Ultrasound versus 'clinical touch' for catheter guidance during embryo transfer in women

Brown J, Buckingham K, Abou-Setta AM, Buckett W

Published Online:

January 20, 2010

The inability to achieve a live birth for some women undergoing fertility treatment can be due to a number of factors such as lack of good quality embryo/s, problems with the uterus, or the transfer technique itself. This review looks at one aspect of the transfer technique and whether ultrasound guidance improves pregnancy rates compared with clinical judgement. Although clinical pregnancies and ongoing pregnancies were increased for the ultrasound guided group compared with the clinical touch group; there was no evidence of a difference between ultrasound guided embryo transfer and clinical touch for the outcome of live birth. The risks of harm using ultrasound guided transfer, including miscarriage, ectopic pregnancies and multiple pregnancies, are no different to when clinical judgement is used.

Abstract (click to read)

Background:

Many women undergoing an Assisted Reproductive Technology (ART) cycle will not achieve a live birth. Failure at the embryo transfer stage may be due to lack of good quality embryo/s, lack of uterine receptivity, or the transfer technique itself. Numerous methods, including the use of ultrasound guidance for proper catheter placement in the endometrial cavity, have been suggested as a more effective technique of embryo transfer. This review evaluates the effectiveness of ultrasound guided embryo transfer (UGET) compared with 'clinical touch' (CTET) the traditional method of embryo transfer.

Objectives:

To determine whether ultrasound guidance influences treatment outcomes in women undergoing embryo transfer (ET) during assisted reproductive technology (ART) cycles.

Search strategy:

Electronic databases were searched in November 2009. We searched the Cochrane Menstrual Disorders and Subfertility Group trials register (searched November 2009), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2009), MEDLINE (1970-2009), EMBASE (1985-2009), BIO Extracts (1980-2009). Relevant conference proceedings were also hand searched (ASRM, ESHRE and FIGO).

Selection criteria:

Only randomised controlled trials were included.

Data collection and analysis:

Two reviewers independently assessed eligibility and quality of trials and extracted data from those selected.

Main results:

This update identified 59 potential trials of which 42 were excluded. Data for analysis was available in seventeen studies. One study reported live births and personal communication resulted in data relating to this outcome being obtained in two additional studies. There is no evidence of a significant difference in the outcome of live birth (OR 1.14 (95%CI0.93 to 1.39; P=0.02) although heterogeneity was high (64%) and the results should be interpreted with caution. Seven studies reported on ongoing pregnancies. The ongoing pregnancies per woman randomised associated with UGET (441/1254) was significantly higher than for clinical touch (350/1218) OR 1.38, 95%CI 1.16 to 1.64, P<0.0003). No statistically significant differences in the incidence of adverse events were identified between the comparison groups. These events are relatively rare and sample sizes limit the ability to detect such differences.

Authors' conclusions:

The studies are limited by their quality with only two studies reporting details of both computerised randomisation techniques and adequate allocation concealment. Ultrasound guidance does appear to improve the chances of live/ongoing and clinical pregnancies compared with clinical touch methods. The quality of future studies should be improved with adequate reporting of randomisation, allocation concealment, and power calculations. The primary outcome measure of future studies should be the reporting of live births per woman randomised.

This record should be cited as:

Brown J, Buckingham K, Abou-Setta AM, Buckett W. Ultrasound versus 'clinical touch' for catheter guidance during embryo transfer in women. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD006107. DOI: 10.1002/14651858.CD006107.pub3

Assessed as up to date:

November 9, 2009

Find the research

Get full text at The Cochrane Library

Primary Review Group:

Menstrual Disorders and Subfertility Group

Health topics:

Gynaecology > Subfertility > Female: assisted conception techniques

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Ultrasound versus 'clinical touch' for catheter guidance during embryo transfer in women

More like this

Copyright © 2011 - The Cochrane Collaboration