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This chapter explores the essential features of embryo transfer (ET) catheters that may have an impact on the success of in vitro fertilization (IVF) in an evidence-based approach. ET catheters can be subdivided mainly on the basis of the material they are made of and whether they are equipped with, or without, an introducing cannula that facilitates the transfer procedure. Despite the wide variations in the design of ET catheters, the main features that have been studied and found to have a possible influence on the success of ET procedure include flexibility, with or without outer sheath, and echodensity. A more recent systematic review and meta-analysis comparing soft catheters with hard (TDT) catheters demonstrated an increased chance of clinical pregnancy when soft ET catheters were used. The use of ultrasound guidance to facilitate ET has proven useful in women with a previously difficult transfer.
The dummy embryo transfer (ET) before the actual one, has been shown to improve the pregnancy rates. It also helps in choosing the most suitable kind of catheter to be used. Proper evaluation of the cervico-uterine angle and determining how much curvature is needed for the catheter should be done before loading the embryos. That is why it is important to perform a dummy ET right before the actual one and revise the previously performed ultrasound picture of the uterus. It has been demonstrated that curving the ET catheter according to the cervico-uterine angle improves the clinical pregnancy rate. One method to facilitate introduction of the catheter is simply by gentle maneuvering of the vaginal speculum. Using a malleable stylet to place the outer sheath correctly and negotiate the cervical canal before introducing the soft catheter was found to have no negative impact on implantation and delivery rates.
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