title: Embryo transfer techniques: an American Society for Reproductive Medicine survey of current Society for Assisted Reproductive Technology practices.
abstract: To better understand practice patterns and opportunities for standardization of ET.
  
  
  
  Cross-sectional survey.
  
  
  
  Not applicable.
  
  
  
  Not applicable.
  
  
  
  An anonymous 82-question survey was emailed to the medical directors of 286 Society for Assisted Reproductive Technology member IVF practices. A follow-up survey composed of three questions specific to ET technique was emailed to the same medical directors. Descriptive statistics of the results were compiled.
  
  
  
  The survey assessed policies, protocols, restrictions, and specifics pertinent to the technique of ET.
  
  
  
  There were 117 (41%) responses; 32% practice in academic settings and 68% in private practice. Responders were experienced clinicians, half of whom had performed <10 procedures during training. Ninety-eight percent of practices allowed all practitioners to perform ET; half did not follow a standardized ET technique. Multiple steps in the ET process were identified as "highly conserved;" others demonstrated discordance. ET technique is divided among [1] trial transfer followed immediately with ET (40%); [2] afterload transfer (30%); and [3] direct transfer without prior trial or afterload (27%). Embryos are discharged in the upper (66%) and middle thirds (29%) of the endometrial cavity and not closer than 1-1.5 cm from fundus (87%). Details of each step were reported and allowed the development of a "common" practice ET procedure.
  
  
  
  ET training and practices vary widely. Improved training and standardization based on outcomes data and best practices are warranted. A common practice procedure is suggested for validation by a systematic literature review.
authors.affiliation: Vincent Reproductive Medicine and IVF, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: TLTOTH@partners.org.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Toth
authors.affiliation: Vincent Reproductive Medicine and IVF, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Malinda S
authors.initials: MS
authors.lastname: Lee
authors.affiliation: USC Fertility, University of Southern California, Los Angeles, California.
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Bendikson
authors.affiliation: University of Alabama, Birmingham, Alabama.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Reindollar
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004624:Embryo Transfer / Q000009:adverse effects / Q000592:standards / Q000639:trends*; D005260:Female; D005298:Fertility; D005307:Fertilization in Vitro; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000592:standards / Q000639:trends*; D006801:Humans; D007246:Infertility / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D059032:Learning Curve; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends*; D011247:Pregnancy; D016896:Treatment Outcome; D014481:United States
keywords: Embryo transfer; in vitro fertilization; survey