Publication:

Does the presence of blood on the catheter or the degree of difficulty in embryo transfer affect the outcome in ART

Background Implantation may be impacted by the embryo transfer (ET) method. It's uncertain whether postprocedural blood at the transfer catheter tip is a true indicator of transfer difficulty because previous studies that examined its impact have produced conflicting findings. Our goal was to calculate the impact of blood at the moment of Embryo Transfer and the degree of difficulty associated with it on live birth rates (LBR).

Methods This was a retrospective study conducted at Kamlesh Tandon test tube baby centre, Agra from July 2022 to April 2024. Patients underwent COS followed by Oocyte retrieval and fresh embryo transfers. Patients with high Serum Oestradiol levels and more than 15 oocytes were deferred for a fresh embryo transfer. A freeze-all policy was followed by a subsequent freeze thawed embryo transfer cycle. The Clinical Pregnancy Rates and the Live Birth Rates were calculated.

Results Generalized estimating equations (GEE) for logistics regression with exchangeable correlation with robust variance was used to estimate the adjusted and unadjusted ORs in this retrospective cohort study. After conducting univariate modelling, all relevant confounders were taken into account in the final multivariate (adjusted) GEE model. At the moment of transfer, the ART specialist would subjectively assess embryo transfers as easy, medium or hard. Blood found at ET was linked to more challenging ETs, retained embryos in the catheter and mucus in the catheter. The degree of difficulty for ET had an adverse effect on the live birth rate (LBR), while ET with blood did not correlate with live birth in the univariate study. The only variables linked to an elevated LBR in the final multivariate GEE model, which took into account a patient's repeated cycles, were the blastocyst transfer, female age and the difficulty of the ET. The presence of blood in the transfer catheter was not linked to the chance of pregnancy and, therefore, was not an independent predictor of cycle outcome after correcting for confounding variables. This suggests that the transfer’s inherent complexity and its difficulties are factors that have a substantial negative predictive impact on pregnancy outcomes.

Conclusions Optimizing ET will allow providers to maximize successful interaction of embryo and endometrium, leading to the establishment of a viable pregnancy. These data suggest that the presence of blood during a routine, easy ET is not detrimental to live birth.