In order to standardize embryo transfer techniques for In Vitro Fertilization (IVF) and Intrauterine Insemination (IUI), America’s chief professional organization in infertility and reproductive medicine, The American Society for Reproductive Medicine, developed a simulation training program with VirtaMed.
ASRM Embryo Transfer Module by VirtaMed
Video Credit: VirtaMed
“The time of see one, do one, teach one is gone. Fellows today need to train on simulators over and over again until they achieve a defined competency level. The Embryo Transfer Certificate Course is essential in both the development and maintenance of embryo transfer skills.”
Richard H. Reindollar, M.D., ASRM Past President
A compelling case for simulation
- During their fellowship, 25% of fellows never carry out an embryo transfer, and a further 25% perform less than ten across their three years of training.
- Embryo transfer is an extremely delicate procedure: patients usually pay around USD 10,000-20,000 out of their own pocket.
- ASRM's survey of over 100 fertility specialists revealed that there were no standardized approaches or well-defined best practices.
- The clinicians work under high stress as patients receive no anesthesia and as both parents-to-be are usually present during the procedure.
- Success rates vary between 15-60%, and procedures must often be repeated.
Confidence and competence
Two-day proficiency-based certification courses are organized by ASRM that are aimed at REI fellows. A study demonstrated that the simulation course increased clinician confidence up to 125% while improving knowledge, technical and cognitive skills.
The results of the full program and study have been published in Fertility and Sterility online.
Image Credit: VirtaMed
To evaluate the merits of the American Society for Reproductive Medicine Embryo Transfer Certificate Course in confidence and skill building for performing a live embryo transfer (ET).
Prospective cohort study.
Two-day simulation workshops using four different uterine models (A–D) and reproductive endocrine and infertility (REI) fellows from American Board of Obstetrics and Gynecology–approved training programs.
Didactic and hands-on simulation training program.
Main outcome measure(s)
The main outcomes included ET simulation scores of all exercises analyzed at numerous points of the training on a 6-point Likert scale of self-assessed confidence before and after the completion of the Embryo Transfer Certificate Course-based and association of both with extent of prior live ET experience and year of fellowship.
Data were gathered for 78 REI fellows who completed the Embryo Transfer Certificate Course, and they showed significant improvements in both confidence and skill.
The data for a subset of 58 fellows who carried out five direct transfers on both Embryo Transfer Certificate Course uterine models A and B exhibited a big improvement overall in ET simulation scores between the first and fifth direct transfers.
A separate data subset of 57 fellows who carried out five afterload transfers for each exercise on all four of the uterine models showed differences in difficulty among them. The one that was consistently the easiest was embryo transfer simulation using the uterine A model.
The ET simulation scores for fellows that were utilizing the uterine B and C models displayed a significant and progressive increase across the five afterload ETs.
ET simulation scores increased significantly between the first and second transfers but stayed at the same level for the remaining three transfers when utilizing the uterine D model.
A notable increase in ET simulation scores between the first and last transfers was seen, except for uterus A, for those fellows with less than 50 prior live transfers and for fellows overall in all afterload transfers.
Data for all 78 fellows showed a surge in self-confidence for all parameters, with the largest overall increase (78%) seen for first-year fellows and for fellows of any year with no prior live transfer experience (109%).
Although they had a lower gain in confidence compared with fellows with less experience, fellows with the largest amount of prior live ET experience started with higher confidence, which also increased significantly.
The effectiveness of simulator-based ET training for REI fellows across the three years of training regardless of prior experience with live ET was demonstrated by The American Society for Reproductive Medicine Embryo Transfer Certificate Course data analysis.
Produced from materials originally authored by Ramaiah S, Ray K, and Reindollar R from VirtaMed.
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