Effect of embryo transfer depth on IVF/ICSI outcomes: A randomized clinical trial

Abstract

Background: Although there has been remarkable advancement in the field of assisted reproductive technology, implantation failure remains a significant issue in most infertile couples receiving these treatments. Embryo transfer is important in assisted reproductive technology and directly affects the implantation rates and pregnancy outcomes.

Objective: To assess the effect of two different distance embryo transfer sites from fundal endometrial surface on the outcomes of in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles.

Materials and methods: A total of 180 women who were candidate for IVF/ ICSI/ embryo transfer in Yazd Research and Clinical Center for Infertility were equally assigned to two groups based on the distance between the fundal endometrial surface and catheter tip to investigate implantation, chemical and clinical pregnancy (group A: 15 $\pm$ 5 mm and group B: 25 $\pm$ 5 mm, respectively).

Results: The subjects in the group B showed significantly higher implantation rate, chemical and clinical pregnancy rate compared to the group A (p = 0.03, 0.01, 0.04, respectively). The rate of ongoing pregnancy and miscarriage indicated no significant differences between groups (p = 0.21, 0.27, respectively).

Conclusion: In conclusion, our study showed that the depth of embryo replacement inside the uterine cavity at a distance of 25 $\pm$ 5 mm beneath fundal endometrial surface have better effects on the pregnancy outcomes of IVF/ICSI cycles and can be considered as an important factor to improve the success of IVF cycles.

Keywords: Endometrium; ICSI; IVF; Pregnancy outcomes; Embryo transfer.

Figure 1

Transabdominal ultrasound viewing embryo transfer catheter and presence of air bubble at the fundus (19).

Figure 2

Embryo fundal distance. D1: Distance from endometrial surface and embryo deposition in group A; D2: Distance from endometrial surface and embryo deposition in group B; EXT.OS: external cervical os; DOUC: Double-outlined uterine cavity.

Figure 3

Consort flow diagram.