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• W2575248897 abstract "ObjectiveOver the past two years we have been performing Transabdominal Sonography (TAS) guided Embryo Transfers using the Sureview® catheter (Wallace, UK) for all ETs in our Donor Oocyte Program. For acutely anteverted uteri we routinely mould the catheter according to the utero-cervical angle seen on TAS. Moulding the embryo transfer catheter according to the uterocervical angle measured by sonography increases clinical pregnancy and implantation rates and diminishes the incidence of difficult and bloody transfers. There are occasional cases where despite accurate moulding and placement of the Sureview® catheters, there were difficulties encountered in negotiating the internal os. We opted to use the Sureview® stilette set instead of the more traumatic transmyometrial transfers which was an option in these cases. The objective of this study was to ascertain the ART outcome in cases where the stilette was used and compare the results using the standard Sureview® catheter.DesignThis prospective comparative study was conducted in a private academic ART center.Materials and methodsOut of a total of 203 consecutive patients undergoing Transabdominal ultrasound-guided embryo transfer by the same physician, 28 patients required the use of a stilette set to negotiate the internal os (Study Group). Once the stilette and sheath were seen to cross the internal os, the stilette was withdrawn and the inner sleeve of a regular Sureview® catheter with embryos loaded was negotiated through the stilette sheath under sonographic guidance to the exact point where we decided to transfer the embryos. All the 203 patients had an hysteroscopic examination performed 30-318 days prior to the ET. Out of the 28 patients requiring the use of the stilette under sonographic guidance, 23 patients had normal hysteroscopic findings. Five patients had some abnormal findings in their operative notes including deviated cervical canals or with notes highlighting difficult cervical dilatation & in one case a false passage with dilator use was documented in a hysteroscopy done almost 6 months prior to the present ET. All the patients were matched in terms of age, number and grade of embryos transferred & endometrial thickness & morphology. The main outcome measures studied were ease of passage of the catheter loaded with embryos, easy visualization of the tip of the catheter & the air-bubble containg media & embryos and pregnancy & implantation rates.ResultsThere was better visualization of the catheter tip & the entire length of catheter in the Control Group (n=175). The technique in the Control Group was also less traumatic with no blood seen on the inner sleeve in all the cases. In the Study Group, there was staining of the inner sleeve of the Sureview® catheter in two cases with easy passage of the stilette set at the first pass in all 28 cases. The inner sleeve in the Study group as well as the air-bubble was seen as clearly as in the Control group. Implantation rates & Pregnancy rates were the same in both the groups.ConclusionThe use of the Sureview® stilette set in difficult Embryo Transfers should be encouraged as a first choice method. Use of the stilette under Sonography guidance to negotiate difficult cervical passage makes the ET technique very easy, less traumatic & bloody. This should be the first option in difficult Embryo Transfers instead of the more invasive transmyometrial ETs. ObjectiveOver the past two years we have been performing Transabdominal Sonography (TAS) guided Embryo Transfers using the Sureview® catheter (Wallace, UK) for all ETs in our Donor Oocyte Program. For acutely anteverted uteri we routinely mould the catheter according to the utero-cervical angle seen on TAS. Moulding the embryo transfer catheter according to the uterocervical angle measured by sonography increases clinical pregnancy and implantation rates and diminishes the incidence of difficult and bloody transfers. There are occasional cases where despite accurate moulding and placement of the Sureview® catheters, there were difficulties encountered in negotiating the internal os. We opted to use the Sureview® stilette set instead of the more traumatic transmyometrial transfers which was an option in these cases. The objective of this study was to ascertain the ART outcome in cases where the stilette was used and compare the results using the standard Sureview® catheter. Over the past two years we have been performing Transabdominal Sonography (TAS) guided Embryo Transfers using the Sureview® catheter (Wallace, UK) for all ETs in our Donor Oocyte Program. For acutely anteverted uteri we routinely mould the catheter according to the utero-cervical angle seen on TAS. Moulding the embryo transfer catheter according to the uterocervical angle measured by sonography increases clinical pregnancy and implantation rates and diminishes the incidence of difficult and bloody transfers. There are occasional cases where despite accurate moulding and placement of the Sureview® catheters, there were difficulties encountered in negotiating the internal os. We opted to use the Sureview® stilette set instead of the more traumatic transmyometrial transfers which was an option in these cases. The objective of this study was to ascertain the ART outcome in cases where the stilette was used and compare the results using the standard Sureview® catheter. DesignThis prospective comparative study was conducted in a private academic ART center. This prospective comparative study was conducted in a private academic ART center. Materials and methodsOut of a total of 203 consecutive patients undergoing Transabdominal ultrasound-guided embryo transfer by the same physician, 28 patients required the use of a stilette set to negotiate the internal os (Study Group). Once the stilette and sheath were seen to cross the internal os, the stilette was withdrawn and the inner sleeve of a regular Sureview® catheter with embryos loaded was negotiated through the stilette sheath under sonographic guidance to the exact point where we decided to transfer the embryos. All the 203 patients had an hysteroscopic examination performed 30-318 days prior to the ET. Out of the 28 patients requiring the use of the stilette under sonographic guidance, 23 patients had normal hysteroscopic findings. Five patients had some abnormal findings in their operative notes including deviated cervical canals or with notes highlighting difficult cervical dilatation & in one case a false passage with dilator use was documented in a hysteroscopy done almost 6 months prior to the present ET. All the patients were matched in terms of age, number and grade of embryos transferred & endometrial thickness & morphology. The main outcome measures studied were ease of passage of the catheter loaded with embryos, easy visualization of the tip of the catheter & the air-bubble containg media & embryos and pregnancy & implantation rates. Out of a total of 203 consecutive patients undergoing Transabdominal ultrasound-guided embryo transfer by the same physician, 28 patients required the use of a stilette set to negotiate the internal os (Study Group). Once the stilette and sheath were seen to cross the internal os, the stilette was withdrawn and the inner sleeve of a regular Sureview® catheter with embryos loaded was negotiated through the stilette sheath under sonographic guidance to the exact point where we decided to transfer the embryos. All the 203 patients had an hysteroscopic examination performed 30-318 days prior to the ET. Out of the 28 patients requiring the use of the stilette under sonographic guidance, 23 patients had normal hysteroscopic findings. Five patients had some abnormal findings in their operative notes including deviated cervical canals or with notes highlighting difficult cervical dilatation & in one case a false passage with dilator use was documented in a hysteroscopy done almost 6 months prior to the present ET. All the patients were matched in terms of age, number and grade of embryos transferred & endometrial thickness & morphology. The main outcome measures studied were ease of passage of the catheter loaded with embryos, easy visualization of the tip of the catheter & the air-bubble containg media & embryos and pregnancy & implantation rates. ResultsThere was better visualization of the catheter tip & the entire length of catheter in the Control Group (n=175). The technique in the Control Group was also less traumatic with no blood seen on the inner sleeve in all the cases. In the Study Group, there was staining of the inner sleeve of the Sureview® catheter in two cases with easy passage of the stilette set at the first pass in all 28 cases. The inner sleeve in the Study group as well as the air-bubble was seen as clearly as in the Control group. Implantation rates & Pregnancy rates were the same in both the groups. There was better visualization of the catheter tip & the entire length of catheter in the Control Group (n=175). The technique in the Control Group was also less traumatic with no blood seen on the inner sleeve in all the cases. In the Study Group, there was staining of the inner sleeve of the Sureview® catheter in two cases with easy passage of the stilette set at the first pass in all 28 cases. The inner sleeve in the Study group as well as the air-bubble was seen as clearly as in the Control group. Implantation rates & Pregnancy rates were the same in both the groups. ConclusionThe use of the Sureview® stilette set in difficult Embryo Transfers should be encouraged as a first choice method. Use of the stilette under Sonography guidance to negotiate difficult cervical passage makes the ET technique very easy, less traumatic & bloody. This should be the first option in difficult Embryo Transfers instead of the more invasive transmyometrial ETs. The use of the Sureview® stilette set in difficult Embryo Transfers should be encouraged as a first choice method. Use of the stilette under Sonography guidance to negotiate difficult cervical passage makes the ET technique very easy, less traumatic & bloody. This should be the first option in difficult Embryo Transfers instead of the more invasive transmyometrial ETs." @default.
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