Tuesday, September 15, 2015

The right Embryo Transfer Technique

Just last week I got a call from one of my patients. She had recently undergone IVF and we had transferred a beautiful blastocyst (5-day old embryo). Just like a number of our well-informed patients, she had conducted a significant amount of research on the different infertility options including IVF. When she came to our clinic, it was obvious that she was well read and had been reading on the subject online.  In the course of her consultation, she asked intelligent questions and I answered every one of them.

Eventually, we did IVF for her and as mentioned at the start, we also transferred one blastocyt to her uterus. Now she was back with a few specific questions- She asked me why we hadn’t used ultrasound while doing the embryo transfer. Her next question was- “Where were the embryos placed in the uterus?” and another one right on its heels- “Have you used the best technique, and if yes; how is it the best?”

I know a lot of doctors who aren’t too comfortable when their patients throw too many questions at them. But I like to take the opposite route and welcome every question that a patient poses. In my opinion, it’s a sign that she is well–informed and taking an active interest in her treatment. Of course, before the ET, she had been told exactly how the transfer takes place. At that point of time, there had been no questions, but now she did have this volley of questions and I was eager to answer them.

About Embryo Transfer

ET or Embryo Transfer is the placement of embryos in the woman’s uterus and is the culmination of the In vitro Fertilization treatment that takes place in this manner:

The patient’s ovaries are first stimulated to produce a larger number or eggs (Ovarian Stimulation)
The eggs are then removed from the ovaries (Oocyte Retrieval)
They are fertilized in the lab with the patient’s  partner’s sperm
We let the embryos grow till the balstocyst stage ( embryo culture)
We choose a good quality blastocyst and place it in the patient’s uterus

Every step in IVF is crucial in its own way and there can never be any slip-up on any one of them.  However, the last step has to be done right and it is critical in achieving a pregnancy. Incidentally, it is also one of the factors which separate a skilled physician and the best IVF clinic from the rest of the pack.

Some Proven Facts

Over the last three decades, a number of ET techniques have been developed, with varying success; however certain things have been show time and again:

Placing the embryo correctly in the uterine cavity can be the difference between a successful or failed IVF cycle
Most IVF specialists agree that when the embryo is placed between 1  & 1.5 cm from the fundus (top of the uterus), it will help achieve the highest possible pregnancy rate
Placing it too close to the bottom or top can reduce the chance that the embryo will get implanted successfully
ET’s that are performed without any kind of trauma to the uterus are obviously the best option. The “difficult” ones or ones that cause any trauma to the uterine lining & cervix or cause bleeding, result in much lower pregnancy rates compared to uncomplicated, smooth transfers
Cervical mucus can prove to be toxic  to the embryos and it’s important that the IVF doctor use a “clean  technique” as this improves outcomes

How Best to Perform an ET?

Just like a lot of other things in the medical field, this subject too, is a highly debatable one:

A number of doctors use ultrasound, and so do we, when needed. This helps in guiding the actual placement of the catheter
Some  IVF specialists perform a “mock” transfer to evaluate the right pathway
Some doctors perform a hysteroscopy in order to evaluate the uterine cavity and the cervical canal before they transfer the embryo

At our clinic we may use either an ultrasound or a “mock transfer” as we had in the case of this particular patient. This allows us to map the correct pathway and gives us a clear idea about where the embryos have to be placed. Some patients find the ultrasound procedure a little uncomfortable (it requires a full bladder & a probe has to be held very firmly to the patient’s abdomen) and we may end up performing a mock transfer instead.

Our Technique Works Superbly

Fortunately for this patient as well as many others that we have treated to date, our technique works well. I explained the entire process to my patient just as I have mentioned here. I told her that it’s possible to achieve a successful transfer without using an ultrasound. But very frankly the most credible explanation came today; the embryo we had transferred was growing as it should and has a  strong heartbeat.

Need more information? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you  !

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