Is there a standard checklist for embryo transfer?

Standard Checklist for Embryo Transfer

While there is no universally standardized checklist specifically for embryo transfer procedures, the European Society of Human Reproduction and Embryology (ESHRE) provides comprehensive guidelines that can be used to develop a structured approach to embryo transfer.

Essential Components for an Embryo Transfer Checklist

Pre-Transfer Assessment

• Document complete patient demographic information including age, BMI, and infertility history 1
• Evaluate and record ovarian response category (normal, low, or high responder) 2
• Perform proper evaluation of the uterine cavity and utero-cervical angulation through dummy embryo transfer and ultrasound assessment 3
• Document previous pregnancy outcomes, particularly any history of recurrent pregnancy loss 1

Transfer Decision-Making

• Determine appropriate number of embryos to transfer based on patient factors 2
• For normal responders, elective single embryo transfer (eSET) is recommended 2
• For patients with low or high ovarian response, eSET is also recommended 2
• If considering transfer of more than one embryo, provide clear information about increased risks of multiple pregnancy 2
• Obtain additional consent form if more than one embryo is to be transferred 2

Technical Procedure Elements

• Remove cervical mucus to prevent it from adhering to the catheter and potentially removing embryos during withdrawal 3
• Use soft catheters and gentle manipulation to avoid initiating uterine contractility 3, 4
• Avoid touching the uterine fundus during transfer 3
• Ensure the transfer catheter has passed the internal cervical os 3
• Use ultrasound guidance for optimal placement of embryos 5, 6
• Document catheter type and transfer technique used 6

Post-Transfer Documentation

• Record number of embryos transferred 1
• Document whether transfer was elective single embryo transfer (eSET) or multiple embryo transfer 1
• Record embryo quality and developmental stage at transfer 1, 7
• Document any technical difficulties encountered during the procedure 4

Critical Considerations for Optimal Outcomes

• The embryo transfer technique is crucial to IVF success and should be performed with great attention to detail and minimal trauma to the endometrium 3, 6
• Ultrasound guidance during transfer has been shown to improve pregnancy rates 6, 4
• The inclusion of hyaluronan in transfer media may benefit implantation 6
• Avoid initiating uterine contractions through gentle technique and appropriate catheter selection 3, 4

Common Pitfalls to Avoid

• Touching the uterine fundus, which can trigger uterine contractions 3
• Failure to remove cervical mucus, which can inadvertently remove embryos during catheter withdrawal 3
• Using rigid catheters that may cause trauma to the endometrium 6, 4
• Inadequate assessment of uterine cavity and cervical angulation before transfer 3, 4
• Inconsistent embryo grading systems that prevent standardized assessment 1

By following this structured approach to embryo transfer, clinicians can optimize the procedure to maximize the chances of successful implantation and pregnancy while minimizing the risks associated with multiple pregnancies.