The document discusses various aspects of embryo transfer techniques in IVF. It describes the typical steps, including selection of the best embryos for transfer. It notes that factors like the transferring physician's skill, catheter type, trial embryo transfer accuracy, ultrasound guidance, and uterine contractions can influence the success of embryo transfer. Research studies are summarized that found around 30% of patients had a uterine measurement discrepancy between trial transfer and ultrasound-guided transfer, and soft catheters were associated with higher pregnancy rates than firm catheters.

1. TRANSFERENCIA
EMBRIONARIA
EMMA E. MARSAL MARTINEZ

3. Basic Steps in IVF
•Estimulación ovárica
•Captura de ovulos
•FIV / ICSI
•Fertilización
Selección
•Transferencia E.
•Progesterona

4. 5. Transferencia embrionaria
Los embriones son clasificados basados en el
número de celulas, grado de crecimiento y
grado de fragmentación.
El número a transferir depende de :
número de embriones disponibles
Edad materna
Otros factores

5. TIPOS DE T.E
TRANSFERENCIA INTRAUTERINA
TRASFERENCIA TRANSMIOMETRIAL

6. TIPOS DE T.E
TRANSFERENCIA INTRATUBÁRICA
Gamete Intra-Fallopian Transfer (GIFT) Asch 1985
Zygote Intrafallopian Transfer (ZIFT) Devroey
Tubal Embryo Transfer (TET) Balmaceda 1988

7. The embryos judged to be the "best" are
transferred to the patient's uterus.
During the embryo transfer
procedure the Wallace catheter
is seen in the cervix and
uterine lining (below the
yellow lines). It is seen coming
from the vagina into the cervix
at the right. The catheter is
also seen inside the uterine
lining (at left side). The
embryos are released from the
catheter tip - seen just right of
the "L". The angle between the
cervix and uterus (green lines)
is not severe.

8. Factores que influyen en el éxito de
T.E.
 Médico trasferidor
 Tipo de cateter
 Prueba de Transferencia
angulaciones cervico-uterinas
 Sangrado
 Retiro del moco cervical
 Contracciones Uterinas
15% residual embryos in failed embryo
transfer. Fertil Steril 1986. Thompson DJ
42% Mansour. Dummy embryo transfer using
methylene blue dye. Human Rep.1997.
 Falla en el paso del cateter a través del
canal cervical
 Ecografía
 Repleción de la vejiga urinaria
 Reposo post TE
 Transferencia difícil.
 Uso de tocolíticos previo a la TE

10. Hum Reprod. 2005 Mar;20(3):709-16. Epub 2005 Feb 2.
Ultrasound-guided embryo transfer and the accuracy of trial embryo transfer.
Shamonki MI, Spandorfer SD, Rosenwaks Z.Cornell
Center for Reproductive Medicine, 505 East 70th Street, 3rd floor, New York, NY 10021, USA.
Studies have suggested that ultrasound-guided embryo transfer (UG-ET) may improve the outcome in IVF;
however, several factors may account for the improvement in pregnancy rate. This study examines the
use of ultrasound to determine the accuracy of trial transfer (TT) in preparation for ET.
METHODS: Sixty-seven consecutive patients prospectively underwent UG-ET over a 2 month period. Total
cavity length by US was compared with the length noted by TT. A difference of > or = 1 cm was
considered significant. All embryos were placed within 1-2 cm of the fundus by US.
RESULTS: Twenty patients (29.9%) had a difference of > or = 1 cm and 13 patients (19.4%) had a
difference of < or = 1.5 cm. Patients with a difference of > or = 1 or > or = 1.5 cm had a significantly
greater depth at transfer (P < 0.001) and uterine cavity length (P < 0.001) when compared with patients
without a difference. Clinical pregnancy, implantation, delivery and overall miscarriage rates did not
differ between patients with a difference of > or = 1 or > or = 1.5 cm versus no difference. There were no
ectopic pregnancies.
CONCLUSIONS: Nineteen percent of patients had a discrepancy of > or = 1.5 cm and approximately 30%
had a difference of > or = 1 cm from TT at UG-ET, suggesting a benefit to UG-ET. A large prospective
randomized trial comparing UG-ET with blind transfer is required to assess further if UG-ET should be
used in all cases of ET.

13. Human Reproduction Vol.20, No.11 pp. 3114–3121, 2005 doi:10.1093/humrep/dei198
Advance Access publication July 22, 2005.
Soft versus firm embryo transfer catheters for assisted reproduction: a systematic
review and meta-analysis*
Ahmed M.Abou-Setta1,3, Hesham G.Al-Inany1,2, Ragaa T.Mansour1, Gamal I.Serour1 and
Mohamed A.Aboulghar1,2 1 The Egyptian IVF–ET Center, 3, Street 161, Hadayek El Maadi,
Cairo 11431 and 2The Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo
University, Cairo, Egypt
The true impact of the embryo transfer catheter choice on an IVF programme has not been fully
examined. We therefore decided to systematically review the evidence provided in the literature so that
we may evaluate a single variable in relation to a successful transfer, the firmness of the embryo transfer
catheter.
METHODS: An extensive computerized search was conducted for all relevant articles published as full
text, or abstracts, and criti- cally appraised. In addition, a hand search was undertaken to locate any
further trials.
RESULTS: A total of 23 ran- domized controlled trials (RCT) evaluating the types of embryo transfer
catheters were identified. Only ten of these trials, including 4141 embryo transfers, compared soft versus
firm embryo catheters. Pooling of the results demon- strated a statistically significantly increased chance
of clinical pregnancy following embryo transfer using the soft (643/2109) versus firm (488/2032)
catheters [P=0.01; odds ratio (OR)=1.39, 95% confidence interval (CI)=1.08–1.79]. When only the truly RCT
were analysed, the results were again still in favour of using the soft embryo transfer cath- eters [soft
(432/1403) versus firm (330/1402)], but with a greater significance (P < 0.00001; OR=1.49, 95% CI = 1.26–
1.77).
CONCLUSION: Using soft embryo transfer catheters for embryo transfer results in a significantly higher
pregnancy rate as compared to firm catheters.

14. Volume 75, Issue 6, Pages 1136-1140 (June 2001)
Effects of vaginal progesterone administration on uterine contractility at the time of embryo
transfer
Renato Fanchin, M.D.a, Claudia Righini, M.D.a, Dominique de Ziegler, M.D.a, François Olivennes, M.D.a,
Nathalie Ledée, M.D.a, René Frydman, M.D.aReceived 18 October 2000; received in revised form 27
December 2000; accepted 27 December 2000.
Objective: To investigate whether uterine contractility at the time of embryo transer (ET) can be
reduced by early onset of luteal support with progesterone administered vaginally.
Design: Prospective analysis.Setting: Assisted reproduction unit.
Patient: Eighty-four women undergoing 84 GnRH-a and FSH/hCG cycles for IVF-ET were
studied.Intervention(s): Vaginal progesterone was randomly started on the day of oocyte retrieval (group
A, n = 43) or on the evening of ET (group B, n = 41). On the day of hCG administration and just before ET,
2-minute sagittal uterine scans were obtained by ultrasound and digitized with an image analysis system
for assessing uterine contraction frequency.Main Outcome Measure(s): Uterine contraction
frequency.Result(s): Whereas uterine contraction frequency was similar in both groups on the day of hCG
(4.6 ± 0.3 and 4.5 ± 0.3 contractions per minute, respectively), only women in group A showed decreased
uterine contraction frequency on the day of ET (2.8 ± 0.2 vs. 4.2 ± 0.3 contractions per minute).
Conclusion: Vaginal progesterone administration starting on the day of oocyte retrieval induced a
decrease in uterine contraction frequency on the day of ET as compared with preovulatory values.
Uterine relaxation before ET is likely to improve IVF-ET outcome by avoiding the displacement of
embryos from the uterine cavity.

15. Effective of metronidazole to bacterial flora in vagina and the
impact of microbes on live birth rate during intracytoplasmic
sperm injection (ICSI).
 PURPOSE: The aim of this study was to investigate the impact of bacterial
vaginal flora on life-birth rate during ICSI and influence of metronidazole as
antibiotic treatment course before ICSI.
 METHOD: We enrolled 71 women who were undergoing ICSI. At embryo
transfer (ET), all of the women had quantitative vaginal culture, ET catheter-tip
culture, and vaginal Gram stain scored for bacterial vaginosis.
 RESULTS: The overall live birth rate (LBR) was 36.6% (26/71), and the rate of
early pregnancy loss was 13% (4/30). In women with bacterial vaginosis,
intermediate flora and normal flora, the conception rates were 35% (9/26),
42% (14/33) and 58% (7/12), respectively (p = 0.06 for trend). Metronidazole
effect to bacterial flora in vaginal. The predominant species isolated from the
tip of the embryo transfer catheter in negative pregnancy was Staphylococcus
epidermidis (7 vs. 15.2%), and Streptococcus viridians (11 vs. 24%).
 CONCLUSIONS: Woman with bacterial vaginosis and with a decreased vaginal
concentration of hydrogen peroxide-producing lactobacilli may have decreased
conception rates and increased rates of failed pregnancy. A larger prospective
treatment trial designed to evaluate the impact on ICSI outcomes of optimizing
the vaginal flora prior to ICSI may be warranted.
Arch Gynecol Obstet. 2011 Feb 18. Selim SA, El Alfy SM, Aziz MH, Mohamed HM, Alasbahi AA.Microbiology Section, Botany Department,
Faculty of Science, Suez Canal University, P.O. 41522, Ismailia, Egyp

16. Factores estudiados en la técnica
de la transferencia embrionaria
1. Sangre o moco en el
catéter
2. Retención embrionaria y
repetición de transferencia
3. Contracciones uterinas
4. Tipo de catéter
5. Carga del catéter
6. Tocar el fondo de del
útero
7. Situación del catéter
8. Transferencia de prueba
9. Dificultad
permeabilización cervical
10. Ultrasonografía
11. Factor humano
 12. Reposo post-transfer
13. La acupuntura
 14. Los rezos

17. MITOS O REALIDADES ?!
Las tasas de embarazo, embarazo evolutivo e
implantación mejoran con la transferencia embrionaria
realizada con ecografía abdominal A 2D.
Un reposo superior a 20 minutos postransferencia no
mejora las tasas de embarazo clínico.B
Los catéteres blandos se asocian a mayores tasas de
embarazo clínico. A
La transferencia embrionaria debe realizarse en el
segmento medio inferior de la cavidad endometrial. B