How we perform Embryo Transfer under Ultrasound Guidance?

Saiprasad Gundeti, Chief Embryologist, Malpani Infertility Clinic

Embryo transfer is the final and the most crucial Step in IVF .

For our patients, we routinely perform embryo transfers on day 5 at the Blastocyst stage.

Safe Placement of Embryos in the ideal Location in the uterus is crucial.

We perform all our Embryo Transfer procedures under ultrasound guidance.

Ultrasound guided embryo transfer is the most efficient technique. It aids to track the catheter during embryo transfer and helps placing the Embryo in the desired location in the Uterine Cavity.

Better results are seen, when the Embryos are place roughly 1 cm away from the Fundus i.e. between mid of cavity and Fundus.

Steps Involved in Embryo Transfer -

1) Blastocysts (Day 5 Embryos) are selected and segregated for Embryo transfer. The blastocyst (s) is shifted to Embryo Transfer Dish containing Culture Medium or Embryo Glue.

2) The Embryologist loads the Blastocyst (s) into the Embryo Transfer Catheter under         

     stereozoom microscope. 

    - When we load  the embryo/blastocysts into the catheter, they are sandwiched between 2    

       air  bubbles.

     - we aspirate bit of culture media, followed by an air bubble, then Embryos with  minimal   

        amount of  culture media followed by another air bubble and finally bit of culture medium.

3) The catheter loaded with embryos are handed over to the surgeon, who passes it through

      the cervical opening into the uterine cavity.

4) Abdominal Ultrasound is used to track the catheter tip entering into the cavity.

5) when the catheter tip reaches the ideal location which is between fundus and mid of uterine cavity.

6) After few seconds of wait for stability,  the surgeon slowly pushes the embryo into the cavity.

7) few second of wait and then the catheter is slowly withdrawn by the surgeon and handed over to the embryologist.

8) The Embryologist checks the catheter under microscope by flushing it with some culture media to confirm  that the Embryos are safely placed in the uterine cavity and that the catheter is clean.

During Embryo transfer, in the abdominal Ulrasound it's not the catheter or the embryo which is visible in the USG, But the 2 air bubbles present in the catheter on both sides of the Embryo which are visible, make it easier for us to track the catheter and place the embryos at the desired place, which is roughly 1 cm away from the fundus.

The Embryo transfer catheter is made of soft polyurethane material that is non-toxic to the Embryos and most of the Catheters are not Echogenic (Ultrasound waves cannot be reflected back) which means it cannot be identified under ultrasound.

Similarly Culture Media is also not Echodense, to be able to get identified under ultrasound.

The  Air Bubbles are Echodense and easily identified under ultrasound.

Hence when we track the catheter in the uterus during the Embryo Transfer, it’s the Air bubbles which are seen in the ultrasound while the catheter going inside and post the Embryo placement in the cavity.

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