Comparing Two Types of Endometrial Activation Before Embryo Transfer: a Pilot Study

Although endometrial activation has been shown to significantly improve clinical pregnancy rates and live birth rates in women undergoing ART, the type of endometrial procedure has not been specified. Our objective was to determine if two types of endometrial activation, Pipelle curette or Shepard malleable insemination catheter prior to embryo transfer result in similar live birth rates. Also to determine if patients experience similar pain from both types of endometrial activation. Prospective, non-blinded, randomized controlled trial with parallel treatment arms of women undergoing ART. Patients were randomized to either standard endometrial biopsy with a Pipelle or four quadrant endometrial activation with a Shepard insemination catheter in the cycle before the embryo transfer. Immediately following the endometrial procedure, patients recorded their pain level on a Numerical Rating Scale. The rest of the IVF cycle and embryo transfer proceeded by standard protocols and procedures. Groups were compared with means, standard deviations, and p-values by Chi-squared testing for normally distributed data and medians, interquartile ranges, and p-values by Mann-Whitney testing for non-normally distributed data. Based on an 80% power calculation in which a 10% change in live birth rate was deemed to be clinically significant, we calculated that the sample size needed to attain adequate power was 200 total patients. There were 94 patients in the Pipelle curette group and 103 in the Shepard catheter group. Pain was significant less for the Shepherd catheter group. The live birth rates were similar.Tabled 1Pipelle Curette vs Shephard CatheterPipelle Curette (n=94)Shepard Catheter (n=103)p-valueAge (Median)35340.76BMI (Mean)24.925.10.88Live Birth Rate (%)38330.43Pain (Median [ IQR])4 [2-6]3 [1-5 ]0.005 Open table in a new tab Our study indicates no difference in live birth rate for two types of endometrial activation. There was however, a difference in patient pain scales with four quadrant endometrial activation with a Shepard catheter having a significantly lower pain score than with Pipelle. This data gives us some guidance as to the type of endometrial activation to be performed prior to ART. With comparable outcomes and less pain, endometrial activation with a Shepherd catheter is preferred over the more painful Pipelle.