Trans-Vaginal Ultrasound to Guide Embryo Transfer: a Randomized Controlled Trial

Introduction: Sonography is used by most physicians during embryo transfer (ET). Patients are asked to fill their urinary bladder prior to ET to enable transabdominal ultrasound. Transvaginal sonography however, enables a better view of the cervical canal and of the endometrium and does not require filling the bladder.

Aim: To compare sonographic visualization and patient pain in the conventional trans-abdominal ultrasound (TAUS) to trans-vaginal ultrasound (TVUS) sonographic guided ET.

Materials & Methods: In this prospective randomized controlled study, 120 patients, (32.9±4.5-year-old) undergoing fresh cleavage stage ET were randomly assigned to the study group (TVUS; n=60) or the control group (TAUS; n=60). Following ET each patient filled out a visual analogue scale (VAS) based questionnaire evaluating pain and discomfort before, during and after the procedure. The physician assessed quality of sonographic visualization. Follow up lasted 12 months and included pregnancy rates.

Results: Visualization of the uterus and the ET location by the physician was significantly better in the TVUS than in the TAUS group (9.57 vs. 8.42 and 9.58 vs. 8.82, respectively). Pain sensation assessed by VAS before, during and after the procedure was significantly lower in the study group compared to the control group (5.45 vs. 1.48, 5.03 vs. 2.42 and 2.97 vs. 1.52). Implantation and live birth rates did not differ between groups (32.9% vs. 23.4%, OR=1.61 95% CI, 0.85-3.07; 31.6% vs. 25.0%, OR=1.39; 95% CI, 0.63-3.09, respectively).

Conclusions: TVUS guidance to facilitate ET is superior to TAUS in visualization of ET location, pain and discomfort to the patients. In this presentation we will review the advantages and disadvantages of US in ET.