TRANSFERENCIA EMBRIONARIA

EMMA E. MARSAL MARTINEZ

Basic Steps in IVF

•Estimulación ovárica•Captura de ovulos•FIV / ICSI•Fertilización Selección •Transferencia E.•Progesterona

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

TIPOS DE T.ETRANSFERENCIA INTRAUTERINA

TRASFERENCIA TRANSMIOMETRIAL

TIPOS DE T.E

TRANSFERENCIA INTRATUBÁRICA

Gamete Intra-Fallopian Transfer (GIFT) Asch 1985

Zygote Intrafallopian Transfer (ZIFT) Devroey

Tubal Embryo Transfer (TET) Balmaceda 1988

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.

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

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.

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.

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.

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

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

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