The use of an embryo transfer simulator to compare transfer techniques and pregnancy outcomes among physicians

Objective: To evaluate the association between embryo transfer technique and pregnancy outcome.Design: Prospective observational with retrospective cohort Subjects: Physicians performing embryo transfer and patients undergoing embryo transfers between 2015-2020.Intervention/Exposures(s): Fourteen physicians performed 25 mock embryo transfers on the embryo transfer simulator and completed a questionnaire assessing preferred embryo transfer techniques.Quantitative performance metrics on the embryo transfer simulator were measured.Individual physician embryo transfer success rates were retrospectively collected from all fresh and cryopreserved embryo transfers between 1/2015 and 1/2020.Associations between embryo transfer technique (preferred technique and simulator performance metrics) and each physician's historical patient pregnancy outcomes were assessed. Main Outcome Measure(s): Association between embryo transfer technique and live birth.Results: There were significant differences in embryo transfer technique between physicians, including touches to fundus, distance to fundus, duration of embryo transfer, duration of complete procedure, time spent navigating cervical canal, velocity of embryo expulsion, time waited after embryo expulsion and total score on embryo transfer simulator.After controlling for confounders and multiple transfers per physician, the duration of embryo transfer was significantly associated with live birth, with longer durations associated with decreased live birth rates.Shorter placement distance to fundus and higher velocity of embryo expulsion were both significantly associated with higher rates of ectopic pregnancy. J o u r n a l P r e -p r o o fConclusions: This study revealed significant differences between physicians in transfer technique.Use of the embryo transfer simulator for physicians in practice can elucidate differences and create opportunity for data driven improvement in embryo transfer success rates.