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      Does the Presence of Blood in the Catheter or the Degree of Difficulty of Embryo Transfer Affect Live Birth?

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          The technique used for embryo transfer (ET) can affect implantation. Prior research that evaluated the effect of postprocedural blood of the transfer catheter tip have yielded mixed results, and it is unclear whether this is actually a marker of difficulty of the transfer. Our objective was to estimate the effect of blood at the time of ET and the difficulty of ET on live birth rates (LBR). This retrospective cohort study utilized generalized estimating equations (GEEs) with nesting for repeated cycles for all analyses. Univariate modeling was performed and a final multivariate (adjusted) GEE model accounted for all significant confounders. Embryo transfers were subjectively graded (easy, medium, or hard) by a physician at the time of transfer. The presence of blood at ET was associated with more difficult ETs, retained embryos, and presence of mucous in the catheter. In the univariate analysis, ET with blood was not associated with live birth, while the degree of difficulty for ET had a negative impact on LBR. In the final multivariate GEE model, which accounts for repeated cycles from a patient, the only factors associated with an increased LBR were the degree of difficulty of the ET, female age, and blastocyst transfer. After controlling for confounding variables, the presence of blood in the transfer catheter was not associated with the likelihood of pregnancy and thus was not an independent predictor of cycle outcome. This indicates that the difficulty of the transfer itself was a strong negative predictor of pregnancy.

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          Author and article information

          Reprod Sci
          Reprod Sci
          Reproductive Sciences
          SAGE Publications (Sage CA: Los Angeles, CA )
          21 September 2016
          May 2017
          : 24
          : 5
          : 726-730
          [1 ]Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver NICHD, National Institutes of Health, Bethesda, MD, USA
          [2 ]Walter Reed National Military Medical Center, Bethesda, MD, USA
          [3 ]Uniformed Services University, Bethesda, MD, USA
          [4 ]Johns Hopkins Department of Gynecology and Obstetrics, Baltimore, MD, USA
          Author notes
          Torie C. Plowden, Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver NICHD, National Institutes of Health, 10 Center Dr, Bethesda, MD 20892, USA. Email: torie.plowden@ 123456nih.gov
          PMC5933179 PMC5933179 5933179 10.1177_1933719116667607
          © The Author(s) 2016
          Original Articles


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