Skip to main content
SpringerLink
Log in

Does the Presence of Blood in the Catheter or the Degree of Difficulty of Embryo Transfer Affect Live Birth?

  • Original Article
  • Published:
Reproductive Sciences Aims and scope Submit manuscript

Abstract

The technique used for embryo transfer (ET) can affect implantation. Prior research that evaluated the effect of postprocedural blood of the transfer catheter tip have yielded mixed results, and it is unclear whether this is actually a marker of difficulty of the transfer. Our objective was to estimate the effect of blood at the time of ET and the difficulty of ET on live birth rates (LBR). This retrospective cohort study utilized generalized estimating equations (GEEs) with nesting for repeated cycles for all analyses. Univariate modeling was performed and a final multivariate (adjusted) GEE model accounted for all significant confounders. Embryo transfers were subjectively graded (easy, medium, or hard) by a physician at the time of transfer. The presence of blood at ET was associated with more difficult ETs, retained embryos, and presence of mucous in the catheter. In the univariate analysis, ET with blood was not associated with live birth, while the degree of difficulty for ET had a negative impact on LBR. In the final multivariate GEE model, which accounts for repeated cycles from a patient, the only factors associated with an increased LBR were the degree of difficulty of the ET, female age, and blastocyst transfer. After controlling for confounding variables, the presence of blood in the transfer catheter was not associated with the likelihood of pregnancy and thus was not an independent predictor of cycle outcome. This indicates that the difficulty of the transfer itself was a strong negative predictor of pregnancy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Mirkin S, Jones EL, Mayer JF, et al. Impact of transabdominal ultrasound guidance on performance and outcome of transcervical uterine embryo transfer. J Assist Reprod Genet. 2003;20(8):318–322.

    Article  Google Scholar 

  2. Buckett WM. A meta-analysis of ultrasound-guided versus clinical touch embryo transfer. Fertil Steril. 2003;80(4):1037–1041.

    Article  Google Scholar 

  3. Lewin A, Schenker JG, Avrech O, Shapira S, Safran A, Friedler S. The role of uterine straightening by passive bladder distension before embryo transfer in IVF cycles. J Assist Reprod Genet. 1997;14(1):32–34.

    Article  CAS  Google Scholar 

  4. Mansour R, Aboulghar M, Serour G. Dummy embryo transfer: a technique that minimizes the problems of embryo transfer and improves the pregnancy rate in human in vitro fertilization. Fertil Steril. 1990;54(4):678–681.

    Article  CAS  Google Scholar 

  5. Neithardt AB, Segars JH, Hennessy S, James AN, McKeeby JL. Embryo afterloading: a refinement in embryo transfer technique that may increase clinical pregnancy. Fertil Steril. 2005;83(3):710–714.

    Article  Google Scholar 

  6. Lesny P, Killick SR, Tetlow RL, Robinson J, Maguiness SD. Uterine junctional zone contractions during assisted reproduction cycles. Hum Reprod Update. 1998;4(4):440–445.

    Article  CAS  Google Scholar 

  7. Jones GM, Trounson AO, Gardner DK, Kausche A, Lolatgis N, Wood C. Evolution of a culture protocol for successful blastocyst development and pregnancy. Hum Reprod. 1998;13(1):169–177.

    Article  CAS  Google Scholar 

  8. Coroleu B, Barri PN, Carreras O, et al. The influence of the depth of embryo replacement into the uterine cavity on implantation rates after IVF: a controlled, ultrasound-guided study. Hum Reprod. 2002;17(2):341–346.

    Article  Google Scholar 

  9. Frankfurter D, Trimarchi JB, Silva CP, Keefe DL. Middle to lower uterine segment embryo transfer improves implantation and pregnancy rates compared with fundal embryo transfer. Fertil Steril. 2004;81(5):1273–1277.

    Article  Google Scholar 

  10. Lesny P, Killick SR, Tetlow RL, Manton DJ, Robinson J, Maguiness SD. Ultrasound evaluation of the uterine zonal anatomy during in-vitro fertilization and embryo transfer. Hum Reprod. 1999;14(6):1593–1598.

    Article  CAS  Google Scholar 

  11. Rhodes TL, McCoy TP, Higdon HL, 3rd, Boone WR. Factors affecting assisted reproductive technology (ART) pregnancy rates: a multivariate analysis. J Assist Reprod Genet. 2005;22(9-10):335–346.

    Article  Google Scholar 

  12. Goudas VT, Hammitt DG, Damario MA, Session DR, Singh AP, Dumesic DA. Blood on the embryo transfer catheter is associated with decreased rates of embryo implantation and clinical pregnancy with the use of in vitro fertilization-embryo transfer. Fertil Steril. 1998;70(5):878–882.

    Article  CAS  Google Scholar 

  13. Tiras B, Korucuoglu U, Polat M, Saltik A, Zeyneloglu HB, Yarali H. Effect of blood and mucus on the success rates of embryo transfers. Eur J Obstet Gynecol Reprod Biol. 2012;165(2):239–242.

    Article  Google Scholar 

  14. Sallam HN, Sadek SS. Ultrasound-guided embryo transfer: a meta-analysis of randomized controlled trials. Fertil Steril. 2003;80(4):1042–1046.

    Article  Google Scholar 

  15. Sallam HN, Agameya AF, Rahman AF, Ezzeldin F, Sallam AN. Impact of technical difficulties, choice of catheter, and the presence of blood on the success of embryo transfer-experience from a single provider. J Assist Reprod Genet. 2003;20(4):135–142.

    Article  Google Scholar 

  16. Alvero R, Hearns-Stokes RM, Catherino WH, Leondires MP, Segars JH. The presence of blood in the transfer catheter negatively influences outcome at embryo transfer. Hum Reprod. 2003;18(9):1848–1852.

    Article  CAS  Google Scholar 

  17. Moragianni VA, Cohen JD, Smith SE, et al. Effect of macroscopic or microscopic blood and mucus on the success rates of embryo transfers. Fertil Steril. 2010;93(2):570–573.

    Article  Google Scholar 

  18. Phillips JA, Martins WP, Nastri CO, Raine-Fenning NJ. Difficult embryo transfers or blood on catheter and assisted reproductive outcomes: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2013;168(2):121–128.

    Article  Google Scholar 

  19. Tur-Kaspa I, Yuval Y, Bider D, Levron J, Shulman A, Dor J. Difficult or repeated sequential embryo transfers do not adversely affect in-vitro fertilization pregnancy rates or outcome. Hum Reprod. 1998;13(9):2452–2455.

    Article  CAS  Google Scholar 

  20. Burke LM, Davenport AT, Russell GB, Deaton JL. Predictors of success after embryo transfer: experience from a single provider. Am J Obstet Gynecol. 2000;182(5):1001–1004.

    Article  CAS  Google Scholar 

  21. Tomas C, Tikkinen K, Tuomivaara L, Tapanainen JS, Martikainen H. The degree of difficulty of embryo transfer is an independent factor for predicting pregnancy. Hum Reprod. 2002;17(10):2632–2635.

    Article  Google Scholar 

  22. Lass A, Abusheikha N, Brinsden P, Kovacs GT. The effect of a difficult embryo transfer on the outcome of IVF. Hum Reprod. 1999;14(9):2417.

    Article  CAS  Google Scholar 

  23. Englert Y, Puissant F, Camus M, Van Hoeck J, Leroy F. Clinical study on embryo transfer after human in vitro fertilization. J In Vitro Fert Embryo Transf. 1986;3(4):243–246.

    Article  CAS  Google Scholar 

  24. Listijono DR, Boylan T, Cooke S, Kilani S, Chapman MG. An analysis of the impact of embryo transfer difficulty on live birth rates, using a standardised grading system. Hum Fertil (Camb). 2013;16(3):211–214.

    Article  Google Scholar 

  25. Ghaffari F, Kiani K, Bahmanabadi A, Akhoond M. Comparison of easy and difficult embryo transfer outcomes in in vitro fertilization cycles. Int J Fertil Steril. 2013;6(4):232–237.

    PubMed  PubMed Central  Google Scholar 

  26. Levens ED, Whitcomb BW, Kort JD, Materia-Hoover D, Larsen FW. Microdose follicular flare: a viable alternative for normal-responding patients undergoing in vitro fertilization? Fertil Steril. 2009;91(1):110–114.

    Article  CAS  Google Scholar 

  27. De Placido G, Wilding M, Stina I, et al. The effect of ease of transfer and type of catheter used on pregnancy and implantation rates in an IVF program. J Assist Reprod Genet. 2002;19(1):14–18.

    Article  Google Scholar 

  28. Shi W, Zhang S, Zhao W, et al. Factors related to clinical pregnancy after vitrified-warmed embryo transfer: a retrospective and multivariate logistic regression analysis of 2313 transfer cycles. Hum Reprod. 2013;28(7):1768–1775.

    Article  Google Scholar 

  29. Phillips SJ, Dean NL, Buckett WM, Tan SL. Consecutive transfer of day 3 embryos and of day 5-6 blastocysts increases overall pregnancy rates associated with blastocyst culture. J Assist Reprod Genet. 2003;20(11):461–464.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver NICHD, National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA

    Torie C. Plowden MD, MPH & Micah J. Hill DO

  2. Walter Reed National Military Medical Center, Bethesda, MD, USA

    Torie C. Plowden MD, MPH, Micah J. Hill DO, Shana M. Miles MD, PhD, Belinda Yauger MD, John M. Csokmay MD & Rebecca J. Chason MD

  3. Uniformed Services University, Bethesda, MD, USA

    Benjamin Hoyt BS

  4. Johns Hopkins Department of Gynecology and Obstetrics, Baltimore, MD, USA

    James H. Segars MD

Authors
  1. Torie C. Plowden MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Micah J. Hill DO
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shana M. Miles MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Benjamin Hoyt BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Belinda Yauger MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. James H. Segars MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. John M. Csokmay MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rebecca J. Chason MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Torie C. Plowden MD, MPH.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Plowden, T.C., Hill, M.J., Miles, S.M. et al. Does the Presence of Blood in the Catheter or the Degree of Difficulty of Embryo Transfer Affect Live Birth?. Reprod. Sci. 24, 726–730 (2017). https://doi.org/10.1177/1933719116667607

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1177/1933719116667607

Keywords

Search

Navigation