Influence of targeted nursing-guided bladder filling on embryo transfer outcomes and patient comfort: A prospective open randomized controlled study

Abstract

BACKGROUND:

The success of assisted pregnancy relies heavily on the effectiveness of the embryo transfer process. Currently, embryo transfer is typically conducted with the assistance of abdominal ultrasound.

OBJECTIVE:

The primary aim of this study was to evaluate the influence of targeted nursing interventions on the embryo transfer procedure, its impact on pregnancy outcomes, and the level of patient comfort concerning bladder management throughout the procedure.

METHODS:

A total of 247 patients who underwent embryo transfer at the Reproductive Center of Peking University People’s Hospital from December 2019 to August 2020 were included in this study. These patients were categorized into two groups: the control group ( $n=$ 124) and the experimental group ( $n=$ 123). Within the control group, patients received conventional preoperative education, whereas those within the experimental group were subjected to targeted nursing interventions. Furthermore, patients in the experimental group were furnished with explicit instructions pertaining to the volume and timing of water intake. Multiple factors were assessed in this study, encompassing bladder filling, the quality of uterine imaging, the utilization of assistive devices during the surgical procedure, and pregnancy outcomes. Additionally, a post-operative questionnaire was administered to both groups to gauge their comfort levels regarding urinary retention.

RESULTS:

Following the targeted nursing intervention, ultrasound scans indicated an increase in bladder depth (5.91 $\pm$ 1.76 vs. 5.40 $\pm$ 1.61, $P=$ 0.02), resulting in clearer endometrial imaging (96.74% vs. 88.71%, $P=$ 0.02). Additionally, the experimental group reported significantly higher levels of comfort with urine retention ( $P=$ 0.01) compared to the control group, and these differences held statistical significance. Furthermore, the pregnancy rate in the experimental group was greater than that in the control group (52.85% vs. 50.8%, $P>$ 0.05).

CONCLUSION:

Based on the premise that pregnancy rates remain unaffected, the implementation of targeted nursing care has the potential to augment bladder filling, enhance the quality of endometrial imaging, reduce the requirement for instrument-assisted embryo transfers, and notably enhance the comfort of patients in relation to urine retention.

Keywords

Bladder filling comfort with urine retention embryo transfer IVF targeted nursing

1. Introduction

In vitro fertilization and embryo transfer (IVF-ET) is a procedure where the eggs and sperm of couples facing infertility are extracted from the body, fertilized in vitro, nurtured into embryos, and then implanted into the uterus to enable a regular pregnancy and childbirth [1]. The success of assisted pregnancy relies heavily on the effectiveness of the embryo transfer process. Currently, embryo transfer is typically conducted with the assistance of abdominal ultrasound [2, 3]. The quality of ultrasound images is, in part, determined by the extent of bladder filling. Maintaining a moderately filled bladder confers advantages in terms of optimizing ultrasound visualization of the uterine cavity, facilitating the embryo transfer procedure, and thereby increasing the likelihood of achieving successful pregnancies and live births per transfer cycle. Consequently, patients are strongly recommended to abstain from voiding their bladders prior to the embryo transfer procedure to ensure that the bladder attains the requisite level of fullness for these purposes.

In prior clinical nursing practices, patients were commonly instructed to withhold urine without specific guidance regarding the requisite urine volume or the duration of retention. Consequently, patients frequently endured prolonged periods of urinary retention prior to surgical procedures, leading to postoperative complications such as urinary retention, urinary tract infections, and potential challenges during embryo transfers due to inadequate bladder volume [4]. Furthermore, there is a scarcity of data on the levels of comfort related with urine retention prior to embryo transfer.

Therefore, targeted nursing guidance was implemented for patients undergoing embryo transfers, and they were advised on the appropriate amount of urine to retain before the procedure. Subsequently, the impact of urine retention on ultrasound imaging, the embryo transfer process, and patient comfort was assessed.

2. Participants and methods

2.1 Participants

A total of 247 patients who underwent embryo transfer at the Reproductive Center of Peking University People’s Hospital between December 2019 and August 2020, were enrolled in this study. A randomized controlled trial was conducted, wherein participants were assigned to one of two groups based on their enrollment order: the experimental group, which received specialized preoperative urine-retention guidance, and the control group, which received standard oral education.

The study included individuals aged 24 to 40 years who underwent frozen embryo transfer and met specific criteria, such as having a sufficient number of implantable embryos and an endometrial thickness $\geqslant$ 8 mm. Patients with infectious diseases of the urinary and reproductive tract or those with a fever were excluded from the study. All patients participated voluntarily and provided signed informed consent to be a part of this research.

2.2 Methods

2.2.1 Protocols for ovarian stimulation

All patients were given a flexible treatment plan involving the use of a gonadotropin-releasing hormone (GnRH) antagonist for controlled ovarian hyperstimulation (COH). Prior to the in-vitro fertilization (IVF) cycle, patients did not take any oral contraceptive. Ovarian stimulation was initiated on the second day of the menstrual cycle using recombinant follicle-stimulating hormone (FSH) (150–225 IU daily, Gonal-F from Merck Serono, Coinsins, Switzerland) for three consecutive days. The initial dosage was determined based on factors such as the patient age, ovarian reserve, body mass index (BMI), and previous response to COH. Subsequently, the recombinant FSH dosage was adjusted based on the levels of estrogen (E2) in the blood and follicular growth, which were monitored through transvaginal ultrasounds performed at regular intervals.

The administration of the GnRH antagonist (0.25 mg of Ganirelix or Cetrotide, given daily at 10 a.m.) followed a flexible protocol, typically commencing when the leading follicle reached a diameter of 13–14 mm. This treatment continued until the day of human chorionic gonadotrophin (hCG) administration. When at least two leading follicles reached a diameter of 18 mm, the final maturation of oocytes was triggered using 250 mg of recombinant hCG (Ovidrel from Merck Serono), which was equivalent to 6,500 IU hCG according to the manufacturer’s data. Alternatively, oocyte maturation was induced using 0.2 mg of triptorelin (Ferring International Center, Saint-Prex, Switzerland) combined with 2000 IU of hCG (Livzon, Zhuhai, China). Oocyte retrieval was performed using transvaginal ultrasonography 35 to 37 hours later. For patients with severe male-factor infertility, intracytoplasmic sperm injection (ICSI) was conducted.

2.2.2 Embryo transfer

In frozen-thawed embryo-transfer (FET) cycles, embryos were placed into the uterus during either natural menstrual cycles or cycles involving hormonal replacement. If women did not ovulate, they were prescribed estradiol valerate (3 mg, orally twice a day, Progynova from Bayer, Leverkusen, Germany) from days two to three of their menstrual cycle. Progesterone (60 mg, administered intramuscularly once daily) was given when the thickness of the uterine lining reached $\geqslant$ 8 mm. The number of embryos transferred ranged from 1 to 2, depending on the quality of the embryos and the age of the patient. Prior to the embryo transfer procedure, a series of medical assessments were undertaken in the preceding year, encompassing comprehensive evaluations such as blood and urine routines, assessments of liver and kidney function, infection markers, human papillomavirus and thin prep cytologic test screenings, as well as TORCH tests [5].

2.2.3 Experimental group

By employing targeted nursing instructions, the timing and quantity of water intake for patients were determined based on the uterine position indicated by the preoperative ultrasound findings. The specifics of this protocol are as follows:

1.
All patients consumed warm water approximately 1.5 to 2 hours before the procedure, typically around 8:30 am.
2.
Depending on the orientation of the uterus, the recommended water intake ranged from 300 to 500 ml for patients with an anterior uterus and 500 to 800 ml for those with a posterior uterus.
3.
Patients were advised to retain sufficient urine in their bladder to maintain a slight urge to urinate, but not to the point of discomfort.
4.
Following the embryo transfer, patients were instructed to empty their bladder within 3 to 5 minutes.

2.2.4 Control group

Patients were provided with standard nursing instructions and received preoperative oral education. The specific instructions included the following: (1) Patients were advised to consume water as usual on the day of the embryo transfer and refrain from urinating after waking up in the morning. (2) Patients were instructed to empty their bladder 3–5 minutes after the embryo transfer. Additionally, patients were informed about medication details and precautions before and after the transfer, dietary guidelines, rest recommendations, urination and defecation guidelines, daily activity suggestions, and the timing for conducting a pregnancy test, all in accordance with the thawing and transfer plans.

2.3 Observation indexes

(1)
Both groups were assessed for the level of bladder fullness and bladder depth (the measurement of the space between the front and back walls of the bladder in a sagittal view), the status of uterine development (including the visibility of the endometrial line), and whether any instruments like cervical forceps or probes were used during the procedure.
(2)
The pregnancy outcomes were documented. Serum human chorionic gonadotropin levels were checked 14 days after the embryo transfer, and an ultrasound was conducted 28 to 35 days after the transfer to determine the occurrence of clinical pregnancy.
(3)
Comfort levels were evaluated using a visual analog scale questionnaire, allowing patients to rate their discomfort while retaining urine. A score of 0 indicated no discomfort, while 10 signified extreme and unbearable discomfort. Scores of 0 were categorized as Level 0 comfort; scores between 1 and 3 were classified as Level I comfort; scores from 4 to 7 represented Level II comfort, and scores between 8 and 10 indicated Level III comfort [6].

2.4 Statistical analysis

The random table approach was employed for the purpose of randomizing groups, and data analysis was conducted using SPSS Statistics 25.0 software (IBM Corp., Armonk, NY, USA). The Kolmogorov-Smirnov test was used to determine normality. Age, BMI, gravidity, parity, endometrial thickness, and bladder depth were all in normal distribution, while other variables were not. Normally distributed data were tested using the $t$ -test and are expressed as mean $\pm$ standard deviation ( $\bar{x}$ $\pm$ SD). Non-normally distributed data were tested using the Man-Whitney-U test, and are expressed as median (min-max) or median (25th-75th percentiles). A value of $P<$ 0.05 was considered statistically significant.

3. Results

3.1 Participants

This study involved 247 patients, with 123 in the experimental group and 124 in the control group. The analysis revealed no notable differences in age, body mass index, endometrial thickness (9.11 $\pm$ 1.96 in the experimental group and 9.19 $\pm$ 1.95 in the control group), or the quantity of transferred embryos between the two groups ( $P>$ 0.05) (See Table 1 and Fig. 1).

Table 1
Comparison of general data between two groups of patients

	Experimental group ( $n=$ 123)	Control group ( $n=$ 124)	$p$
Age	34.43 $\pm$ 4.93	34.90 $\pm$ 5.12	0.46
BMI	22.26 $\pm$ 3.56	21.98 $\pm$ 3.38	0.13
Gravidity	2.03 $\pm$ 1.09	1.40 $\pm$ 0.85	0.12
Parity	0.42 $\pm$ 0.89	0.56 $\pm$ 0.89	0.57
Cause of infertility			0.72
Male factor	20	29
Tubal factor	45	42
Ovulation dysfunction	19	18
Endometriosis	16	11
Combined	8	7
Unexplained	15	17
Embryo transferred			0.48
D3	51	57
D5	72	67
Endometrial preparation protocol			0.28
Ovulation induction	42	27
Natural cycle	30	32
HRT	51	65
Thickness of endometrium	9.11 $\pm$ 1.96	9.19 $\pm$ 1.95	0.75
Uterine position before holding urine	Posterior (42, 34.15%)	Posterior (47, 37.90%)	0.76
	Anterior (81, 65.85%)	Anterior (77, 62.10%)

Figure 1.

Summary of patients included and excluded in this randomized controlled trial.

3.2 Comparison of surgical methods between the two groups

In contrast to the control group, the experimental group exhibited a greater bladder depth ( $P=$ 0.02), improved clarity in endometrial development ( $P=$ 0.02), and a relatively lower proportion of patients opting for instrument-assisted transfer (11.38% vs. 14.52%). While the pregnancy rate in the experimental group was higher than that in the control group (52.85% vs. 50.81%), this difference was not statistically significant ( $P=$ 0.56), as indicated in Table 2.

Table 2
Comparisons of intraoperative conditions and pregnancy outcomes between two groups of patients

Bladder depth		5.91 $\pm$ 1.76		5.40 $\pm$ 1.61	0.02
		Experimental group ( $n=$ 123)		Control group ( $n=$ 124)	$P$
Endometrial imaging	Clear	96.74%	(119/123)	88.71% (110/124)	0.02
	Unclear	3.26%	(4/123)	11.29% (14/124)
Device-assistant	Use	11.38%	(14/123)	14.52% (18/124)	0.75
	Not use	88.62%	(109/123)	85.48% (106/124)
Pregnancy	Yes	52.85%	(65/123)	50.81% (63/124)	0.56
	No	47.15%	(58/123)	49.19% (61/124)

Table 3

Comparison of the comfort of holding urine between the two groups of patients

	Experimental group ( $n=$ 123)	Control group ( $n=$ 124)	$P$
Comfort level 0	20	13	0.01
Comfort level I	65	48
Comfort level II	30	42
Comfort level III	5	15

3.3 Comparison of the comfort with urine retention in the two groups

The focus of this research was aimed at determining the comfort level of patients with urine retention. Following the embryo transfer operation, a survey using questionnaires was performed. A total of 118 questionnaire responses were collected in both the experimental and control groups, with a recovery rate of more than 90% in both. The findings demonstrated that individuals in the experimental group reported significantly greater comfort when it came to urine retention compared to those in the control group, and the difference was statistically significant ( $P<$ 0.05) (Table 3).

4. Discussion

In recent years, many reproductive centers have favored using abdominal ultrasound guidance for embryo transfer. A systematic review conducted in 2016 demonstrated that employing ultrasound during the procedure could significantly enhance the success rate of embryo transfers [7]. When the bladder is moderately filled, it aids in ascertaining the position of the uterus, and the ultrasound image allows for a clear visualization of the endometrial thickness. This, in turn, enables the operator to smoothly insert the catheter along a specific arc from the sagittal section of the cervix into the uterine cavity, precisely locate the site for embryo placement, and observe the embryo to confirm its successful transfer into the uterine cavity. The findings from this study indicate that with targeted nursing guidance, urine retention had a more positive impact. The depth of the bladder during embryo transfer notably increased, improving endometrial visibility, and there was a decrease in the proportion of patients requiring device-assisted transfer, leading to a moderate increase in the pregnancy rate. These results imply that targeted nursing guidance facilitated a smoother embryo transfer process for patients.

An overly full bladder may complicate surgery and cause discomfort for the patient. A prior study discovered that when the water intake surpassed 1,100 mL and the bladder became too full, displaying the uterine shape and measuring endometrial thickness became difficult. This difficulty in vision made locating the embryo more difficult [8]. Furthermore, an overfilled bladder can cause pelvic organ distortion and displacement. Pressure on the bladder can reduce the anterior-posterior diameter of the uterus, elongate and thin the cervix, and cause the uterus to tilt backward, making embryo transfer difficult and unpleasant, thus lowering the success rate [2]. Furthermore, an overly full bladder may cause uterine contractions, which can interfere with embryo implantation and potentially lead to treatment failure [9, 10, 11]. If the bladder is not sufficiently filled, it may potentially complicate surgery. During the procedure, ultrasonography imaging of the uterine cavity and cervix is hampered due to insufficient filling. The operator may struggle to see the cervix-uterine cavity junction, and the graft tube may not enter the uterine cavity smoothly. This condition may require the use of cervical forceps to hold the cervix and probes to locate the inner opening, complicating the surgery and potentially triggering uterine contractions, which can affect the success of the embryo transfer [12]. Therefore, achieving the right level of bladder filling is essential for the success of the embryo transfer procedure.

In the past, the advice given to patients regarding urine retention before embryo transfer was somewhat unclear. Patients were simply instructed to drink water and retain their urine, but this lacked specificity. Under normal bodily conditions, when a person drinks a substantial amount of water, the osmotic pressure of their plasma decreases, and the secretion of antidiuretic hormone decreases as well. This leads to a reduction in water reabsorption by the renal distal convoluted tubule and collecting duct epithelial cells, ultimately resulting in increased urine output. Typically, urine output peaks around 1 hour after water intake, and the bladder reaches a certain level of filling about 1 to 2 hours after drinking a significant amount of water.

Therefore, based on the results of this study, patients should commence drinking water 1 to 2 hours before the embryo transfer procedure. The optimal placement for the embryos is approximately 1 to 1.5 cm below the fundus of the uterus [13, 14]. To facilitate the operator to visualize the fundus using ultrasound, it is essential for a posterior uterus to have the bladder adequately filled [15]. Consequently, in this study, the amount of water recommended for patients to drink was adjusted based on the position of the uterus. This guideline was developed with the aim of avoiding two potential issues: Firstly, preventing patients from consuming excessive amounts of water and retaining urine excessively, which can cause discomfort and potentially overfill the bladder, thereby affecting the embryo transfer process. Secondly, ensuring that patients don’t consume an insufficient amount of water, as this could result in inadequate visibility of the endometrium, ultimately impacting the precise placement of the embryo.

It was also found that by providing targeted nursing education, it is possible to enhance the comfort of patients. In a study conducted in 2016, it was observed that patients who experienced significant discomfort during embryo transfer had a notably lower pregnancy rate compared to those who did not [16]. Consequently, patient well-being plays a pivotal role in determining the success of IVF-ET. Under the conventional education model, patients often grapple with the mental burden of uncertainty regarding the appropriate filling state of their bladder, which can impose psychological stress during IVF-ET treatment [17, 18, 19]. In contrast, patients in the experimental group in this study acquired a comprehensive understanding of how to correctly fill their bladder through targeted nursing guidance. This alleviated the anxiety stemming from concerns about water intake, significantly improving patient comfort.

The findings underscore that the implementation of targeted nursing care can yield advancements in intraoperative endometrial development, optimize procedural efficiency, and elevate levels of patient satisfaction. It is imperative to acknowledge that the present investigation is characterized as a case-control study, featuring a comparatively limited sample size. Consequently, it is incumbent upon future research endeavors to expand upon these findings, in order to derive definitive conclusions with broader applicability and generalizability.

5. Conclusion

The provision of targeted nursing care to patients undergoing embryo transfer yields several notable benefits, including improved bladder filling outcomes, enhanced clarity in endometrial imaging, decreased reliance on instrument-assisted transfers, and a substantial enhancement in patient comfort. This approach contributes to the establishment of a patient-centric diagnostic and therapeutic framework. The outcomes of this study underscore the importance of implementing precise fluid management protocols for patients undergoing IVF-ET, as it effectively mitigates patient discomfort without compromising pregnancy success rates. Additionally, it fosters improved patient-provider communication and fortifies the doctor-patient relationship. Consequently, the advocacy for the adoption of targeted nursing-guided bladder filling is warranted.

Funding

The study was supported by the Research and Development Program of Peking University People’s Hospital (RDL2021-09 and RDN2019-03).

Competing interests

The authors declare that they have no competing interests.

Ethics statement

This study was conducted with approval from the Ethics Committee of People’s Hospital of Peking University (2019PHB207-01). This study was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants.

Data availability statement

All data generated or analyzed during this study are included in this article or its supplementary material files. Further enquiries can be directed to the corresponding author.

Footnotes

Acknowledgments

The authors would like to acknowledge the hard and dedicated work of all staff that implemented the intervention and evaluation components of the study.

References

DeCherney

. In vitro fertilization and embryo transfer: A brief overview. Yale J Biol Med. 1986 Jul-Aug; 59(4): 409-14. PMID: 3532577; PMCID: PMC2590090.

Teixeira

Dassunção

Vieira

Barbosa

Coelho Neto

Nastri

Martins

. Ultrasound guidance during embryo transfer: A systematic review and meta-analysis of randomized controlled trials. Ultrasound Obstet Gynecol. 2015 Feb; 45(2): 139-48. doi: 10.1002/uog.14639. Epub 2015 Jan 5. PMID: 25052773.

Leong

Leung

Tucker

Wong

Chan

. Ultrasound-assisted embryo transfer. J In Vitro Fert Embryo Transf. 1986 Dec; 3(6): 383-5. doi: 10.1007/BF01133254. PMID: 3805858.

Choong

Emberton

. Acute urinary retention. BJU Int. 2000 Jan; 85(2): 186-201. doi: 10.1046/j.1464-410x.2000.00409.x. PMID: 10671867.

Romito

Gulino

Laganà

Vitale

Tuscano

Leanza

Musmeci

Leanza

Rapisarda

Palumbo

. Renal and hepatic functions after a week of controlled ovarian hyperstimulation during in vitro fertilization cycles. Int J Fertil Steril. 2017 Apr-Jun; 11(1): 15-19. doi: 10.22074/ijfs.2016.4689. Epub 2016 Nov 11. PMID: 28367300; PMCID: PMC5215706.

Agarwal

Dhiraaj

Singhal

Kapoor

Tandon

. Comparison of efficacy of oxybutynin and tolterodine for prevention of catheter related bladder discomfort: A prospective, randomized, placebo-controlled, double-blind study. Br J Anaesth. 2006 Mar; 96(3): 377-80. doi: 10.1093/bja/ael003. Epub 2006 Jan 16. PMID: 16415311.

Brown

Buckingham

Buckett

Abou-Setta

. Ultrasound versus ‘clinical touch’ for catheter guidance during embryo transfer in women. Cochrane Database Syst Rev. 2016 Mar 17; 3: CD006107. doi: 10.1002/14651858.CD006107.pub4. PMID: 26984325.

Agarwal

Raza

Singhal

Dhiraaj

Kapoor

Srivastava

Gupta

Singh

Pandey

Singh

. The efficacy of tolterodine for prevention of catheter-related bladder discomfort: A prospective, randomized, placebo-controlled, double-blind study. Anesth Analg. 2005 Oct; 101(4): 1065-1067. doi: 10.1213/01.ane.0000167775.46192.e9. PMID: 16192522.

Allahbadia

, et al. (eds.). Textbook of Assisted Reproduction. doi: 10.1007/978-981-15-2377-9_22.

10.

Bortoletto

Bakkensen

Anchan

. Embryo transfer: Timing and techniques. Minerva Endocrinol. 2018 Mar; 43(1): 57-68. doi: 10.23736/S0391-1977.17.02649-9. Epub 2017 Apr 4. PMID: 28381082.

11.

Practice Committee of the American Society for Reproductive Medicine. Electronic address: ASRM@asrmorg; Practice Committee of the American Society for Reproductive Medicine. Performing the embryo transfer: A guideline. Fertil Steril. 2017 Apr; 107(4): 882-896. doi: 10.1016/j.fertnstert.2017.01.025. PMID: 28366416.

12.

Saravelos

. Embryo transfer techniques. Best Pract Res Clin Obstet Gynaecol. 2019 Aug; 59: 77-88. doi: 10.1016/j.bpobgyn.2019.01.004. Epub 2019 Jan 11. PMID: 30711373.

13.

Saravelos

Wong

Chan

Kong

Cheung

Chung

. Assessment of the embryo flash position and migration with 3D ultrasound within 60 min of embryo transfer. Hum Reprod. 2016 Mar; 31(3): 591-6. doi: 10.1093/humrep/dev343. Epub 2016 Jan 11. PMID: 26759141.

14.

Saravelos

Wong

Chan

Kong

. How often does the embryo implant at the location to which it was transferred? Ultrasound Obstet Gynecol. 2016 Jul; 48(1): 106-12. doi: 10.1002/uog.15778. PMID: 26437908.

15.

Zhu

. How to deal with fluid in the endometrial cavity during assisted reproductive techniques. Curr Opin Obstet Gynecol. 2011 Jun; 23(3): 190-4. doi: 10.1097/GCO.0b013e3283468b94. PMID: 21505333.

16.

Saravelos

Wong

Kong

Huang

Klitzman

. Pain during embryo transfer is independently associated with clinical pregnancy in fresh/frozen assisted reproductive technology cycles. J Obstet Gynaecol Res. 2016 Jun; 42(6): 684-93. doi: 10.1111/jog.12962. Epub 2016 Feb 24. PMID: 26916559.

17.

Abou-Setta

. What is the best site for embryo deposition? A systematic review and meta-analysis using direct and adjusted indirect comparisons. Reprod Biomed Online. 2007 May; 14(5): 611-9. doi: 10.1016/s1472-6483(10)61054-1. PMID: 17509204.

18.

Liu

Chen

Fan

. The analysis of anxiety and depression in different stages of in vitro fertilization-embryo transfer in couples in China. Neuropsychiatr Dis Treat. 2021 Feb 25; 17: 649-657. doi: 10.2147/NDT.S287198. PMID: 33658786; PMCID: PMC7920591.

19.

Wang

Yao

Liang

Zuo

Zhu

. Detection of the metabolites of human plasma and follicular fluid in IVF-ET with microextraction and LC-TOF-MS. Technol Health Care. 2015; 23 Suppl 1: S29-36. doi: 10.3233/thc-150925. PMID: 26410324.

Influence of targeted nursing-guided bladder filling on embryo transfer outcomes and patient comfort: A prospective open randomized controlled study

Abstract

BACKGROUND:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Keywords

1. Introduction

2. Participants and methods

2.1 Participants

2.2 Methods

2.2.1 Protocols for ovarian stimulation

2.2.2 Embryo transfer

2.2.3 Experimental group

2.3 Observation indexes

3. Results

3.1 Participants

Table 1 Comparison of general data between two groups of patients

Table 2 Comparisons of intraoperative conditions and pregnancy outcomes between two groups of patients

4. Discussion

5. Conclusion

Funding

Competing interests

Ethics statement

Data availability statement

Footnotes

Acknowledgments

References

Table 1
Comparison of general data between two groups of patients

Table 2
Comparisons of intraoperative conditions and pregnancy outcomes between two groups of patients