Training in embryo transfer: How should it be done?

摘要

There are two essential technical skills required of all assisted reproductive technology (ART) providers: oocyte retrieval and embryo transfer (ET). Of the two, ET is by far the more difficult to master. Pregnancy rates are affected by a variety of factors including patient age, the cause of infertility, embryo quality, endometrial thickness, and duration of gonadotropin exposure. In addition, differences in ET technique may affect success rates at ART, such as use of ultrasound guidance or the type of ET catheter. Some ETs may be traumatic or bloody, which adversely affects the likelihood of pregnancy. The soft ET catheter necessitates mastery of the skill required to negotiate the catheter into the uterus without trauma. Unfortunately, not all providers are equally adept; differences in success rates exist even among members of the same practice using similar techniques and may be related to the experience and dexterity of each individual practitioner (1). Since it is clear that acquisition of skills is needed for mastery of ET, and level of skill affects pregnancy rates, a conundrum is created: how can these skills be imparted to trainees without reducing pregnancy rates?