Literature Review Article
Effects of embryo transfer catheters on endometrial surface noted at hysteroscopy. Ressler IB, Pakrashi T, Sroga JM, DiPaola KB, Thomas MA, Lindheim SR. J Minim Invasive Gynecol. 2013; 20(3): 381-5.
Dr. John Preston Parry, M.D., M.P.H.
The study question relates to whether hysteroscopy can be used to identify the degree of endometrial trauma associated with different catheters for patients with difficult transfers. The authors looked at 20 patients with difficult transfers as reflected by significant blood on a catheter, use of a tenaculum, or greater than 90 seconds to cannulate the cervix at trial transfer. The authors found that 50% of participants could be successfully cannulated with a Wallace Embryo Replacement Catheter and all of these were without endometrial trauma. In contrast, 50% required either a Soft-Pass catheter for a second attempt or an Echosight Patton Catheter with a coaxial wire for a third attempt. Both Soft-Pass catheter patients were found to have subendometrial tunneling and three of the eight patients requiring the Echosight Patton catheter had endometrial shearing. Though suggestive that a flexible Wallace catheter is least likely to cause trauma, the step wise progression through the catheters with greater difficulty of transfer still allows for potential confirmation bias. Also, in two of the patients receiving just the Wallace catheter, ostial cannulation occurred and in a third, this flexible catheter bent back towards the lower uterine segment. However, all three of these events could have occurred secondary to catheter advancement during hysteroscopic cannulation. In summary, though not definitive, hysteroscopic data validate the beliefs that with greater catheter rigidity there is greater potential for endometrial trauma, and that particularly for flexible catheters, sonographic visualization may not fully identify inadvertent placement.
Dr. Daniel Williams, M.D.
This small study evaluates the effect of various embryo transfer catheters on the endometrium in patients with a prior history of difficult trial transfer. As expected, they found that the easier the transfer, the lower the amount of potential trauma to the endometrium. Likewise, softer catheters were shown to cause less endometrial trauma compared to stiffer catheters. Additionally, the authors were also able to visually document the degree of endometrial trauma using hysteroscopy.
The above review and commentary on this article were written by SRS members. Publication of these summaries does not reflect endorsement of any particular procedure or treatment. Views expressed in these summaries do not necessarily reflect the views of SRS or ASRM.