There is no doubt that the technique of embryo transfer, although apparently a simple and straightforward procedure, is absolutely critical in safe delivery of the embryos to the site of their potential implantation (Figure 5.8). Studies repeatedly show that pregnancy rates can vary in the hands of different operators, and with the use of different embryo transfer catheters. In a study of embryo transfer procedures under ultrasound-guided control, Woolcott and Stanger (1998) observed guiding cannula and transfer catheter placement in relation to the endometrial surface and uterine fundus during embryo transfer: their results indicated that tactile assessment of embryo transfer catheter was unreliable, in that the cannula and the catheter could be seen to abut the fundal endometrium, and indent or embed in the endometrium in a significant number of cases. Endometrial movement due to sub-endometrial myometrial contraction was obvious in 36% of cases, and this movement was associated with a reduced pregnancy rate. Their studies highlight the fact that 'blind' ET procedures may often lead to an unsatisfactory outcome, and they recommend the use of ultrasound guidance as a routine during ET. Historically,
patients remained supine for several hours after ET, sometimes with legs elevated. An additional part of the above study examined fluid/air bubble movement within the uterus when the patient was asked to stand up immediately after the procedure. Repeat ultrasound examination showed that standing up immediately had no effect on embryo movement within the uterus, reinforcing the idea that bed rest following ET is unnecessary.
/3-HCG levels can be monitored at five-day intervals after a positive day 15 test; sub-optimal levels suggest the presence of an ectopic gestation or blighted ovum, and the patient is advised to return for vaginal ultrasound scan. If /J-HCG levels are within the normal expected range, ultrasound scan is carried out on day 35 to confirm the presence of (hopefully) a single intrauterine gestation sac with visible fetal heartbeat.
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Whenever a doctor informs the parents that their child is suffering with Autism, the first & foremost question that is thrown over him is - How did it happen? How did my child get this disease? Well, there is no definite answer to what are the exact causes of Autism.