Evaluation of a strategy for difficult embryo transfers from a prospective series of 2,046 transfers

Assisted Reproduction

VOLUME 2, ISSUE 1, P43-49, MARCH 01, 2021


Lionel Larue, M.D., Ph.D., Laure Bernard, M.D., Julie Moulin, M.D., Anne Massari, M.D., Nino-Guy Cassuto, Ph.D., Dominique Bouret, M.D., Gwenola Keromnes, M.D.



To evaluate an embryo transfer strategy for difficult transfers (DiTs).


Prospective, nonrandomized, observational, cohort study


A hospital fertility center in France.


Data were collected on all embryo transfers conducted using the strategy between February 2014 and February 2020.


Anatomical characteristics that could cause DiT were identified by transvaginal ultrasound and the catheter was adapted accordingly. Transfer was guided by transvaginal ultrasound. After passage through the cervix, a rest period was introduced to allow any contractions to stop before embryo deposition in the uterus.

Main Outcome Measure(s)

The primary criterion was the percentage of pregnancies per transfer (P/T) after an easy transfer (EaT) or a DiT. The secondary criteria included the anatomical causes of DiT and the patients’ levels of discomfort.


Of 2,046 transfers, 257 (12%) were DiTs: minor difficulties (n = 152; 7.4%), major difficulties (n = 96; 4.7%), very significant difficulties (n = 7; 0.3%), or impossible (n = 2; 0.1%). The most common causes of DiTs were endocervical crypts (54%), tortuous cervical canal (36%), and marked uterine anteversions (30%). Several causes were often responsible for DiTs. There was no statistically significant difference in the P/T between the EaTs (n = 1,789, 41%) and all degrees of DiT (n = 257, 37%). In addition, there was no statistically significant difference between the level of patient-reported discomfort in the EaT and DiT groups.


This study demonstrated that an adapted embryo transfer strategy, monitored by transvaginal ultrasound, led to similar pregnancy rates regardless of whether the transfer was easy or difficult.

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