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• W2058049974 abstract "We very much appreciate the commentary presented by Biervliet, Lesny, Maguiness and Killick. We are delighted to add further clarification as requested. Our center sounds the uterus of each patient anticipating IVF in a previous cycle remote from the current treatment. In this patient, the uterus had been sounded to 9.0 cm during a natural cycle, and the two embryos were placed at 8.0 cm. The fundus was not touched at any point during the embryo transfer. The degree of difficulty was graded as mild. While degree of difficulty is somewhat subjective, mild difficulty implies that some additional manipulation was required in order to proceed with the embryo transfer. In most cases, this involves a maneuver such as adjustment of the transfer catheter or sheath. No tenaculum was used. A second attempt at catheter placement was not required. There was no trauma to the uterus or cervix. Perhaps the phrase “atraumatic transfer” would have been more appropriate. Junctional zone contractions as an etiology of ectopic pregnancy is a fascinating theory. Birnholz (1Birnholz J. Ultrasonic visualization of endometrial movements.Fertil Steril. 1984; 41: 157-158Abstract Full Text PDF PubMed Scopus (82) Google Scholar) was the first to measure rhythmic myometrial contractions occurring in the nongravid uterus. Ijland et al. (2Ijland M.M. Evers J.L.H. Dunselman G. van Katwijk C. Lo C.R. Hoogland H.J. Endometrial wavelike movements during the menstrual cycle.Fertil Steril. 1996; 65: 746-749Abstract Full Text PDF PubMed Scopus (128) Google Scholar) further characterized these as waves of different types. These waves had four variants: fundus to cervix, cervix to fundus, opposite waves starting simultaneously at cervix and fundus, and random waves starting at various foci. In a study by Lesny et al. (3Lesny P. Killick S.R. Tetlow R.L. Robinson J. Maguiness S.D. Embryo transfer—can we learn anything new from the observation of junctional zone contractions?.Human Reprod. 1998; 13: 1540-1546Crossref PubMed Scopus (164) Google Scholar), such junctional zone contractions were seen as dispersing a fluid bolus, which represents embryos and transfer medium, into the cervix and fallopian tubes. Difficult embryo transfers in the Lesny study were associated with increased contractions, and possibly increased ectopic pregnancy rates. It is possible that increased junctional zone contractions may lead to displacement of embryos into ectopic locations. If this were found to be true, then the random variant of waves might explain the passage of two simultaneously placed embryos into opposite fallopian tubes. We welcome this and any other theories which may explain the bilaterality of this ectopic pregnancy." @default.
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• W2058049974 date "2001-07-01" @default.
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• W2058049974 title "Mechanisms for bilateral ectopics after embryo transfer? Reply of the authors:" @default.
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• W2058049974 doi "https://doi.org/10.1016/s0015-0282(01)01861-1" @default.
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