• Alejandro Kava-Braverman, Francisca Martínez, Ignacio Rodríguez, Manuel Álvarez, Pedro N Barri, and Buenaventura Coroleu.
• Servicio de Medicina de la Reproducción, Department of Obstetrics, Gynecology and Reproduction, Hospital Universitario Dexeus, Barcelona, Spain. Electronic address: alexkava@gmail.com.
• Fertil. Steril. 2017 Mar 1; 107 (3): 657-663.e1.

ObjectiveTo establish the relationship between the degree of difficulty of ET and pregnancy rate (PR), with a view to proposing an algorithm for the objective assessment of ET.DesignRetrospective, observational study.SettingIn vitro fertilization unit.Patient(S)Women undergoing assisted reproductive technology (ART) with ET after IVF/intracytoplasmic sperm injection, in whom fresh embryo transfer or frozen-thawed embryo transfer was performed.Intervention(S)None.Main Outcome Measure(S)Clinical pregnancy rate (CPR).Result(S)A total of 7,714 ETs were analyzed. The CPR was significantly higher in the cases of easy ET compared with difficult ET (38.2% vs. 27.1%). Each instrumentation needed to successfully deposit the embryos in the fundus involves a progressive reduction in the CPR: use of outer catheter sheath (odds ratio [OR] 0.89; 95% confidence interval [CI] 0.79-1.01), use of Wallace stylet (OR 0.71; 95% CI 0.62-0.81), use of tenaculum (OR 0.54; 95% CI 0.36-0.79). Poor ultrasound visualization significantly diminish the CPR.Conclusion(S)The CPR decreases progressively with the use of additional maneuvers during ET. An objective classification of the instrumentation applied during ET is proposed.Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

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