Overcoming Cervical Stenosis: A Case Study of Transmyometrial Embryo Transfer in Infertility Treatment.

Abstract

Cervical stenosis can be congenital or acquired, often resulting from previous surgeries, radiation therapy, or infections. It presents a significant challenge for embryo transfer during in vitro fertilization (IVF) procedures. This case study highlights the successful use of transmyometrial embryo transfer (TMET) as an alternative approach in a patient with severe cervical stenosis, leading to a positive clinical pregnancy outcome. A 36-year-old woman with primary infertility for four years underwent three failed IVF attempts due to severe cervical stenosis. Despite multiple attempts at conventional transcervical embryo transfer, the procedures were unsuccessful, resulting in complications such as cervical bleeding and uterine contractions. Her husband's semen analysis was normal. Following detailed counseling, the decision was made to proceed with TMET under ultrasound guidance. A catheter was inserted through the myometrium directly into the uterine cavity for embryo placement. The TMET procedure was performed without complications. Embryo transfer was successful, and the patient demonstrated a positive clinical pregnancy outcome. Early pregnancy monitoring revealed appropriate gestational sac development, and no further complications were reported. This case illustrates the effectiveness of TMET in overcoming anatomical barriers caused by cervical stenosis. TMET offers a viable alternative for patients who experience recurrent implantation failure due to failed transcervical transfers. Careful patient selection and the use of ultrasound guidance are essential for maximizing success rates and minimizing complications. Further research and comparative studies are recommended to establish standardized protocols and assess long-term outcomes of TMET in similar cases. TMET proved effective for a patient with severe cervical stenosis, leading to a successful pregnancy. Ultrasound guidance and careful patient selection were key to the procedure's success.