Transfert embryonnaire en cas de col sténosé et/ou infranchissable

Transmyometrial embryo transfer as a useful method to overcome difficult embryo transfers - a single-center retrospective study

OBJECTIVE

Pregnancy after an embryo transfer depends largely on embryo quality, endometrial receptivity, and the technique used in the embryo transfer. Embryo transfers have been reported as inevitably traumatic and difficult for 5-7% of patients in assisted reproduction treatment. In these cases, transmyometrial embryo transfer should be considered as a suitable method to overcome difficult embryo transfers. The aim of this study was to report our experience with this technique and analyze its causes, results and complications.

METHODS

Since 1993, 39 women (40 cycles of assisted reproductive technology treatment) were submitted to transmyometrial embryo transfers in our center. The procedures were carried out as described by the Towako group.

RESULTS

The enrolled female patients had a mean age of 34 years and a mean baseline FSH level of 6.89 IU/mL. The median number of retrieved oocytes was 7.50 and a mean of 2.63 embryos were transferred. Implantation rate was 9.5%. With respect to clinical results, pregnancy and miscarriage rates were 25% and 30%, respectively. Since there were two twin pregnancies, the live birth rate was 22.5% (9/40). No major complications were reported.

CONCLUSION

Transmyometrial embryo transfer can and should be an option in cases of difficult/impossible transcervical embryo transfer.

Fertility-preserving surgery in patients with early stage cervical carcinoma

Fertility preservation is an important issue for patients in reproductive age with early stage cervical cancer. In view of recent developments, our purpose was to review and discuss available surgical alternatives. A literature search was conducted using PUBMED, including papers between 1980 and December 2011. In patients with stage IA1 cervical cancer, conization is a valid alternative. Patients with stage IA2-IB1 disease can be conservatively treated by radical trachelectomy. This is as well-established conservative approach and appears to be safe and effective in allowing a high chance of conception. Prematurity is the most serious issue in pregnancies following trachelectomy. Less invasive options such as simple trachelectomy or conization seem to be feasible for stages IA2-IB1, but more and better evidence is needed. Neoadjuvant therapy might allow conservative surgery to be performed also in patients with more extensive lesions. Ovarian transposition is important when adjuvant radiation is needed. In conclusion, available literature shows that there are interesting fertility-sparing treatment alternatives to the “golden standard” for the management of early cervical cancer in young women.

Use of Versapoint to refashion the cervical canal to overcome unusually difficult embryo transfers and improve in-vitro fertilization-embryo transfer outcome: A case series

BACKGROUND

Smooth atraumatic embryo transfer is paramount for the success of in-vitro fertilization (IVF). In difficult cases, cervical canal manipulation may be required.

AIM

To see if surgical correction of the cervical canal or cervical canal refashioning could improve ease of embryo transfer.

SETTING

Private infertility and IVF hospital.

DESIGN

Prospective study.

MATERIALS AND METHODS

PATIENTS

11 women with failed 1-3 IVF cycles with history of extremely difficult embryo transfers (ETs) despite undergoing cervical dilatation in the cycle prior to IVF.

INTERVENTIONS

Operative hysteroscopy using Versapoint for refashioning of the cervical canal.

MAIN OUTCOME MEASURES

Ease of ET in the subsequent IVF cycle. Secondary outcome measure was to assess reproductive outcome.

RESULTS

Easy and atraumatic ET in the IVF cycle after procedure in 100% patients. PR was 46.5%.

CONCLUSIONS

Use of Versapoint for refashioning the cervical canal can improve the quality of ET and PR.