Among women undergoing embryo transfer, is the probability of pregnancy and live birth improved with ultrasound guidance over clinical touch alone? A systemic review and meta-analysis of prospective randomized trials.

Objective: To investigate the theory that ultrasound guidance during ET improves clinical outcomes.

Design: Systematic review of prospective, randomized, controlled trials comparing ultrasound with clinical touch methods of embryo catheter guidance.

Setting: Infertility centers.

Patient(s): 5,968 ET cycles in women.

Intervention(s): Embryo transfer with or without ultrasound guidance.

Main Outcome Measure(s): Meticulous electronic (e.g., PubMed, EMBASE, CENTRAL) and hand searches were performed to locate trials. Primary outcome measures were the live-birth, ongoing pregnancy, and clinical pregnancy rates. Secondary outcome measures were the implantation, multiple pregnancies, and miscarriage rates. In addition, the incidences of ectopic pregnancies and difficult transfers were evaluated.

Result(s): Twenty-five studies were retrieved, of which five were excluded. Meta-analysis of the remaining studies (5,968 ET cycles in women) was conducted by using the Mantel-Haenszel method (fixed-effect model). There was a significantly increased chance of a live birth (odds ratio [OR] = 1.78, 95% confidence interval [CI] = 1.19 to 2.67), ongoing pregnancy (OR = 1.51, 95% CI = 1.31 to 1.74), clinical pregnancy (OR = 1.50, 95% CI = 1.34 to 1.67), embryo implantation (OR = 1.35, 95% CI = 1.22 to 1.50), and easy transfer rates after ultrasound guidance (OR = 0.68, 95% CI = 0.58 to 0.81). There was no difference in multiple pregnancy, ectopic pregnancy, or miscarriage rates.

Conclusion(s): Ultrasound-guided ET significantly increases the chance of live birth and ongoing and clinical pregnancy rates compared with the clinical touch method.