Prospective Randomized Trial Comparing Embryo Transfers of Cases with and without Catheter Rotation during Its Withdrawal

Abstract

Objective: To compare embryo transfer (ET) technique based on catheter rotation during its withdrawal in cases with unexplained infertility in a prospective, randomized trial (NCT03097042). Methods: Two hundred intracytoplasmic sperm injection (ICSI) patients undergoing ET with cleaving or blastocyst-stage fresh embryos were randomized into 2 groups: cases with (n = 100), and without (n = 100) catheter rotation during its withdrawal. Groups were matched for age and some clinical parameters. A soft catheter was used to transfer a single embryo with catheter rotation during its withdrawal in the study group and without rotation in the control. The use of a stiff catheter or tenaculum was not needed in any case. Groups were compared in terms of cycle characteristics and clinical pregnancy rates. Results: Pregnancy rate was significantly higher in the study group (41 vs. 26%, p = 0.04). Clinical pregnancy rate was also significantly higher in the study group (39 vs. 25%, OR 1.9 [1.1–3.5], p = 0.05). On the other hand, the ongoing pregnancy rate was similar between the 2 groups (33 vs. 23%, p = 0.2). Conclusion: Catheter rotation during its withdrawal may be associated with increased pregnancy and clinical pregnancy rates; however, the difference in ongoing pregnancy rates did not reach statistical significance.

Does rotation during catheter withdrawal in embryo transfer increase pregnancy rates?

“…There was no evidence that catheter rotation following ET had a positive effect on pregnancy outcomes. These results were different from those reported by Yayla Abide et al, 12 and we attributed this discrepancy to the small number of samples in their study. On average, ET is performed on day 5 after ovarian stimulation in our clinic at the present time.…”

“…1 Rotation of embryo transfer catheter during withdrawal. 12 that aspiration of cervical mucus through the endocervical canal using sterile cotton swabs or a catheter improved clinical outcomes, 8,9 and others showed no change in pregnancy results with the use of cervical brush removal. 13 A meta-analysis of Craciunas of medium-and low-quality studies showed that removing cervical mucus before ET was of little benefit.…”

“…The strengths of the study were that a single physician performed the ETs, and the number of patients was much higher than those in previous studies. 12 During the planning stages of this study, rotation was considered to have potential to increase ET efficiency and result in higher pregnancy rates. However, the results of this study suggest that this technique was ineffective.…”

“…10,11 A recent study reported that after ET, rotating the catheter by 360° while withdrawing it ensured that the embryo remained in the uterus, rather than being removed due to adherence to the cervical mucus in the catheter tip, thereby improving the pregnancy rate. 12…”

“…10,11 A recent study reported that after ET, rotating the catheter by 360° while withdrawing it ensured that the embryo remained in the uterus, rather than being removed due to adherence to the cervical mucus in the catheter tip, thereby improving the pregnancy rate. 12 The present study was performed to determine whether there is a difference in pregnancy rate according to use of ET catheter rotation by retrospectively examining the files of patients in whom the ET catheter was removed either directly or by rotating 360°.…”