The effect of embryo transfer using abdominal and vaginal ultrasound methods on pregnancy outcome: a retrospective cohort study

Document Type : Original Article


1 Fellowship of Infertility, Research Development Center, Mahdiyeh Educational Hospital, Faculty of Medicine, Shahid Beheshti University Medical Science, Tehran, Iran.

2 Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

3 Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.


Introduction: Abdominal ultrasound (TAUS) and transvaginal ultrasound (TVUS) are used in IVF/ICSI methods to transfer the embryo into the uterine cavity. Since these methods have limitations, the present study was conducted with aim to compare them and their effect on pregnancy outcome.
Methods: This retrospective cohort study was conducted in 2018-2022 on 522 intracytoplasmic sperm injection cycles in the Fertility Unit of Mahdieh Hospital in Tehran. After reviewing the files, the patients were divided into two groups of embryo transfer with transvaginal and abdominal ultrasound. After collecting demographic information, pregnancy outcomes including chemical pregnancy and clinical pregnancy, abortion under 10 weeks, ectopic pregnancy and the duration of embryo transfer were compared in the two groups. Data analysis was done using SPSS statistical software (version 26) and Mann-Whitney and Pearson Chi-square tests. P<0.05 was considered significant.
Results: The frequency of chemical and clinical pregnancy and abortion was higher in the TAUS group, however, the incidence of EP was higher in the TVUS group (p>0.05). Also, the duration of embryo transfer using TAUS was longer compared to TVUS, but it was not statistically significant (p>0.05). The number of transferred embryos was equal in both groups, but the number of 5-day embryos was higher in the TAUS group, which was statistically significant (p<0.05).
Conclusion: There was no difference between abdominal ultrasound and transvaginal ultrasound in terms of pregnancy outcomes.


Main Subjects

  1. Miyamoto T, Minase G, Shin T, Ueda H, Okada H, Sengoku K. Human male infertility and its genetic causes. Reproductive medicine and biology 2017; 16(2):81-8.
  2. Eisenberg ML, Esteves SC, Lamb DJ, Hotaling JM, Giwercman A, Hwang K, Cheng YS. Male infertility. Nature Reviews Disease Primers 2023; 9(1):49.
  3. Feizollahi N, Zayeri ZD, Moradi N, Zargar M, Rezaeeyan H. The effect of coagulation factors polymorphisms on abortion. Frontiers in Biology 2018; 13:190-6.
  4. Nosrati R, Graham PJ, Zhang B, Riordon J, Lagunov A, Hannam TG, et al. Microfluidics for sperm analysis and selection. Nature Reviews Urology 2017; 14(12):707-30.
  5. Lehmann P, Vélez MP, Saumet J, Lapensée L, Jamal W, Bissonnette F, et al. Anti-Müllerian hormone (AMH): a reliable biomarker of oocyte quality in IVF. Journal of assisted reproduction and genetics 2014; 31:493-8.
  6. Saravelos SH, Wong AW, Kong GW, Huang J, Klitzman R, Li TC. Pain during embryo transfer is independently associated with clinical pregnancy in fresh/frozen assisted reproductive technology cycles. Journal of Obstetrics and Gynaecology Research 2016; 42(6):684-93.
  7. Larue L, Keromnes G, Massari A, Roche C, Moulin J, Gronier H, et al. Transvaginal ultrasound-guided embryo transfer in IVF. Journal of gynecology obstetrics and human reproduction 2017; 46(5):411-6.
  8. Tran HP, Tran TT, Le LT, Pham BT, Vu SN, Ly LT, et al. The impact of an endometrial receptivity array on personalizing embryo transfer for patients with infertility: a meta-analysis. F&S Reviews 2022; 3(3):157-73.
  9. Kosmas IP, Janssens R, De Munck L, Al Turki H, Van der Elst J, Tournaye H, et al. Ultrasound-guided embryo transfer does not offer any benefit in clinical outcome: a randomized controlled trial. Human Reproduction 2007; 22(5):1327-34.
  10. Anderson RE, Nugent NL, Gregg AT, Nunn SL, Behr BR. Transvaginal ultrasound-guided embryo transfer improves outcome in patients with previous failed in vitro fertilization cycles. Fertility and sterility 2002; 77(4):769-75.
  11. Wageh A, Abdelhafez MS, Shams M. Transvaginal sonography (TVS) guided versus transabdominal sonography (TAS) guided embryo transfer: A retrospective analysis. Middle East Fertility Society Journal 2018; 23(4):431-4.
  12. Karavani G, Ben-Meir A, Shufaro Y, Hyman JH, Revel A. Transvaginal ultrasound to guide embryo transfer: a randomized controlled trial. Fertility and Sterility 2017; 107(5):1159-65.
  13. Mohamed Hassan S, Ramadan W, Elsharkawy M, Ali Bayoumi Y. The role of Transvaginal ultrasound guided embryo transfer to improve pregnancy rate in obese patients undergoing Intracytoplasmic sperm injection. International journal of women's health 2021: 861-7.
  14. Jha B, Singh P. P-315 To study the efficacy of Transvaginal ultrasound-guided Embryo Transfer over Transabdominal ultrasound-guided Embryo Transfer in transfers with poor visibility due to obesity or marked retroversion. Human Reproduction 2023; 38(Supplement_1):dead093-673.
  15. Kavrut M, Sagir FG, Atayurt Z. Large-scale retrospective analysis of methodological factors affecting pregnancy rates after embryo transfer for in vitro fertilization. Medicine 2023; 102(36):e35146.
  16. Nakano R, Radaelli MR, Fujihara LS, Yoshinaga F, Nakano E, Almodin CG. Efficacy of a modified transvaginal ultrasound-guided fresh embryo transfer procedure. JBRA Assisted Reproduction 2022; 26(1):78-83.
  17. Zhang HX, Li F, Jin H, Song WY, Su Y, Li G. Effect of retained embryos on pregnancy outcomes of in vitro fertilization: a matched retrospective cohort study. BMC Pregnancy and Childbirth 2023; 23(1):5.
  18. Deen Hamouda MS, El Halwagy AE, Gergawy E, El Shahat A, El Khyat AM, Mohamed AM. Trans Vaginal Versus Trans Abdominal Ultrasound Guided Embryo Transfer in In vitro Fertilization and Intra Cytoplasmic Sperm Injection (IVF–ICSI). Journal of Advances in Medicine and Medical Research 2021; 33(23):145-52.
  19. Samy AA, El-Kassar YS, Gaafar SS, Hamza HA, Menshawi SS. Comparison between transvaginal and transabdominal ultrasound-guided embryo transfer: A randomized, prospective trial. Menoufia Medical Journal 2020; 33(2):419.
  20. Tiras B, Polat M, Korucuoglu U, Zeyneloglu HB, Yarali H. Impact of embryo replacement depth on in vitro fertilization and embryo transfer outcomes. Fertility and sterility 2010; 94(4):1341-5.
  21. Zhu W, Yeung Q, Chan D, Chi L, Huang J, Wang Q, et al. Maternal β-HCG concentrations in early IVF pregnancy: association with the embryo development stage of blastocysts. Reproductive BioMedicine Online 2019; 38(5):683-90.
  22. Demirdağ E, Güler İ, Akdulum MF, Şahin E, Tufan AD, Erdem A, et al. Comparison of natural and artificial cycles in frozen-thawed embryo transfer: A retrospective analysis of 1696 cycles. Turkish Journal of Obstetrics and Gynecology 2022; 19(1):28-34.