asrm standard embryo transfer protocol template: a committee … · 2019-11-14 · ization of the...

ASRM standard embryo transferprotocol template: acommittee opinion

Practice Committee of the American Society for Reproductive Medicine

American Society for Reproductive Medicine, Birmingham, Alabama

Standardization improves performance and safety. A template for standardizing the embryo transfer procedure is presented here with 12basic steps supported by published scientific literature and a survey of common practice of SART programs; it can be used by ART prac-tices to model their own standard protocol. (Fertil Steril� 2017;107:897–900.�2017 by American Society for Reproductive Medicine.)

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T he 2014 to 2019 American Soci-ety for Reproductive Medicine(ASRM) Strategic Plan is focusedon seven goals. Two of those goals are:1) setting new standards in thecontinuing medical education of, and,2) having maximal impact on repro-ductive medicine. In response to accu-mulating evidence that suggested agap in clinician training and standard-ization of the embryo transfer proced-ure, ASRM presents the results of anembryo transfer initiative in this issueof Fertility and Sterility. Prior reportshave suggested that the majority of fel-lows in reproductive endocrinologyand infertility training perform veryfew, if any, embryo transfers. In addi-tion, studies have consistently demon-strated that in vitro fertilization (IVF)pregnancy rates vary by the clinicianperforming the transfer (1–4).

ASRM formed an Embryo TransferAdvisory Panel to move this initiativeforward. The panel collaborated with aleading medical simulation company,VirtaMed, to develop a virtual reality-based simulator for training in embryotransfer and intrauterine insemina-

Received February 21, 2017; accepted February 21, 2Reprint requests: Practice Committee, American Soci

ery Hwy, Birmingham, Alabama 35216 (E-mail:

Fertility and Sterility® Vol. 107, No. 4, April 2017 00Copyright ©2017 American Society for Reproductivehttp://dx.doi.org/10.1016/j.fertnstert.2017.02.108

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tions. The panel also developed anextensive 82-question survey that wassent to all Society for Assisted Repro-ductive Technology (SART) medical di-rectors and was completed by 41% ofthem. The results of that survey aresummarized in this issue in the articletitled, ‘‘Embryo transfer techniques:an ASRM survey of current SART prac-tices’’ (5). Survey results were used toguide the development of the embryotransfer simulator and to determinecommon practices around embryotransfer. The results were also used todevelop a ‘‘common practice’’ docu-ment that allows clinicians to reviewall of the steps of the embryo transferprocedure and better understand com-mon practice. The survey article canbe used to identify variations in clinicalpractice and potential areas for change.

Aspart of the embryo transfer initia-tive, a subset of the Embryo TransferAdvisory Panel served as a special taskforce of the ASRM Practice Committeeto perform a systematic review of theliterature around the major steps of theembryo transfer procedure. The goal ofthis work was to identify those parts ofthe embryo transfer procedure that are

017; published online March 11, 2017.ety for Reproductive Medicine, 1209 Montgom-ASRM@asrm.org).

15-0282/$36.00Medicine, Published by Elsevier Inc.

supported by the literature as well asgaps in research for which the literatureis unable to provide guidance. A newASRM guideline, ‘‘Performing the em-bryo transfer: a guideline,’’ summarizesthe findings of that extensive reviewand is also published in this issue (6).

Figure 1 combines the findings ofboth the systematic review of the litera-ture and the embryo transfer survey ofSART medical directors. In Figure 1 are12 basic steps of the embryo transfer pro-tocol adopted by the ASRM PracticeCommittee. A number of the steps aresupported by evidence in the literatureand the new ASRM guideline on per-forming the embryo transfer (6). Forthose steps not supported by the litera-ture, data from the survey demonstratecommonpractice.While there are accept-able variations around some of the stepsincluded here and the names given tosomeof theproceduresmaydiffer locally,the purpose is to fill a need for standard-ization. Literature onquality and safety isfilled with evidence that standardizationimproves performance and safety (7).The embryo transfer survey paper dem-onstrates that only 50% of SART prac-tices responding had a standard embryotransfer protocol for all of their cliniciansto follow. The ASRM Standard EmbryoTransfer Protocol Template providesassociated evidence for all practices touse tomodel their own standard protocol.

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ASRM Standard Embryo Transfer Protocol Template.

ASRM. Embryo transfer protocol template. Fertil Steril 2017.

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Acknowledgments: This report was developed under thedirection of the Practice Committee of the American Societyfor Reproductive Medicine as a service to its members andother practicing clinicians. Although this document reflectsappropriate management of a problem encountered in thepractice of reproductive medicine, it is not intended to bethe only approved standard of practice or to dictate an exclu-sive course of treatment. Other plans of management may beappropriate, taking into account the needs of the individualpatient, available resources, and institutional or clinical prac-tice limitations. The Practice Committee and the Board of Di-rectors of the American Society for Reproductive Medicinehave approved this report.

This document was reviewed by ASRMmembers and theirinput was considered in the preparation of the final docu-ment. The following members of the ASRM Practice Commit-tee participated in the development of this document. Allcommittee members disclosed commercial and financial rela-tionships with manufacturers or distributors of goods or ser-vices used to treat patients. Members of the committee whowere found to have conflicts of interest based on the relation-ships disclosed did not participate in the discussion or devel-opment of this document.

Alan Penzias, M.D.; Kristin Bendikson, M.D.; SamanthaButts, M.D., M.S.C.E.; Christos Coutifaris, M.D.; TommasoFalcone, M.D.; Gregory Fossum, M.D.; Susan Gitlin, Ph.D.;

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Clarisa Gracia, M.D., M.S.C.E.; Karl Hansen, M.D., Ph.D.; Jen-nifer Mersereau, M.D.; Randall Odem, M.D.; Robert Rebar,M.D.; Richard Reindollar, M.D.; Mitchell Rosen, M.D.; JaySandlow, M.D.; Michael Vernon, Ph.D.

REFERENCES1. Angelini A, Brusco GF, Barnocchi N, El-Danasouri I, Pacchiarotti A,

Selman HA. Impact of physician performing embryo transfer on pregnancyrates in an assisted reproductive program. J Assist Reprod Genet 2006;23:329–32.

2. Hearns-Stokes RM, Miller BT, Scott L, Creuss D, Chakraborty PK, Segars JH.Pregnancy rates after embryo transfer depend on the provider at embryotransfer. Fertil Steril 2000;74:80–6.

3. Karande VC, Morris R, Chapman C, Rinehart J, Gleicher N. Impact of the‘‘physician factor’’ on pregnancy rates in a large assisted reproductive tech-nology program: do too many cooks spoil the broth? Fertil Steril 1999;71:1001–9.

4. Morin SJ, Franasiak JM, Juneau CR, Scott RT. O-63 Live birth rate followingembryo transfer is significantly influenced by the physician performing thetransfer: data from 2707 euploid blastocyst transfers by 11 physicians. FertilSteril 2016;106:e25.

5. Toth TL, Lee MS, Bendikson KA, Reindollar RH. Embryo transfer techniques:An ASRM Survey of Current SART Practices. Fertil Steril 2017;107:1003–11.

6. Practice Committee of the American Society for Reproductive Medicine. Per-forming the embryo transfer: a guideline. Fertil Steril 2017;107:882–96.

7. Leotsakos A, Zheng H, Croteau R, Loeb JM, Sherman H, Hoffman C, et al.Standardization in patient safety: the WHO High 5s project. Int J Qual HealthCare 2014;26:109–16.

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http://refhub.elsevier.com/S0015-0282(17)30228-5/sref1http://refhub.elsevier.com/S0015-0282(17)30228-5/sref1http://refhub.elsevier.com/S0015-0282(17)30228-5/sref1http://refhub.elsevier.com/S0015-0282(17)30228-5/sref1http://refhub.elsevier.com/S0015-0282(17)30228-5/sref2http://refhub.elsevier.com/S0015-0282(17)30228-5/sref2http://refhub.elsevier.com/S0015-0282(17)30228-5/sref2http://refhub.elsevier.com/S0015-0282(17)30228-5/sref3http://refhub.elsevier.com/S0015-0282(17)30228-5/sref3http://refhub.elsevier.com/S0015-0282(17)30228-5/sref3http://refhub.elsevier.com/S0015-0282(17)30228-5/sref3http://refhub.elsevier.com/S0015-0282(17)30228-5/sref3http://refhub.elsevier.com/S0015-0282(17)30228-5/sref3http://refhub.elsevier.com/S0015-0282(17)30228-5/sref4http://refhub.elsevier.com/S0015-0282(17)30228-5/sref4http://refhub.elsevier.com/S0015-0282(17)30228-5/sref4http://refhub.elsevier.com/S0015-0282(17)30228-5/sref4http://refhub.elsevier.com/S0015-0282(17)30228-5/sref5http://refhub.elsevier.com/S0015-0282(17)30228-5/sref5http://refhub.elsevier.com/S0015-0282(17)30228-5/sref6http://refhub.elsevier.com/S0015-0282(17)30228-5/sref6http://refhub.elsevier.com/S0015-0282(17)30228-5/sref7http://refhub.elsevier.com/S0015-0282(17)30228-5/sref7http://refhub.elsevier.com/S0015-0282(17)30228-5/sref7mailto:Image of Figure 1|eps

ASRM standard embryo transfer protocol template: a committee opinionAcknowledgmentsReferences