Ultrasound versus 'clinical touch' for catheter guidance during embryo transfer in women

 

Abstract

Background

Many women undergoing an Assisted Reproductive Technology (ART) cycle will not achieve a live birth. Failure at the embryo transfer stage may be due to lack of good quality embryo/s, lack of uterine receptivity, or the transfer technique itself. Numerous methods, including the use of ultrasound guidance for proper catheter placement in the endometrial cavity, have been suggested as a more effective technique of embryo transfer. This review evaluates the effectiveness of ultrasound guided embryo transfer (UGET) compared with 'clinical touch' (CTET) the traditional method of embryo transfer.

Objectives

To determine whether ultrasound guidance influences treatment outcomes in women undergoing embryo transfer (ET) during assisted reproductive technology (ART) cycles.

Search methods

Electronic databases were searched in November 2009. We searched the Cochrane Menstrual Disorders and Subfertility Group trials register (searched November 2009), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2009), MEDLINE (1970-2009), EMBASE (1985-2009), BIO Extracts (1980-2009). Relevant conference proceedings were also hand searched (ASRM, ESHRE and FIGO).

Selection criteria

Only randomised controlled trials were included.

Data collection and analysis

Two reviewers independently assessed eligibility and quality of trials and extracted data from those selected.

Main results

This update identified 59 potential trials of which 42 were excluded. Data for analysis was available in seventeen studies. One study reported live births and personal communication resulted in data relating to this outcome being obtained in two additional studies. There is no evidence of a significant difference in the outcome of live birth (OR 1.14 (95%CI0.93 to 1.39; P=0.02) although heterogeneity was high (64%) and the results should be interpreted with caution. Seven studies reported on ongoing pregnancies. The ongoing pregnancies per woman randomised associated with UGET (441/1254) was significantly higher than for clinical touch (350/1218) OR 1.38, 95%CI 1.16 to 1.64, P<0.0003). No statistically significant differences in the incidence of adverse events were identified between the comparison groups. These events are relatively rare and sample sizes limit the ability to detect such differences.

Authors' conclusions

The studies are limited by their quality with only two studies reporting details of both computerised randomisation techniques and adequate allocation concealment. Ultrasound guidance does appear to improve the chances of live/ongoing and clinical pregnancies compared with clinical touch methods. The quality of future studies should be improved with adequate reporting of randomisation, allocation concealment, and power calculations. The primary outcome measure of future studies should be the reporting of live births per woman randomised.

 

Plain language summary

Ultrasound versus 'clinical touch' for catheter guidance during embryo transfer in women

The inability to achieve a live birth for some women undergoing fertility treatment can be due to a number of factors such as lack of good quality embryo/s, problems with the uterus, or the transfer technique itself. This review looks at one aspect of the transfer technique and whether ultrasound guidance improves pregnancy rates compared with clinical judgement. Although clinical pregnancies and ongoing pregnancies were increased for the ultrasound guided group compared with the clinical touch group; there was no evidence of a difference between ultrasound guided embryo transfer and clinical touch for the outcome of live birth. The risks of harm using ultrasound guided transfer, including miscarriage, ectopic pregnancies and multiple pregnancies, are no different to when clinical judgement is used.

 

摘要

背景

在婦女之胚胎植入過程中使用超音波與「臨床觸診」進行導管引導之比較

諸多進行輔助生殖技術 (Assisted Reproductive Technology；ART) 週期治療之婦女無法達成活產。胚胎植入階段之失敗可能係因為缺乏高品質之胚胎、缺乏子宮內膜容受性、或是植入技術本身而造成。諸多之方法已被建議為較有效之胚胎植入技術，包括使用超音波引導以將導管適當放置於子宮內膜腔中。本回顧係評估比較超音波導引性胚胎植入 (ultrasound guided embryo transfer；UGET) 與傳統之「臨床觸診」性胚胎植入 (‘clinical touch’ embryo transfer；CTET) 的有效性。

目標

判定超音波導引是否可影響在輔助生殖技術 (assisted reproductive technology；ART) 週期中進行胚胎植入 (embryo transfer；ET) 之婦女的治療結果。

搜尋策略

2009年11月搜尋電子資料庫，我們搜尋了Cochrane Menstrual Disordersand and Subfertility Group trials register (searched 2009年11月) 、 Cochrane Central Register of Controlled Trials (Cochrane Library, Issue 3, 2009) 、 MEDLINE (1970年2009) 、 EMBASE (1985 – 2009) 、 BIO Extracts (1980 – 2009) 。並用人工的方式搜尋相關研討會手冊 (ASRM, ESHRE以及FIGO) 。

選擇標準

僅收納隨機對照試驗。

資料收集與分析

由2名回顧作者獨立評估試驗之適用性及品質，並由所選之試驗摘錄數據。

主要結論

此一更新共辨識出59項潛在適用試驗，其中排除42項。由其中17項研究進行數據分析取得。其中1項研究報告了活產數，並在另外2項研究中藉由私人通訊產生與此結果相關之數據。並無證據顯示活產數之結果具有顯著差異 (OR 1.14 (95% CI0.93 to 1.39; P = 0.02) ，但其異質性較高 (64%) ，而此等結果應予小心闡述。共有7項研究提出有關繼續懷孕率之報告。就每名隨機分派婦女之繼續懷孕率而言，使用UGET者 (441/1254) 顯著高於使用臨床觸診者 (350/1218) (OR 1.38, 95% CI 1.16 to 1.64, P<0.0003) 。在該等比較組間並未發現不良作用發生率之統計顯著性差異。此等不良作用相對極少發生，而樣本大小亦限制了偵測此等差異之能力。

作者結論

研究之數量極為有限，僅有2項實驗報告了有關電腦隨機分派技術以及適當分組隱匿之細節。相較於臨床觸診法，超音波之導引可改善活產/繼續懷孕的機率。未來之研究應要有改善之品質，適當報告隨機分派、分組隱匿、及檢定力之計算。未來研究之主要結果標準應為報告每位隨機分派婦女之活產數。

翻譯人

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

在婦女之胚胎植入過程中使用超音波與「臨床觸診」進行導管引導之比較：部分進行受孕治療之婦女無法達成活產之情形可能係由諸多因子造成，諸如，缺乏高品質之胚胎、子宮問題、或是植入技術本身。本回顧針對植入技術之其中一個範疇進行探究，並探究超音波之導引相較於臨床判斷是否可改善懷孕率。僅管超音波導引組相對於臨床觸診組具有較高之臨床懷孕率及繼續懷孕率，並無證據顯示超音波導引性胚胎植入與臨床觸診之間具有活產數結果的差異。使用超音波引導性植入之危害風險，包括流產、異位妊娠、及多胎妊娠，與使用臨床判斷時並無差異。