Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Endometrial Aspiration & Pregnancy Resolution

Am J Obstet Gynecol; ePub 2017 Apr 19; Insogna, et al

By utilizing endometrial aspiration with Karman cannula, a large proportion of women with pregnancy of unknown location (PUL) following in vitro fertilization (IVF) can be spared methotrexate, with a shorter time to pregnancy resolution than those receiving methotrexate, a recent study found. The retrospective cohort study included 14,505 autologous fresh and frozen IVF cycles from October 2007 to September 2015. 110 patients were diagnosed with PUL and underwent outpatient endometrial sampling with Karman cannula aspiration. Among the results:

  • Among women with PUL, failed intrauterine pregnancy was diagnosed in 46 (42%) patients and ectopic pregnancy in 64 (58%) patients, across 8 years of follow-up.
  • 100% of patients with failed intrauterine pregnancy demonstrated adequate post-sampling human chorionic gonadotropin (hCG) declines, while villi were identified in just 46% of patients.
  • Patients with failed intrauterine pregnancy had significantly shorter time to resolution after sampling compared to patients with ectopic pregnancy.


Insogna IG, Farland LV, Missmer SA, Ginsburg ES, Brady PC. Outpatient endometrial aspiration: An alternative to methotrexate for pregnancy of unknown location. [Published online ahead of print April 19, 2017]. Am J Obstet Gynecol. doi:10.1016/j.ajog.2017.04.023.