Objectives: To facilitate embryo transfer technique in cases with previous failed or difficult transfer using office hysteroscopy. Study Design: Case report of 3 cases of previous difficult embryo transfer (ET). Methods: Hysteroscopic assisted insertion of cervical stent at the end of withdrawal bleeding in the stimulation cycle. This stent was used as a track for embryo transfer catheter. Results: One case cancelled before (embryo transfer) ET and the other 2 cases didn’t get pregnant in spite of easy embryo transfer. Conclusion: This hysteroscopic assisted ET technique may facilitate ET technique in cases with difficult embryo transfer due to deformed cervix.
Embryo transfer is a crucial step in the process of (intra cytoplasmic sperm injection) ICSI. Systematic reviews have shown that US guidance improves the clinical pregnancy, ongoing pregnancy, and live-birth rates in women when compared with the standard clinical touch method [
Different maneuvers were tried to overcome difficult transfer; when patent tubes are present, zygote intrafallopian transfer is an excellent way in cases of failed or difficult cervical transfer [
Facilitate embryo transfer technique in cases with previous failed or difficult transfer using office hysteroscopy.
Case report of 3 cases of previous difficult embryo transfer due to abnormal cervical canal associated with irregular track or acute angulation of the cervix.
2 cases of previous difficult embryo transfer and one case of cancelled transfer and all embryos were cryo preserved.
The first case was 37-year-old complaining of secondary infertility 10 years after first trimester abortion. She had 3 trials of ICSI/ ET but were unsuccessful. The last two trials were very difficult and under general anesthesia with prolonged maneuver. Office hysteroscopy was done before the last trial and revealed abnormal cervical canal track. In this trial she had very easy ET for one embryo (4A) on day 3.
The second case is 39-year-old with previous failed one trial of ICSI due to failed embryo transfer and three embryos were cryo preserved. Office hysteroscopy was done and revealed fibrosed cervical canal with irregular track. In this trial she had smooth ET for two (4A, 4B) embryos.
The third case was 37-year-old with previous failed 2 trials of ICSI with extreme difficulty in embryo transfer. in this trial there was failure of fertilization.
Informed written consent was taken from the patients after explaining the technique and its complications and that it is under trial.
After complete pituitary down regulation with the end of the withdrawal bleeding office hysteroscopy was done using Trophy scope® (Storz) with distension media (normal saline 0.9%) to insert guide wire 4 Fr (
distance between the external os and just above the internal os. Doxycycline 100 mg was given twice daily for 7 days. On the day of embryo transfer repeated wash of the catheter using Ham’s F10 media® (Irvine scientific) (Nutrient Mixture) composed of L-glutamine and sodium bicarbonate, Sterile-filtered, Endotoxin tested and Cell culture tested previously incubated to remove any discharge or any debris. Ultrasound guided embryo transfer by labotect® embryo transfer catheter and then the stent was removed.
Difficult embryo transfer is a problem that affects the outcome of IVF and ICSI cases. In this technique, introducing the embryo transfer catheter through the stent was very easy without need for anesthesia, less invasive without any trauma to the endometrium near the time of embryo transfer. If compared to the other approaches used for difficult transfer it is easier.
Different maneuvers were tried before by changing the type of embryo transfer catheter type but this isn’t helpful in all cases. Hysteroscopic shaving of the cervical canal was tried before to facilitate the transfer in cases with abnormal cervical canal [
The two problems which may be encountered are infection and the material of the catheter used. Patients with recurrent vaginitis or cervicitis may not be a suitable candidate for this technique. Also, vaginal and cervical culture and sensitivity must be done before insertion to avoid ascending uterine or pelvic infection. So, hysteroscopic guided insertion of cervical stent may be a tool in cases of difficult or failed embryo transfer due to abnormal cervical track. The small number of cases was the limitation to this technique assessment. So, further trial on wide scale may improve the outcome.
To the IVF laboratory staff members for their technical support.
There is nothing to disclose.
MohamedElmahdy,Hoda F. AbdelSalam,Nehal A.Kobeisy, (2016) Office Hysteroscopy in Difficult Embryo Transfer; Case Report of Three Cases. Open Journal of Obstetrics and Gynecology,06,167-170. doi: 10.4236/ojog.2016.63021