Presentation given in 2018 on the techniques used during embryo transfer - undertaken during assisted reproductive technology use (IVF / ICSI)

1.  Director Anu Test Tube Baby
Centre, Hyderabad
 Fellow of Royal College of Obstetrics
& Gynaecology, London, UK
 Worked as consultant, Mid Land
Fertility Services (MFS), UK
 Established IVF unit in Hyderabad
in 1994
 1st IVF & ICSI Baby of Andhra
Pradesh, 1995.
 Performing nearly 1000 IVF – ICSI
cycles per year since 1994
Dr. K. Anuradha
FRCOG

2. Dr. Anuradha Katragadda
ANU TEST TUBE BABY CENTER

3. William B. Schoolcraft, M.D.

4. Avoiding difficult ET is important to
optimize clinical outcomes
Ultrasound guidance seems to be a key
adjunct toward this goal

5. Frequent and
significantly PR
Poor ET technique:-
responsible for
30 % of all IVF
failures

6. A retrospective analysis of
- 306 patients
- between 10/06/17 – 09/09/17
• Difficult ET’s
- 54 patients (17 %)

7. Total
No.
306
V.V. full
Bladder
Empty
Bladder
Anatomical
variants
107
60 51

8. Deeply
placed cx &
Lax vagina
AC, AV/RV
Angulation
& curvature
22
13
7
5
1
Cervical
stenosis
Cx flushed
with vault

11. Use of
outersheath of
sure-view catheter
Use of a wallace
malleable stylet
Application of a
tenaculum
Insertion of
Hysterometer

12. Initiate a catheter loaded
with embryos and
once difficult ET is
appreciated
Hand over the loaded
catheter to the
embryologist
To return the embryos to
culture medium to
maintain their
temperature

13. i. Continue with the ET
progressively and the
additional maneuvers –
‘knowing the PR with
each maneuver’
ii. Use of anaesthesia
iii. Abandoning ET –
• Offering embryo
freezing or
refreezing
• And optimization of ET
procedure

14. Precautions to be taken to
identify –
- Possibly difficult ET in
advance (mock ET)
Every effort made to optimize ET
- Good ET technique being an
important final step in ART