title: Embryo transfer by reproductive endocrinology fellows vs attending physicians: are live birth rates comparable?
abstract: OBJECTIVE
  To compare live birth rates following ultrasound-guided embryo transfer (ET) by reproductive endocrinology and infertility fellows versus attending physicians.
  
  
  METHODS
  Women who underwent their first day-3, fresh, nondonor ET between Oct. 1, 2005, and April 1, 2011, at our academic center were included in this retrospective cohort study. Embryos were designated high quality if they had 8 cells, less than 10% fragmentation, and no asymmetry. ET was performed with the afterload technique under ultrasound guidance. Categorical variables were evaluated with the χ(2) test and continuous variables with the Student t test. Logistic regression was performed to assess the relationship between ET physician and live birth rate while adjusting for potential confounders.
  
  
  RESULTS
  Seven hundred sixty women underwent ET by an attending physician, and 104 by a fellow. Baseline characteristics were similar between the groups. The live birth rate was 31% following ET by an attending physician, compared with 34% following ET by a fellow (P = .65). Logistic regression adjusting for potential confounders demonstrated no significant association between ET physician and live birth rate.
  
  
  CONCLUSIONS
  This retrospective study demonstrated no significant difference in live birth rates following ultrasound-guided ET by fellows vs attending physicians at our institution. These data suggest that academic practices using the afterload method and ultrasound guidance can train fellows to perform ET without compromising success rates.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University School of Medicine, Chicago, IL. Electronic address: jennifer.eaton@duke.edu.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Eaton
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University School of Medicine, Chicago, IL.
authors.forename: Xingqi
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University School of Medicine, Chicago, IL.
authors.forename: Randall B
authors.initials: RB
authors.lastname: Barnes
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004624:Embryo Transfer / Q000379:methods*; D005257:Fellowships and Scholarships; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007246:Infertility / Q000628:therapy*; D050498:Live Birth; D016015:Logistic Models; D008503:Medical Staff; D011247:Pregnancy; D018873:Pregnancy Rate; D018456:Reproductive Medicine / Q000193:education; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: assisted reproductive technology; embryo transfer; in vitro fertilization