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• W2076304269 abstract "A recent article, “Pregnancy rates after embryo transfer depend on the provider at embryo transfer” by Rhonda M. Hearns-Stokes et al. (1Hearns-Stokes R.M. Miller B.T. Scott L. Creuss D. Chakraborty P.K. Segars J.H. Pregnancy rates after embryo transfer depend on the provider at embryo transfer.Fertil Steril. 2000; 74: 80-86Abstract Full Text Full Text PDF PubMed Scopus (122) Google Scholar), addresses a very topical clinical scenario. In a move to overcome the risk of high order pregnancies National Fertility Authorities and individual IVF clinics have started promoting one or maximum two zygote transfers. They are obviously faced with the dilemma of reducing the pregnancy rates and there is hope that by improving the transfer techniques similar success rates will be obtained with two and even single zygote transfers. As regards the distance from the uterine fundus at which the zygotes are placed, it might be useful to know if the authors effectively measured this distance for all the transfers, i.e. the distance between the tip of the catheter and the uterine fundus. The authors acknowledge the increased risk of ectopic pregnancy if the zygotes are deposited too close to the uterine fundus, but unfortunately there is no individualization with how far each of the providers placed the tip of the catheter in the uterus. It will also be useful to know if the same, independent, ultrasonographer performed all the scans since otherwise could be a significant bias. The authors mention that 20% of the zygote transfers were difficult but there is no information on what is the percentage of difficult transfers per provider or how “difficult” were the difficult transfers, on a scale from 1 to 10. It will be interesting to see if the provider that had the most difficult transfers had a lower pregnancy rate or not. We consider that it is of paramount importance that guidelines for difficult transfers are available so that all clinicians will apply the same techniques in a strictly described order. The norm might be the technique used by the provider that achieves the highest success rate in the difficult transfer group of patients. In relation to the quality of the zygotes, only the grade was considered for the purpose of this study. We feel it would have been valuable to look at the cell stage too, since zygotes with a higher number of cells are more likely to reach the blastocyst stage (2Shapiro B.S. Harris D.C. Richter K.S. Predictive value of 72-hour blastomere cell number on blastocyst development and success of subsequent transfer based on the degree of blastocyst development.Fertil Steril. 2000; 73: 582-586Abstract Full Text Full Text PDF PubMed Scopus (86) Google Scholar), thus increasing the chances of success. If any of the providers would have had more zygotes with a higher cell number compared to the other providers, then this could be a potential bias. It is interesting to realize that provider number 1, which has an overall pregnancy rate around 50%, during cycle 6 had the lowest pregnancy rate (26.5%) of the 12 cycles. The technique of zygote transfer should be satisfactory since providers number 1 and 2 are responsible for 76.5% of all studied transfers, although they are done on a rotational basis. Understanding the factors that intervened in this disparate result might offer a few clues as to what is important for a successful zygote transfer. Is it the zygote quality and their adequate selection, the provider’s technique or the provider’s charisma that make a difference?" @default.
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• W2076304269 date "2001-02-01" @default.
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• W2076304269 title "Role of providers in art success" @default.
• W2076304269 cites W1573429104 @default.
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• W2076304269 doi "https://doi.org/10.1016/s0015-0282(00)01729-5" @default.
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