Objectives: To compare the performance of a new coaxial catheter system with an echo-dense tip (Cook Echo-Tip® catheter) with a Wallace catheter during ultrasound-guided ET. Design: Prospective, randomized study Setting: Private academically affiliated infertility center. Patient(s): Two hundred fifty-one patients undergoing IVF-ET. Intervention(s): The patients underwent ultrasound-guided ET by a single physician with a standardized technique alternately using one of the two catheters. Main Outcome Measure(s): Implantation rates, pregnancy rates, ease of transfer, visualization, and status of catheter tip. Result(s): The echo-dense tip of the Cook Echo-Tip® catheter was consistently seen with ultrasound guidance, minimizing the need for catheter movement to identify the tip. Implantation rate (30% vs. 35%), clinical pregnancy rate (57% vs. 55%), and ongoing pregnancy rate (49% vs. 47%) were similar in both groups. Conclusion(s): The Cook Echo-Tip® catheter with its echogenic tip simplifies ultrasound-guided ET, but pregnancy success rates are similar to those obtained when a Wallace catheter is used.