Pregnancy following a difficult transfer: a case report

Successful pregnancy and delivery after delaying the initiation of progesterone supplementation in a postmenopausal donor oocyte recipient

Progesterone luteal support has become a standard procedure during IVF cycles. Donor egg cycle women without inherent ovarian function require complete hormone replacement, in contrast with women undergoing IVF in which luteal support is used to supplement endogenous progesterone production. Progesterone support is clearly beneficial, although the timing of its initiation can affect overall outcomes. This paper describes a case in which a postmenopausal woman attending for oocyte donation did not receive her first progesterone injection at the correct time. Treatment with progesterone began when she arrived for the transfer of the donor embryos. The two embryos were maintained in culture and one was transferred on day 6 when the delayed progesterone administration had induced a secretory transformation in her endometrium. A single gestation sac was recorded 8 weeks later, and a healthy baby was subsequently born. On the morning of day 6, delayed progesterone supplementation had induced the secretory endometrial transformation typical of the second phase of the menstrual cycle.

Embryo transfer: hysteroscopic assessment of transfer catheter effects on the endometrium

So far as is known, this is the first series to report the effects of embryo transfers on endometrial integrity as assessed by direct hysteroscopic visualization. Subjects (n = 30) were patients of reproductive age undergoing diagnostic hysteroscopy. A mock embryo transfer was performed by a single clinician, immediately followed by saline hysteroscopy using a 2.7 mm hysteroscope. Hegar dilators or uterine sounds were not used. Representative video clips were recorded for independent assessment of endometrial integrity. (The movie sequence may be purchased for viewing on the internet at www.rbmonline.com/Article/1040; it is free to web subscribers.) Outcomes measured were ease of transfer (easy, moderate, difficult, very difficult) and details of the transfer technique. Endometrial damage was independently assessed and graded as follows: none, minor, moderate or severe. Of the easy transfers, 54% showed no endometrial damage. However, there 37% showed moderate to severe damage in the easy transfer group. Of the moderately difficult transfers, there was no clear association between perceived difficulty of transfer and amount of endometrial damage. Clinical perception of ease of transfer does not correlate well with the degree of endometrial disruption (P = 0.41). Use of hysteroscopy offers a unique insight into the effects of embryo transfer on endometrial integrity.