane Database Syst Rev, 2009) • Difficult ET not common • RV uterus can become AV time to time (Henne and Milki, 20014) • Mock ET prior to first IVF cycle may not improve the success rates in young women • Mock ET should be reserved for subjects with risk factors for potential difficult ET (Borkar et al., 2020)
  • 31. Troubleshooting during actual ET • More forced catheterization using a tenaculum to stabilize the cervix (traction) • A thicker stylet catheter or external cervical dilators. • When to abandon (Freeze all)? • Transmyometrial ET
  • 33. Outcome of TMET • Increase in junctional zone contractions (Biervliet, et al., 2002) • Comparable with difficult transcervical transfer (Khairy et al., 2016). • Consider, rather than trying difficult transcervical transfer
  • 34. Ferreri J, Portillo EG, Peñarrubia J, Vidal E, Fábregues F. Transmyometrial embryo transfer as a useful method to overcome difficult embryo transfers - a single-center retrospective study. JBRA Assist Reprod. 2018 Jun 1;22(2):134-138. doi: 10.5935/1518-0557.20180029. PMID: 29757581; PMCID: PMC5982560.
  • 35. Training • Supervised/ Mock ET • Simulator-pregnancy rate improved form 31% to 46% (Heitmann et al. Fertil Steril, 2017) • At least 75 ET (Vlaisavljevic et al., 2021) • Once proficient, avoid break for more than 10 days to prevent drop in performance (Lopez et al., Hum Reprod, 2014). • Peer-to-peer observational audits • Cumulative summation test (CUSUM) (Dessolle et al., 2010)
  • 36. Conclusion • Effective communication and documentation • Review previous notes • Full bladder • Gynaecological couch • Ultrasound guided ET • Soft catheter • Atraumatic • Less duration of transfer • Abandon when appropriate • No antibiotics, tocolytics, bed rest