Does the experience of the provider affect pregnancy rates after embryo transfer?

OBJECTIVE: To study the influence of provider experience in a university hospital where resident physicians need to learn how to perform embryo transfer (ET). STUDY DESIGN: A cohort prospective study was conducted in a tertiary care university medical center between March 2008 and August 2009. A total of 443 women undergoing fresh ET after in vitro fertilization were studied. ET with Frydman catheter or tight difficult transfer (TDT), conducted by three groups of providers of varying experience were studied: attending physicians with > 20 years of experience, assistant physicians with 2-5 years of experience and resident physicians with < 6 months of experience. The main outcomes were clinical pregnancy and implantation rates. RESULTS: The provider's experience had an impact on the pregnancy rate: 29.9% for attending physicians, 28.2% for assistant physicians and 19.1% for resident physicians (p < 0.05). Resident physicians used TDT catheter more often than attending physicians: 42% vs. 21.3% (p < 0.05). CONCLUSION: Resident physicians must be better monitored to avoid the lower pregnancy rates. ET should be further standardized. In this study, the ET protocol was modified in our assisted reproductive technology unit.

Leiomyoma remaining after vaginal hysterectomy for symptomatic leiomyomas. A case report.

BACKGROUND: A remaining leiomyoma, an uncommon postoperative complication of vaginal hysterectomy for symptomatic leiomyomas, occurred. CASE: A second vaginal operation for a remaining leiomyoma was necessary 1 month after a vaginal hysterectomy for a myomatous uterus. CONCLUSION: Checking the pelvic cavity during hysterectomy may avoid this complication.