ASRM announces major new publications on embryo transfer in Fertility and Sterility
Mar 30, 2017
Origin: ASRM Press Release
The American Society for Reproductive Medicine’s flagship journal Fertility and Sterility today featured several publications relating to embryo transfer. The new publications include revised guidance on the number of embryos to transfer, a new guideline on the performance of the embryo transfer, a new Practice Committee opinion designed to serve as a template for practitioners/practices to implement a standardized embryo transfer protocol, and results of a survey collecting information about individual embryo transfer practice among physicians.
The ASRM Practice Committee’s publication “Guidance on the limits to the number of embryos to transfer: a committee opinion” is the latest revision of a document first published in 1998. The guideline has been revised several times since its original publication, and has had demonstrable impact; leading to a dramatic decline in the number of high- order multiple, and more recently twin, gestations.
In the latest version of the document, a strong emphasis is placed on single -embryo transfer. The opinion states that “in patients of any age, transfer of a euploid embryo has the most favorable prognosis and should be limited to one.” Even in patients of advanced maternal age “where euploid embryos are available, a single blastocyst transfer should be the norm.”
The Committee opinion recognizes that not all patients will have a good prognosis and that clinical conditions may occasionally justify transfer of a number of embryos greater than called for in the report. However, such deviations must be carefully justified, those justifications documented in the medical record, and the risks carefully explained to the patient.
In IVF, embryo transfer is not just about the numbers. As part of a major focus to improve clinical outcomes, the ASRM formed an Embryo Transfer Advisory Panel in 2015 to examine the procedure, to assist in the development of an embryo transfer simulator and to develop protocols. One of the projects of this advisory panel led to an article also being published in this issue of Fertility and Sterility, detailing the results of a survey examining what techniques were actually followed by clinicians doing the embryo transfer procedure. In the article “Embryo Transfer Techniques: an ASRM Survey of Current SART Practices,” over 100 Reproductive Endocrinologists in a variety of practice settings responded to a 82 82-question survey that sought information from every stage of the embryo transfer procedure, from patient preparation to physician hand washing to catheter placement and removal. The survey showed some areas of significant variation while other steps were fairly universal.
The ASRM Embryo Transfer Advisory Panel also served as a special task force of the ASRM Practice Committee as they developed two important new documents released today. “Performing the Embryo Transfer: A Guideline”, and “The ASRM Standard Embryo Transfer Protocol Template: A Committee Opinion.”
The Guideline on performing the embryo transfer was developed following a systematic review of the scientific literature to examine each major step of the embryo transfer. The resulting recommendations were made for improving pregnancy rates based on interventions demonstrated to be beneficial or not beneficial. The guideline finds good evidence to support trans-abdominal ultrasound guidance, use of a soft embryo transfer catheter, removal of cervical mucus, placement of the embryo transfer tip in the upper or middle areas of the uterine cavity and immediate ambulation (no bed rest) upon completion.
Several interventions were not proven to be beneficial: Acupuncture, analgesics, massage, general anesthesia, prophylactic antibiotics and waiting after expulsion of embryos to withdraw the catheter.
Building on the review of the literature used for the Embryo Transfer Guideline, and the survey of current practices allowed the Practice Committee to develop a Standard Embryo Transfer Protocol Template. This breaks the embryo transfer procedure down into 12 steps. For each of the steps the template provides recommendations based on the systematic literature review, the survey, or both. Using this document, ART practices can move toward standardization of techniques based on the best information available.
“Embryo transfer is the foundational technology in assisted reproduction. The suite of publications we are releasing today represents a major initiative on the part of ASRM. In an increasingly data-driven field, we are determined to work with our members to catalyze investigation, to share studies and to review and summarize it into digestible, actionable formats, so that patients can rest assured their physicians have access to the best information possible.” Said Richard J. Paulson, MD, President of the ASRM.
- Guidance on the limits to the number of embryos to transfer: a committee opinion, Part of the ASRM Practice Committee Guideline Series
- Performing the embryo transfer: a guideline, Part of the ASRM Practice Committee Guideline Series
- The ASRM standard embryo transfer protocol template: a committee opinion, Part of the ASRM Practice Committee Guideline Series
- Embryo transfer techniques: an ASRM survey of current SART practices, Part of the ASRM Practice Committee Guideline Series