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;107:897900.2017 by American Society for Reproductive
Medicine.)
Discuss: You can discuss this article with its authors and with
other ASRM members at
https://www.fertstertdialog.com/users/16110-fertility-and-sterility/posts/15158-23913
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 (14).
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
VOL. 107 NO. 4 / APRIL 2017
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 [email protected]).
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.
897
https://www.fertstertdialog.com/users/16110-fertility-and-sterility/posts/15158-23913https://www.fertstertdialog.com/users/16110-fertility-and-sterility/posts/15158-23913mailto:[email protected]://dx.doi.org/10.1016/j.fertnstert.2017.02.108http://crossmark.crossref.org/dialog/?doi=10.1016/j.fertnstert.2017.02.108&domain=pdf
FIGURE 1 Continued
print&
web4C=FPO
ASRM. Embryo transfer protocol template. Fertil Steril 2017.
ASRM PAGES
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.;
900
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;23:32932.
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;74:806.
3. Karande VC, Morris R, Chapman C, Rinehart J, Gleicher N.
Impact of thephysician factor on pregnancy rates in a large
assisted reproductive tech-nology program: do too many cooks spoil
the broth? Fertil Steril 1999;71:10019.
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;107:100311.
6. Practice Committee of the American Society for Reproductive
Medicine. Per-forming the embryo transfer: a guideline. Fertil
Steril 2017;107:88296.
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;26:10916.
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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|epsASRM standard embryo transfer protocol template: a
committee opinionAcknowledgmentsReferences
