|Year : 2014 | Volume
| Issue : 1 | Page : 29-31
Microdrop in utero movements after embryo transfer
Alex Garcia-Faura1, E Velilla1, A Martí1, M Lopez-Teijón2
1 Service of Reproductive Medicine, Institut Marquès, Barcelona, Spain
2 Service of Reproductive Medicine, Institut Marquès; Leonardo Marquès Foundation, Barcelona, Spain
|Date of Web Publication||14-Feb-2014|
Service of Reproductive Medicine, Institut Marquès, Barcelona
Source of Support: None, Conflict of Interest: None
Introduction: Embryo transfer (ET) techniques and modifications have been extensively studied recently as one the main variables affecting in vitro fertilization (IVF) pregnancy rates; many of ET independent variables have been studied with discordant results: A better understanding of endometrial movements could help improve ET efficiency and IVF success. Objectives: The aim of this study was to record and study microdrop in utero movements after ET by ultrasound (US). Materials and Methods: 18 patients underwent pelvic US for 4 h following ET, at 15 min intervals. ET occurred on day + 3 of embryo development following IVF stimulation. The microdrop that contained the embryos consisted of 25 ΅L of culture media and was randomly placed 1-3 cm from the fundus. Results: The microdrop could be seen leaving the catheter and deposited in the final 3 cm of the uterine cavity. In the following US, endometrial wave movements flowing from the cervix to fundus and fundus to cervix could clearly be seen, and these waves started at both ends simultaneously. The microdrop moved from the fundus to about 1 cm from the isthmus, and back again. There were times when it was virtually stationary. In all cases, after 1 h the microdrop had moved from its original position. The intensity of the endometrial movements was different in every patient. Discussion: The endometrial waves that start immediately after ET probably serve to keep the embryo within the uterine cavity, and to select the most appropriate place for implantation. This study shows for the first time microdrop movements after ET. Given this endometrial activity, we should not be concerned about positioning the embryo correctly at transfer as simply ensuring the catheter is within the uterine cavity should be enough, avoiding endometrial damage.
Keywords: Embryo transfer, endometrial movements, in vitro fertilization, microdrop video recording
|How to cite this article:|
Garcia-Faura A, Velilla E, Martí A, Lopez-Teijón M. Microdrop in utero movements after embryo transfer. IVF Lite 2014;1:29-31
|How to cite this URL:|
Garcia-Faura A, Velilla E, Martí A, Lopez-Teijón M. Microdrop in utero movements after embryo transfer. IVF Lite [serial online] 2014 [cited 2023 Jan 30];1:29-31. Available from: http://www.ivflite.org/text.asp?2014/1/1/29/127088
| Introduction|| |
For the past two decades, embryo quality and stage, endometrial receptivity, and embryo transfer (ET) technique have been established as the main variables affecting implantation rates and in vitro fertilization (IVF) success;  a variety of transcervical ET techniques have recently being studied to try to improve pregnancy rates and reduce the incidence of ectopic pregnancies. Many independent variables have been evaluated in prospective randomized studies, with discordant results and conclusions published recently in the international literature: bed rest after ET, ,,,, clinical touch versus ultrasound (US) guided ET, , bi-dimensional versus tri-dimensional US guided ET,  depth of embryo replacement into the uterine cavity, , volume of air bubbles,  culture media, charge of the catheter,  as the most significant. Endometrial movements have been described during spontaneous ,, and stimulated IVF cycles, ,,, and different patterns of endometrial waves have been observed depending on the phase in the ovulatory cycle or variations in hormone levels, and with iatrogenic endometrial mechanical stimulation;  therefore a better understanding of in utero microdrop movements could help us improve ET efficiency and IVF success.
| Objectives|| |
The aim of this study was to video record microdrop in utero movements after ET by US, and to study: average detection of the microdrop after ET, endometrial wave patterns and speed, splitting of the drop, average drop movement during the 1 st h after ET and time to drop image vanishing.
| Materials and Methods|| |
We present a prospective preliminary observational study, including 18 randomly chosen patients undergoing IVF at our assisted reproduction service in 2011. Exclusion and inclusion criteria were not established as all patients were completing an IVF cycle with their own eggs and with fresh ET, and all had had previous easy catheter test. The mean age of the patients was 37.7 years, 89% of them were being treated for primary infertility. ET was performed on day + 3 of embryo development, using a soft Wallace catheter, including a 25 μL culture media microdrop (G-2 v5 Plus Vitrolife), and excluding any air bubbles; embryo depth placement into the uterine cavity was randomized to 1, 2 or 3 cm from the fundus. Patients were allowed to move around normally after the initial 5 min of horizontal rest. An US scan was performed using a Toshiba-Xario's transvaginal probe, and video recorded for 4 h at 15 min intervals, in every patient. Images were digitally edited and accelerated × 5 using adobe after effects CS and 6, before all the data included in the objectives of the study was collected. No statistical tools were used as this was a preliminary descriptive study.
| Results|| |
Even if an air bubble was not introduced during the embryo charge, the microdrop could be easily seen in all patients after leaving the catheter, if left between 1 and 3 cm from the uterine fundus: Microdrops created using oily culture media gave a hyperechogenic US image that could be easily seen and recorded [Figure 1].
|Figure 1: Transvaginal ultrasound image showing hyperechogenic microdrop|
Click here to view
In the following US, endometrial wave movements flowing from the cervix to fundus and from fundus to cervix could be clearly seen, and these waves started at both ends simultaneously. The microdrop moved from the fundus to about 1 cm from the isthmus, and back again, even if there were times when it was virtually stationary. The intensity and speed of the endometrial movements was different in every patient. No splitting of the drop was seen in the studied cases [Video 1].
In all cases, after 1 h, the drop had moved from its original position, and 3-4 h after the ET the microdrop US image had faded and vanished in each patient; it was no longer possible to detect or record its movements.
| Discussion|| |
The peristaltic endometrial waves that start in the myometrial subendometrium immediately following ET, as intensively described by Ijland, van Gestel et al., (1995-2008), probably serve to keep the embryo within the uterine cavity, and also to select the most appropriate place for implantation, avoiding both the fundus and the isthmus. This study shows for the first time microdrop movements after ET. Given this endometrial activity, we should not be concerned about positioning the embryo correctly at transfer; simply ensuring that the catheter is within the uterine cavity should be enough. In this manner, we would avoid damaging the endometrium and causing bleeding, erroneously proceeding with a subendometrial transfer, or provoking uterine contractions if we touch the fundus.
| References|| |
|1.||Kovacs GT. Which factors are important for successful embryo transfer after in-vitro fertilization? Hum Reprod 1999;14:2679. |
|2.||Küçük M. Bed rest after embryo transfer: Is it harmful? Eur J Obstet Gynecol Reprod Biol 2013;167:123-6. |
|3.||Li B, Zhou H, Li W. Bed rest after embryo transfer. Eur J Obstet Gynecol Reprod Biol 2011;155:125-8. |
|4.||Abou-Setta AM, D'Angelo A, Sallam HN, Hart RJ, Al-Inany HG. Post-embryo transfer interventions for in vitro fertilization and intracytoplasmic sperm injection patients. Cochrane Database Syst Rev 2009:CD006567. |
|5.||Lambers MJ, Lambalk CB, Schats R, Hompes PG. Ultrasonographic evidence that bedrest after embryo transfer is useless. Gynecol Obstet Invest 2009;68:122-6. |
|6.||Purcell KJ, Schembri M, Telles TL, Fujimoto VY, Cedars MI. Bed rest after embryo transfer: A randomized controlled trial. Fertil Steril 2007;87:1322-6. |
|7.||Kosmas IP, Janssens R, De Munck L, Al Turki H, Van der Elst J, Tournaye H, et al. Ultrasound-guided embryo transfer does not offer any benefit in clinical outcome: A randomized controlled trial. Hum Reprod 2007;22:1327-34. |
|8.||Ata B, Urman B. Ultrasound guided embryo transfer does not offer any benefit in clinical outcome: A randomized controlled study. Hum Reprod 2008;23:457-8. |
|9.||Fang L, Sun Y, Su Y, Guo Y. Advantages of 3-dimensional sonography in embryo transfer. J Ultrasound Med 2009;28:573-8. |
|10.||Coroleu B, Barri PN, Carreras O, Martínez F, Parriego M, Hereter L, et al. The influence of the depth of embryo replacement into the uterine cavity on implantation rates after IVF: A controlled, ultrasound-guided study. Hum Reprod 2002;17:341-6. |
|11.||Franco JG Jr, Martins AM, Baruffi RL, Mauri AL, Petersen CG, Felipe V, et al. Best site for embryo transfer: The upper or lower half of endometrial cavity? Hum Reprod 2004;19:1785-90. |
|12.||Friedman BE, Lathi RB, Henne MB, Fisher SL, Milki AA. The effect of air bubble position after blastocyst transfer on pregnancy rates in IVF cycles. Fertil Steril 2011;95:944-7. |
|13.||Matorras R, Mendoza R, Expósito A, Rodriguez-Escudero FJ. Influence of the time interval between embryo catheter loading and discharging on the success of IVF. Hum Reprod 2004;19:2027-30. |
|14.||IJland MM, Evers JL, Hoogland HJ. Velocity of endometrial wavelike activity in spontaneous cycles. Fertil Steril 1997;68:72-5. |
|15.||IJland MM, Evers JL, Dunselman GA, Volovics L, Hoogland HJ. Relation between endometrial wavelike activity and fecundability in spontaneous cycles. Fertil Steril 1997;67:492-6. |
|16.||Ijland MM, Evers JL, Dunselman GA, van Katwijk C, Lo CR, Hoogland HJ. Endometrial wavelike movements during the menstrual cycle. Fertil Steril 1996;65:746-9. |
|17.||van Gestel I, IJland MM, Evers JL, Hoogland HJ. Complex endometrial wave-patterns in IVF. Fertil Steril 2007;88:612-5. |
|18.||van Gestel I, Ijland MM, Hoogland HJ, Evers JL. Endometrial waves in in vitro fertilization cycles: A validation study. Fertil Steril 2005;83:491-3. |
|19.||IJland MM, Hoogland HJ, Dunselman GA, Lo CR, Evers JL. Endometrial wave direction switch and the outcome of in vitro fertilization. Fertil Steril 1999;71:476-81. |
|20.||Ijland MM, Evers JL, Dunselman GA, Hoogland HJ. Endometrial wavelike activity, endometrial thickness, and ultrasound texture in controlled ovarian hyperstimulation cycles. Fertil Steril 1998;70:279-83. |
|21.||van Gestel I, Ijland MM, Willekes C, Evers JL, Hoogland HJ. Intrauterine manipulation does not adversely influence the direction and frequency of endometrial waves. Fertil Steril 2008;90:1995-8. |
| Authors|| |
Alex Garcia-Faura (1974, Barcelona) graduated in Medicine in 1999 from University of Barcelona. He has spent 10 years as a gynaecologist and fertility consultant at Institut Marques, Barcelona, and is the current Clinical Director. In this role, and as member of the Scientific Committee, his time is focused on clinical research, management, and quality in healthcare. As a consultant specializing in breast cancer he sits on the CIMA and Corachan Clinic Tumour Committees, attending to patients from all over the world on IVF treatment after cancer.