Difficult embryo transfer: Challenges, techniques, and solutions – our experience

Embryo transfer (ET) is a critical step in the success of in vitro fertilization, yet it can be technically challenging in a small but significant proportion of cases. These challenges arise due to anatomical variations and acquired conditions affecting the cervix and uterus. Difficult ET is associated with reduced pregnancy rates, increased procedural complexity, and patient discomfort. This review explores the multifactorial causes of difficult ET, including cervical stenosis, uterine angulation, and technical factors. It highlights the role of pre-procedural assessment, ultrasound guidance, and catheter selection in improving outcomes. In addition, we discuss practical strategies for managing difficult transfers, supported by current evidence and clinical experience. Through a structured synthesis of literature and clinical insights, this article provides a comprehensive and practical guide for clinicians to optimize ET outcomes in challenging scenarios.