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Steps forward in embryo transfer technique: a retrospective study comparing direct versus afterload catheters at different time frames

  • Assisted Reproduction Technologies
  • Published:
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Abstract

Purpose

To assess whether embryo transfer (ET) technique can influence the clinical pregnancy rate (CPR) and its correlation with the embryo transfer difficulty.

Design

This single center retrospective cohort analysis of fresh and frozen single blastocyst transfers performed between January 2016 and December 2021 included fresh and frozen single blastocyst transfers performed during the study timeframe. Direct technique was the only one used from January 2016 to September 2017. From September 2017 to March 2019, the choice between the two techniques was given by randomization, due to a clinical trial recruitment. From April 2019, only the afterload technique was used. Preimplantation genetic testing cycles and gamete donation procedures and cycles performed with external gametes or embryos were excluded. CPR was the primary outcome, while difficult transfer rate the secondary one. Univariate and multivariate logistic regressions were performed.

Results

During the period, 8,189 transfers were performed. CPR of the afterload group resulted significantly higher compared to the direct group (44.69% versus 41.65%, OR 1.13, 95% CI 1.02–1.25, p = 0.017) and the rate of difficult transfers two-thirds lower (9.06% versus 26.85%, OR 0.27, 95% CI 0.24–0.31, p < 0.001).

Conclusion

Our study demonstrated that CPR is significantly affected by the ET technique. In particular, with the afterload protocol, both CPR and easy transfer rates increased.

Trial registration

http://clinicaltrials.gov registration number: NCT05364528, retrospectively registered on 3rd of May 2022

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Data availability

The dataset underlying this article is available in Zenodo repository and can be accessed, on reasonable request to the corresponding author, since it includes sensitive data.

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Acknowledgements

The authors thank all the embryologists, gynecologist, nurses, and staff working at Humanitas Fertility Center, Rozzano, Milan, Italy.

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Authors and Affiliations

  1. Fertility Center, Division of Gynaecology and Reproductive Medicine, Department of Gynaecology, Humanitas Research Hospital IRCCS, via Manzoni 57, 20089, Rozzano, Milan, Italy

    Federico Cirillo, Valentina Immediata, Camilla Ronchetti, Elena Albani, Annamaria Baggiani & Paolo Emanuele Levi-Setti

  2. Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy

    Federico Cirillo, Valentina Immediata, Camilla Ronchetti, Teresa Carletti, Emanuela Morenghi & Paolo Emanuele Levi-Setti

  3. Biostatistics Unit, Humanitas Research Hospital IRCCS, via Manzoni 57, 20089, Rozzano, Milan, Italy

    Emanuela Morenghi

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  1. Federico Cirillo
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Contributions

F. C. and P. E. L.-S. were involved in the study concept and design, analyzed data, and wrote the manuscript. V. I., C. R., and T. C. contributed to the acquisition of data, analyzed data, wrote the manuscript, and contributed to bibliography updating. E. M. analyzed data, wrote the manuscript, and supervised the analysis. E. A. contributed to the acquisition of data. A. B. critically revised the manuscript and helped for data analysis.

Corresponding author

Correspondence to Paolo Emanuele Levi-Setti.

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Ethics approval

Approval was obtained from the ethics committee of the Humanitas institutional review board. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Informed consent was obtained from all individual participants included in the study.

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Patients signed informed consent regarding publishing their data.

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The authors declare no competing interests.

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Cirillo, F., Immediata, V., Ronchetti, C. et al. Steps forward in embryo transfer technique: a retrospective study comparing direct versus afterload catheters at different time frames. J Assist Reprod Genet 40, 2895–2902 (2023). https://doi.org/10.1007/s10815-023-02957-y

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