title: Large randomized trial comparing transabdominal ultrasound-guided embryo transfer with a technique based on uterine length measurement before embryo transfer.
abstract: OBJECTIVE
  To compare in a randomized, non-inferiority trial the embryo transfer (ET) technique based on uterine length measurement before transfer (ULMbET) with transabdominal ultrasound-guided embryo transfer (TA-UGET) in a large population of patients undergoing in-vitro fertilization (IVF).
  
  
  METHODS
  Patients undergoing IVF with ET with cleaving fresh embryos were randomized to receive ULMbET or TA-UGET. The transfer of one to three embryos on day 2-3 of culture was performed using a soft catheter either under transabdominal ultrasound guidance (TA-UGET group) or after measurement of the uterine cavity by transvaginal ultrasound and calculation of the discharge site (ULMbET group). The primary outcome measures were clinical pregnancy rate, ongoing pregnancy rate and implantation rate, and secondary outcomes included patient discomfort during ET.
  
  
  RESULTS
  A total of 1648 patients undergoing IVF were randomized to receive ULMbET (n = 828) or TA-UGET (n = 820) and were included in the analysis. Comparable clinical pregnancy rate (38.2% vs 38.9%), implantation rate (24.8% vs 25.2%) and ongoing pregnancy rate (33.1% vs 34.8%) were observed in ULMbET and TA-UGET groups. The discomfort intensity score and the proportion of patients with moderate-to-severe discomfort during ET were significantly higher in the TA-UGET group (2.6 vs 1.5 visual analog scale points and 19.8% vs 1.2%; P = 0.045 and P = 0.003, respectively).
  
  
  CONCLUSIONS
  The ULMbET technique leads to IVF results comparable to those obtained with UGET, but is better tolerated than is TA-UGET and is technically easier to perform for a single operator. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Sant'Anna Hospital, University of Turin, Turin, Italy. alberto.revelli@unito.it.
authors.forename: A
authors.initials: A
authors.lastname: Revelli
authors.affiliation: Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Sant'Anna Hospital, University of Turin, Turin, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Rovei
authors.affiliation: Medical Statistics Unit, Department of Public Health and Microbiology, Città della Salute e della Scienza, University of Turin, Turin, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Dalmasso
authors.affiliation: Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Sant'Anna Hospital, University of Turin, Turin, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Gennarelli
authors.affiliation: Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Sant'Anna Hospital, University of Turin, Turin, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Racca
authors.affiliation: Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Sant'Anna Hospital, University of Turin, Turin, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Evangelista
authors.affiliation: Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Sant'Anna Hospital, University of Turin, Turin, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Benedetto
mesh_terms: D000328:Adult; D010064:Embryo Implantation; D004624:Embryo Transfer / Q000379:methods*; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D006801:Humans; D011247:Pregnancy; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014599:Uterus / Q000000981:diagnostic imaging* / Q000473:pathology
keywords: in-vitro fertilization; in-vitro fertilization outcome; ultrasound-guided embryo transfer