P-324: A prospective, randomized, single-center study comparing the use of an echogenic embryo transfer catheter to a standard embryo transfer catheter in an IVF program

Abstract

Most IVF programs utilize a trial embyro transfer prior to the actual transfer to evaluate and circumvent potential difficulties at the time of the actual embryo transfer. Many successful IVF programs have adopted the use of ultrasound-guided embryo transfer as a method to ensure an accurate, atraumatic transfer. Recently, several manufacturers have developed echogenic transfer catheters with the hope that visualization will be improved under ultrasound quidance. The improved visualization should offer smooth, atraumatic transfers. Prospective, randomized, single-center study comparing the use of an echogenic embryo transfer catheter to a standard embryo transfer catheter in women undergoing IVF. This study conformed to the quidelines established by the Institutional Review Board of the University of Tennessee. All women undergoing IVF had a sonohysterogram that demonstrated a normal uterine cavity. All patients had a trial embryo transfer while on oral contraceptive pills and a map of the uterine cavity was drawn. Randomization was established with the use of a computer-generated randomization table. A total of 94 women were enrolled in the study. Forty-six women (mean age 34.3 years, range 24-43) underwent embryo transfer with the Echogyn catheter (Ultrasoft Echogyn Embryoview FEP 23 cm, Laboratorie C.C.D., Paris, France) and forty-eight women (mean age 34.2 years, range 22-44) underwent embryo transfer with the Wallace catheter (Wallace Embryo Replacement Catheter, Irvine Scientific, Santa Anna, CA). All embryo transfer procedures were performed under ultrasound quidance using A Toshiba Justvision 400 (Tustin, CA). Statistical analysis was performed using Fishers exact test with a power to detect a 10% difference in pregnancy rates (alpha = 0.05, beta = 0.80). Overall positive pregnancy test were obtained in 59 of 94 patients (62.8%). There were no statistical differences in the pregnancy rates when type of catheter was analyzed. Patients who were randomized to have embryo transfer with the Echogyn catheter had positive pregnancy test in 29 of 46 transfers (63%) while patients randomized to theWallace caatheter had pregnancies in 30 of 48 transfers (62.5 %). There were no differences in the time required for embryo transfer defined as the time that the loaded catheter was handed to the physician until the embryo discharge. There was a trend towards a longer time for the embryologist to load two embryos into the Echogyn catheter. There was a physician learning curve that had to be overcome when transitioning to a new transfer catheter. There were no significant differences in the prenancy rates when an Echogyn catheter was used when compared to a standard catheter. Clinics should use multiple criteria when evaluating which embryo catheter to use including the ease of handling, clarity of the catheter tip, ease of loading, smoothness of the catheter tip, and cost effectiveness.