Ultrasound versus 'clinical touch' for catheter guidance during embryo transfer in women
Abstract
Background
Many women undergoing an Assisted Reproductive Technology (ART) cycle will not achieve a live birth. Failure at the embryo transfer stage may be due to poor embryo quality, lack of uterine receptivity, or the transfer technique itself. Numerous methods, including the use of ultrasound guidance for proper catheter placement in the endometrial cavity, have been suggested as a means of improving the technique of embryo transfer. This review evaluates the effectiveness of ultrasound (UGET) in comparison with 'clinical touch' embryo transfer (CTET) the traditional method of embryo transfer.
Objectives
To determine whether ultrasound guidance influences treatment outcomes in women undergoing embryo transfer (ET) during assisted reproductive technology (ART) cycles.
Search methods
All electronic databases were searched on 20 th August 2006. We searched the Cochrane Menstrual Disorders and Subfertility Group trials register (searched August 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2006), MEDLINE (1970‐2006), EMBASE (1985‐2006), BIO Extracts (1980‐2006). Relevant conference proceedings were also hand searched (ASRM, ESHRE and FIGO).
Selection criteria
Only randomised controlled trials were included.
Data collection and analysis
Two reviewers independently assessed eligibility and quality of trials and extracted data from those selected.
Main results
Thirteen out of fifteen identified studies were eligible for analysis. No study reported live births, however, personal communication resulted in data relating to this outcome being obtained in two of the studies. Six studies reported on ongoing pregnancies. The live birth/ ongoing pregnancies per woman randomised associated with UGET (452/1376) was significantly higher than for clinical touch (353/1338) OR 1.40, 95%CI 1.18 to 1.66, P<0.0001). This means, for example, that for a population of women with a 25% chance of pregnancy using clinical touch this would be increased to 32% (28% to 46%) by using UGET.
There were no statistically significant differences in the incidence of adverse events between the two comparison groups with the exception of blood on the catheter.
Authors' conclusions
The studies are limited by their quality with only one of the thirteen studies reporting details of both computerised randomisation techniques and adequate allocation concealment. Ultrasound guidance does appear to improve the chances of live/ongoing and clinical pregnancies compared with clinical touch methods. The quality of future studies should be improved with adequate reporting of randomisation, allocation concealment, and power calculations. The primary outcome measure of future studies should be the reporting of live births per woman randomised.
PICOs
Plain language summary
Ultrasound versus 'clinical touch' for catheter guidance during embryo transfer in women
Many women undergoing fertility treatment will not achieve a live birth. This can be due to a number of factors such as poor embryo quality, problems with the uterus, or the transfer technique itself. This review looks at one aspect of the transfer technique and whether ultrasound guidance improves pregnancy rates compared with clinical judgement. The results found that ultrasound guided embryo transfer during IVF/ICSI result in increased clinical pregnancy and ongoing pregnancy rates per woman randomised, however the risks of harm including miscarriage, ectopic pregnancies and multiple pregnancies are no different to when clinical judgement is used. However, the primary outcome of live birth/ongoing pregnancies per woman randomised was not adequately addressed in the included studies.
