The Final Step – Embryo Transfer. Preparation is the key at Dominion Fertility.

Preparation can really make all the difference with an embryo transfer. As faithful readers of this blog may recall, I spent a couple of days over Spring Break hiking and camping with my daughter. Our trip to the Pine Mountain Trail was cut short by bad weather in Washington DC (and along the entire Eastern Seaboard) but the time we spent on the trail was quite enjoyable. One of the biggest factors in the success of the trip was being prepared. As an Eagle Scout I completely agree with the concept of being prepared. We had excellent gear and camping chairs and a large rain/dining fly that I purchased knowing that it would absolutely rain during the trip (because it always rains on my camping trips…just ask my sons). The trip was more enjoyable and less stressful because I had taken the time to prepare in advance. In fact, I actually had all of our camping gear that I rented delivered to our office just in case our dogs scared off the UPS/FedEx guy! I was totally on top of the situation. Now if we are talking about household chores then that is another story….but in this case I was at the top of my game.

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So what does this have to do with IVF and Reproductive Medicine? The answer is being prepared! Recently the American Society for Reproductive Medicine released guidelines about performing the embryo transfer in IVF. The guidelines list the following recommendations:

  • Abdominal ultrasound guidance for embryo transfer…CHECK
  • Removal of cervical mucus…CHECK
  • Use of soft embryo transfer catheters…CHECK
  • Placement of embryo transfer tip in the upper or middle (central) area of the uterine cavity, greater than 1 cm from the fundus, for embryo expulsion…CHECK
  • Immediately withdraw the catheter following embryo transfer…CHECK
  • Immediate ambulation once the embryo transfer procedure is completed…CHECK
So we are doing exactly what we should be doing in performing these embryo transfers according to the Practice Committee of the ASRM…Thank you very much… But in addition to the fine recommendations from the committee, I would add three other recommendations.
Don’t rush.
Get the patient set up exactly as needed. If her bladder is too full, let her empty a bit. If she empties too much just wait for it to fill up again. I hate hearing stories about patients at other clinics where the doctor seemed too harried to do things right. You get one shot at this transfer for this patient….do it right!
Don’t panic.
We currently use the afterload technique for embryo transfer. We get everything set and then we place the catheter past the cervix and once we see that the positioning is good we withdraw the inner catheter. The embryologist then walks in from the lab with a new inner catheter (looks like a strand of spaghetti) and threads it into the outer which we have held steady waiting for the embryologist. Previously we would take the catheter with the embryo inside of it and attempt to thread it past the cervix. Most of the time it went fine but occasionally the curve of the cervix would preclude an easy transfer and everyone’s anxiety seemed to increase as the seconds and minutes ticked by. In fact, I am not sure it really mattered but it stressed everyone out. Eventually someone would say “is it supposed to take this long?” Ugh. I don’t miss those days at all.
Don’t forget Sam Cooke
For reasons that I cannot fathom, the playing of Sam Cooke’s classic ballad “You Send Me” was not included in the ASRM recommendations. This song is absolutely critical to successful embryo transfer and in my experience 100% of the successful embryo transfers performed by yours truly have been performed with this song playing in the background.  How other physicians are able to successfully perform embryo transfers in the absence of this song baffles me…..

Just remember…Be Prepared.

– Dr. Gordon