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Mock embryo transfer in early luteal phase, the cycle before in vitro fertilization and embryo transfer: a
V Knutzen1, C J Stratton, G Sher
1Northern Nevada Fertility Center, Reno.
Objective:
To investigate visually the uterine retention or sequestration of boluses of radiopaque dye, mimicking embryo transfer (ET).
Design:
During the cycle before in vitro fertilization (IVF) and ET, patients underwent a mock ET of 40 microL of radiopaque dye into the uterine cavity. The patient was positioned supine for retroverted or axial and knee chest for anteverted uteri. The position of the dye at injection, during and after catheter removal, and during patient roll over and standing was monitored.
Setting:
Treatment of infertility in a private practice.
Patients:
Thirty-four IVF patients.
Interventions:
During the cycle before IVF/ET, patients underwent a mock ET using a bolus of 40 microL of radiopaque dye.
Main Outcome Measures:
Planned before visual observation began.
Results:
The dye remained primarily in the uterine cavity in only 68% (optimum ET position is knee chest for anteverted and supine for retroverted or axial uterus) and 48% (nonoptimum position is supine for anteverted uterus) at mock ET; in those groups, a 33% clinical pregnancy rate (PR) per retrieval resulted. Dye motility into the fallopian tube(s), cervix, and/or vagina is 38.2%, 8.8%, and 11.8%, respectively.
Conclusions:
If the mock ET had been the actual ET, 32% (optimum ET position) and 52% (nonoptimum ET position) of all patients would have lost their opportunity for pregnancy as a result of the ET procedure. Our 33% PR per retrieval among those patients who retained the dye in utero is more consistent with our expectations, given the advanced technologies of IVF/ET today.