title: Effects of embryo transfer catheters on the endometrial surface noted at hysteroscopy.
abstract: OBJECTIVE
  To assess the effects on the endometrial surface of embryo transfer catheters using hysteroscopy with ultrasound guidance.
  
  
  METHODS
  Prospective descriptive study (Canadian Task Force classification III).
  
  
  METHODS
  University-based clinical practice.
  
  
  METHODS
  Twenty patients with a documented difficult trial transfer (TT).
  
  
  METHODS
  All patients underwent an intraoperative TT using an Edwards-Wallace catheter (n = 10), a Soft-Pass catheter with obturator (n = 2), or an Echosight Patton catheter with a coaxial wire (n = 8), with placement assured using ultrasound. This was followed by hysteroscopy and cervical surgical correction.
  
  
  RESULTS
  A 5-mm hysteroscope was used to visualize, assess, and document TT catheter placement and effects on the endometrial cavity. The Wallace catheter caused the least trauma (20%). The Soft-Pass catheter with obturator (100%) resulted in linear grooves in the endometrial surface. The most traumatic effects occurred with use of the coaxial catheter (38%), which caused shaving with petechial bleeding past the point of obstruction. In addition, 3 of the Wallace catheters were improperly placed (cannulation of tubal ostia, n = 2) and coiled back (n =1).
  
  
  CONCLUSIONS
  Despite ultrasound guidance, endometrial disruption and catheter displacement occurs with difficult embryo transfer catheter placement, which may suggest an explanation for lower pregnancy rates in these difficult cases. Greater attention to correction of cervical disease before an in vitro fertilization-embryo transfer cycle may improve clinical outcomes.
authors.affiliation: Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
authors.forename: Ilana B
authors.initials: IB
authors.lastname: Ressler
authors.forename: Tarita
authors.initials: T
authors.lastname: Pakrashi
authors.forename: Julie M
authors.initials: JM
authors.lastname: Sroga
authors.forename: Krystene B
authors.initials: KB
authors.lastname: DiPaola
authors.forename: Michael A
authors.initials: MA
authors.lastname: Thomas
authors.forename: Steven R
authors.initials: SR
authors.lastname: Lindheim
mesh_terms: D002404:Catheterization / Q000379:methods; D057785:Catheters / Q000009:adverse effects*; D004624:Embryo Transfer / Q000295:instrumentation*; D004717:Endometrium / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology*; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D011446:Prospective Studies; D018084:Ultrasonography, Interventional