Received March 28, 2026
Accepted April 07, 2026

ABSTRACT Objective: The impact of difficult embryo transfer (ET) on clinical pregnancy rate (CPR) remains uncertain, with prior studies reporting inconsistent findings. This study aimed to evaluate the association between difficult versus easy ET and CPR in patients undergoing in vitro fertilization (IVF). Methods: This retrospective cohort study was conducted at King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia, between January 2022 and November 2024. Difficult ET was defined by procedural challenges such as resistance, need for force, or use of additional instruments. The primary outcome was CPR, defined as the presence of a gestational sac or fetal heartbeat on ultrasound following a positive ?-hCG test. Multivariable logistic regression was performed to adjust for potential confounders. Results: A total of 481 cycles were included, of which 442 (91.9%) involved easy ET and 39 (8.1%) difficult ET. Baseline characteristics were comparable between groups. The overall CPR was 31.6%, with no statistically significant difference between the difficult and easy ET groups (23.08% vs. 32.35%, p=0.282). In unadjusted analysis, difficult ET was associated with lower odds of CPR (OR 0.63, 95% CI 0.29–1.36). After adjustment for confounders, difficult ET remained associated with reduced odds of CPR (adjusted OR 0.49, 95% CI 0.22–1.11), although this did not reach statistical significance (p=0.087). Conclusion: Difficult ET was associated with a non-significant trend toward lower CPR. These findings suggest a potential negative effect; however, larger studies are needed to confirm this association.