Registration is open for the 2024 ASRM Scientific Congress & Expo

Menu
Close Close Icon

ASRM standard embryo transfer protocol template: a committee opinion (2017)


The 2014 to 2019 American Society for Reproductive Medicine (ASRM) Strategic Plan is focused on seven goals. Two of those goals are:1) setting new standards in the continuing medical education of, and, 2) having maximal impact on reproductive medicine. In response to accumulating evidence that suggested a gap in clinician training and standardization of the embryo transfer procedure, ASRM presents the results of an embryo transfer initiative in this issue of Fertility and Sterility. Prior reports have suggested that the majority of fellows in reproductive endocrinology and infertility training perform very few, if any, embryo transfers. In addition, studies have consistently demonstrated that in vitro fertilization (IVF) pregnancy rates vary by the clinician performing the transfer (1–4).

ASRM formed an Embryo Transfer Advisory Panel to move this initiative forward. The panel collaborated with a leading medical simulation company, VirtaMed, to develop a virtual realitybased simulator for training in embryo transfer and intrauterine inseminations. The panel also developed an extensive 82-question survey that was sent to all Society for Assisted Reproductive Technology (SART) medical directors and was completed by 41% of them. The results of that survey are summarized in this issue in the article titled, ‘‘Embryo transfer techniques: an ASRM survey of current SART practices’’ (5). Survey results were used to guide the development of the embryo transfer simulator and to determine common practices around embryo transfer. The results were also used to develop a ‘‘common practice’’ document that allows clinicians to review all of the steps of the embryo transfer procedure and better understand common practice. The survey article can be used to identify variations in clinical practice and potential areas for change.

As part of the embryo transfer initiative, a subset of the Embryo Transfer Advisory Panel served as a special task force of the ASRM Practice Committee to perform a systematic review of the literature around the major steps of the embryo transfer procedure. The goal of this work was to identify those parts of the embryo transfer procedure that are supported by the literature as well as gaps in research for which the literature is unable to provide guidance. A new ASRM guideline, ‘‘Performing the embryo transfer: a guideline,’’ summarizes the findings of that extensive review and is also published in this issue (6).

Figure 1 combines the findings of both the systematic review of the literature and the embryo transfer survey of SART medical directors. In Figure 1 are 12 basic steps of the embryo transfer protocol adopted by the ASRM Practice Committee. A number of the steps are supported by evidence in the literature and the new ASRM guideline on performing the embryo transfer (6). For those steps not supported by the literature, data from the survey demonstrate common practice. While there are acceptable variations around some of the steps included here and the names given to some of the proceduresmay differ locally, the purpose is to fill a need for standardization. Literature on quality and safety is filled with evidence that standardization improves performance and safety (7). The embryo transfer survey paper demonstrates that only 50% of SART practices responding had a standard embryo transfer protocol for all of their clinicians to follow. The ASRM Standard Embryo Transfer Protocol Template provides associated evidence for all practices to use tomodel their ownstandard protocol.

Figure 1


Figure-1-ASRM-standard-embryo-transfer-protocol-template.jpg

Figure 1 continued


Figure-2-ASRM-standard-embryo-transfer-protocol-template.jpg

Figure 1 continued


Figure-3-ASRM-standard-embryo-transfer-protocol-template.jpg

Acknowledgments:

This report was developed under the direction of the Practice Committee of the American Society for Reproductive Medicine as a service to its members and other practicing clinicians. Although this document reflects appropriate management of a problem encountered in the practice of reproductive medicine, it is not intended to be the only approved standard of practice or to dictate an exclusive course of treatment. Other plans of management may be appropriate, taking into account the needs of the individual patient, available resources, and institutional or clinical practice limitations. The Practice Committee and the Board of Directors of the American Society for Reproductive Medicine have approved this report.

This document was reviewed by ASRM members and their input was considered in the preparation of the final document. The following members of the ASRM Practice Committee participated in the development of this document. All committee members disclosed commercial and financial relationships with manufacturers or distributors of goods or services used to treat patients. Members of the committee who were found to have conflicts of interest based on the relationships disclosed did not participate in the discussion or development of this document.

Alan Penzias, M.D.; Kristin Bendikson, M.D.; Samantha Butts, M.D., M.S.C.E.; Christos Coutifaris, M.D.; Tommaso Falcone, M.D.; Gregory Fossum, M.D.; Susan Gitlin, Ph.D.; Clarisa Gracia, M.D., M.S.C.E.; Karl Hansen, M.D., Ph.D.; Jennifer Mersereau, M.D.; Randall Odem, M.D.; Robert Rebar, M.D.; Richard Reindollar, M.D.; Mitchell Rosen, M.D.; Jay Sandlow, M.D.; Michael Vernon, Ph.D.

REFERENCES

  1. Angelini A, Brusco GF, Barnocchi N, El-Danasouri I, Pacchiarotti A, Selman HA. Impact of physician performing embryo transfer on pregnancy rates in an assisted reproductive program. J Assist Reprod Genet 2006;23:329–32.
  2. Hearns-Stokes RM, Miller BT, Scott L, Creuss D, Chakraborty PK, Segars JH. Pregnancy rates after embryo transfer depend on the provider at embryo transfer. Fertil Steril 2000;74:80–6.
  3. Karande VC, Morris R, Chapman C, Rinehart J, Gleicher N. Impact of the ‘‘physician factor’’ on pregnancy rates in a large assisted reproductive technology program: do too many cooks spoil the broth? Fertil Steril 1999;71:1001–9.
  4. Morin SJ, Franasiak JM, Juneau CR, Scott RT. O-63 Live birth rate following embryo transfer is significantly influenced by the physician performing the transfer: data from 2707 euploid blastocyst transfers by 11 physicians. Fertil Steril 2016;106:e25.
  5. Toth TL, Lee MS, Bendikson KA, Reindollar RH. Embryo transfer techniques: An ASRM Survey of Current SART Practices. Fertil Steril 2017;107:1003–11.
  6. Practice Committee of the American Society for Reproductive Medicine. Performing the embryo transfer: a guideline. Fertil Steril 2017;107:882–96.
  7. Leotsakos A, Zheng H, Croteau R, Loeb JM, Sherman H, Hoffman C, et al. Standardization in patient safety: the WHO High 5s project. Int J Qual Health Care 2014;26:109–16.

Practice Documents

ASRM Practice Documents have been developed to assist physicians with clinical decisions regarding the care of their patients.
Practice Committee Documents teaser

Current evaluation of amenorrhea: a committee opinion (2024)

Amenorrhea is the absence or abnormal cessation of the menses.
Practice Committee Documents teaser

Inclusive language and environment to welcome lesbian, gay, bisexual, transgender, queer, questioning, intersex, and asexual+ patients (2024)

Creating an inclusive clinical environment to serve lesbian, gay, bisexual, transgender, queer, questioning, intersex, and asexual+ patients is vital.
Practice Committee Documents teaser

Subclinical hypothyroidism in the infertile female population: a guideline (2024)

This guideline reviews the risks and benefits of treating subclinical hypothyroidism in female patients with a history of infertility and miscarriage.
Practice Committee Documents teaser

Tobacco or marijuana use and infertility: a committee opinion (2023)

In the United States, approximately 21% of adults report some form of tobacco use, although 18% report marijuana use.

More Resources

MAC 2021 teaser
ASRM Academy on the Go

ASRM MAC Tool 2021

The ASRM Müllerian Anomaly Classification 2021 (MAC2021) includes cervical and vaginal anomalies and standardize terminology within an interactive tool format.

View the MAC Tool
EMR Phrases teaser
Practice Guidance

EMR Shared Phrases/Template Library

This resource includes phrases shared by ASRM physician members to provide a template for individuals to create their own EMR phrases.

View the library
Practice Committee Documents teaser

ASRM Practice Documents

These guidelines have been developed by the ASRM Practice Committee to assist physicians with clinical decisions regarding the care of their patients.

View ASRM Practice Documents
Ethics Committee teaser

ASRM Ethics Opinions

Ethics Committee Reports are drafted by the members of the ASRM Ethics Committee on the tough ethical dilemmas of reproductive medicine.

View ASRM Ethics Opinions
Coding Corner general teaser
Practice Guidance

Coding Corner Q & A

The Coding Corner Q & A is a list of previously submitted and answered questions from ASRM members about coding. Answers are available to ASRM Members only.

View the Q & A
Covid-19 teaser
Practice Guidance

COVID-19 Resources

A compendium of ASRM resources concerning the Novel Corona virus (SARS-COV-2) and COVID-19.

View the resources
Couple looking at laptop for online patient education materials

Patient Resources

ReproductiveFacts.org provides a wide range of information related to reproductive health and infertility through patient education fact sheets, infographics, videos, and other resources.

View Website

Topic Resources

View more on the topic of embryo transfer
Podcast Icon

Fertility and Sterility On Air - TOC: June 2024

Covering articles on embryo transfer, PIEZO-ICSI, pregnancy outcomes, oocyte maturity, estradiol levels, and ovarian carcinoma and more! Listen to the Episode
Podcast Icon

Fertility and Sterility On Air - TOC: May 2024

Topics this month include Iatrogenic and demographic determinants of the national plural birth increase, outcomes between ICSI and IVF with PGT-A. Listen to the Episode
Coding Icon

Coding for an endometrial biopsy/Mock cycle

We had patients request us to bill their insurance for the two monitoring visits and the Endo BX and change the diagnosis code to something that is payable.  View the Answer
PR Bulletin Icon

IVF-assisted pregnancies constitute 2.5% of all births in 2022

In 2022, the number of babies born from IVF increased from 89,208 in 2021 to 91,771 in 2022. This means that 2.5% of births in the US are a result of ART.

View the Press Release
PR Bulletin Icon

ASRM provides testimony to Senate Judiciary Committee on threats facing IVF

ASRM shared with the Senate Judiciary Committee the dangers to reproductive medicine nearly two years after the Dobbs decision.

View the Press Release
Videos Icon

Journal Club Global - Actualización en la suplementación con progesterona en fase lútea para transferencias de embriones congelados

Efectividad del rescate de progesterona en mujeres que presentan niveles bajos de progesterona circulante alrededor del día de la transferencia de embriones View the Video
Videos Icon

Journal Club Global: Transferencia de embriones frescos versus congelados: ¿Cuál es la mejor opción

Los resultados de nuevas técnicas de investigación clínica que utilizan información de bancos nacionales de vigilancia médica.   View the Video
Coding Icon

US Embryo Transfer

At the meeting, we learned about the CPT code 76705-Ultasound guidance for embryo transfer, can this code be billed with CPT code 76942? View the Answer
Coding Icon

US Embryo Transfer in Surgery Center

Can we use code 76998 for the ultrasound guidance as this patient is being seen in the Surgery Center? View the Answer
Coding Icon

US Embryo Transfer-Transmyometrial

How would you code for an ultrasound- guided transvaginal-transmyometrial test transfer of embryo catheter? View the Answer
Coding Icon

CPT 89253 and 89254 for Assisted hatching

Can I bill CPT codes 89253 and 89254 together? If yes, do I need a modifier on any of the codes? View the Answer
Coding Icon

Trial Transfer

Can you advise the proper coding process for a trial transfer? View the Answer
Coding Icon

IVF Case Rates

What ICD-10 codes apply to case rates? View the Answer
Coding Icon

IVF Lab vs Physician Practice Billing

We are planning to open an IVF lab that is not contracted with insurance companies. View the Answer
Coding Icon

Monitoring FET

What is the correct diagnosis code to use on the follicle ultrasound (76857) for a patient who is undergoing frozen embryo transfer (FET)? View the Answer
Coding Icon

In Vitro Maturation

Have CPT codes been established for maturation in vitro? View the Answer
Coding Icon

Endometrial Biopsy/Scratch

What CPT code should be used for a “scratch test”?  View the Answer
Coding Icon

Embryo Thawing/Warming

Is it allowable to bill 89250 for the culture of embryos after thaw for a frozen embryo transfer (FET) cycle? View the Answer
Coding Icon

D&C Under Ultrasound Guidance

What are the CPT codes and ICD-10 codes for coding a surgical case for a patient with history of Stage B adenocarcinoma of the cervix ... View the Answer
Coding Icon

Elective Single Embryo Transfer

Has any progress been made in creating/obtaining a specific CPT code for an elective single embryo transfer (eSET)?  View the Answer
Coding Icon

Assisted Hatching Billed With Embryo Biopsy

Do you know if both assisted hatching (89253) and embryo biopsy for PGS/PGD/CCS (89290/89291) can be billed during the same cycle?  View the Answer
Coding Icon

Embryo Transfer

A summary of Embryo Transfer codes collected by the ASRM Coding Committee View the Coding Summary
Videos Icon

Journal Club Global Live from PCRS - Non-Invasive Embryo Selection Techniques

The next great frontier in reproductive medicine is how to non-invasively select an embryo with the highest reproductive potential for transfer. View the Video
Videos Icon

Journal Club Global - Should Fellows Perform Live Embryo Transfers in Fellowship?

Few things are more taboo in reproductive medicine fellowship training than allowing fellows to perform live embryo transfers. View the Video
Videos Icon

Journal Club Global Live from ASRM - Optimal Management of the Frozen Embryo Transfer Cycle: Insights From Recent Literature

Three recent papers published in the Fertility and Sterility family of journals, all explore different aspects of optimizing frozen embryo transfer cycles. View the Video
Document Icon

Guidance on the limits to the number of embryos to transfer: a committee opinion (2021)

ASRM's guidelines for the limits on the number of embryos to be transferred during IVF cycles have been further refined ... View the Committee Opinion
Document Icon

Compassionate transfer: patient requests for embryo transfer for nonreproductive purposes (2020)

A patient request to transfer embryos into her body in a location or at a time when pregnancy is highly unlikely ... View the Committee Opinion
Document Icon

Blastocyst culture and transfer in clinically assisted reproduction: a committee opinion (2018)

The purposes of this document is to review the literature regarding the clinical application of blastocyst transfer. View the Committee Opinion
Document Icon

Transferring embryos with genetic anomalies detected in preimplantation testing: an Ethics Committee Opinion (2018)

Patient requests for transfer of embryos with genetic anomalies linked to serious health-affecting disorders detected in preimplantation testing are rare but do exist. View the Committee Document
Document Icon

ASRM standard embryo transfer protocol template: a committee opinion (2017)

Standardization improves performance and safety of embryo transfer View the Committee Opinion
Document Icon

Performing the embryo transfer: a guideline (2017)

A systematic review of the literature was conducted which examined each of the major steps of embryo transfer. Recommendations made for improving pregnancy rates are based on interventions demonstrated to be either beneficial or not beneficial. (Fertil Steril® 2017;107:882–96. ©2017 by American Society for Reproductive Medicine.) View the Committee Guideline