Ultrasound Guided Embryo Transfer

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Hans van der Slikke, MD, PhD: "It's October of 2001 and we're at the ASRM in Orlando. Next to me is Dr. Karande from Chicago. Welcome, Dr. Karande."

Vishvanath Karande, MD: "Good to be here."

Hans van der Slikke, MD, PhD: "You did a presentation yesterday and today we talked about the different catheters you can use with embryo transfer, and you compared two types of catheters in your presentation yesterday. Could you explain to us what your set up was and what your results were?"

Vishvanath Karande, MD: "Yes, we have been using ultrasound guidance for embryo transfers now in our practice for almost three years, and Cook Ob-Gyn has come out with a new catheter that has an echogenic tip which can be seen very clearly on ultrasound. The tip is so easily seen that you don't have to move the catheter in a two-hand manner to identify the tip. They hypothesize that because of that, you could deposit the embryos more accurately and that will result in better pregnancy rates. We had a group of 251 patients where we randomized them to either the Wallace catheter which is the usual soft catheter that's used all over the world and compared it with the Cook echotip catheter, and really the results in both groups were very comparable, we couldn't find any significant differences. So we concluded that the Cook catheter is at least as good as the Wallace, although the echotip made visualization more convenient, at the end of the day the pregnancy rates were very similar in both groups."

Hans van der Slikke, MD, PhD: "Wasn't this a little bit of a disappointment for you because you've been using ultrasound guidance for three years?"

Vishvanath Karande, MD: "Not really because both groups had excellent pregnancy rates and I was using ultrasound guidance in both groups, it was just comparing these two catheters. Although I didn't find any difference in pregnancy rates, I did think the catheter was very convenient to use. This is especially so in the women who are obese or with retroverted uteri or when a bladder was not full."

Hans van der Slikke, MD, PhD: "Why do you use ultrasound guidance?"

Vishvanath Karande, MD: "Ultrasound guidance is not something which is new, it has been around for more than fifteen years. I think it was Strickler and then it was later Leong that came out with ultrasound guidance embryo transfers. For about ten years there was not much data supporting the use of ultrasound guidance but for the last three years there have been about eight or ten publications where they're now finding statistically significant pregnancy rates with ultrasound guidance compared to ¨clinical touch¨, and we have found that in our practice as well."

Hans van der Slikke, MD, PhD: "Can you elaborate on the details of why you're using this because one could say if you did ultrasound before you'd know the length of the uterine cavity and the position so it's as easy as doing it with guidance. You just put it in, pull back one centimeter and you're there."

Vishvanath Karande, MD: "What you're saying theoretically makes a lot of sense to me, but the results that has been published and studies are otherwise. There was a paper by a group in Australia where they had experienced physicians place the embryo transfer catheter where they thought they would do the transfer. Then they put in the ultrasound and in a significant percentage of cases the tip was in the wrong place so I'm willing to accept that there are centers where physicians have established pregnancy rates with just clinical touch. Maybe those people don't need to make any adjustments but I firmly believe that in a majority of programs the use of ultrasound guidance in embryo transfers should have a positive impact on pregnancy rates."

Hans van der Slikke, MD, PhD: "What kind of research do you plan next for the future?"

Vishvanath Karande, MD: "With ultrasound guidance?"

Hans van der Slikke, MD, PhD: "Yes, in this field, do you already have new trials set up?"

Vishvanath Karande, MD: "There are other people that have asked me to look at their catheters but currently I don't have any ongoing study in this particular field."

Hans van der Slikke, MD, PhD: "Thank you very much for this talk."

Vishvanath Karande, MD: "My pleasure, thank you."