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An alternative method to transferring embryos through the cervix is transmyometrial embryo transfer (TMET), also known as the Towako method [15–18]. The technique is performed under transvaginal ultrasound guidance (see Chapter 65) and is not too dissimilar to oocyte retrieval. A special needle (Towako Needle Set, Cook IVF, Queensland, Australia) with its stylet attached to the vaginal probe needle holder is inserted transmyometrially and guided into the endometrial cavity. The stylet is removed, and a transfer catheter loaded with embryos is passed through the needle [18].

Despite concern about possible trauma to the endometrium, the pregnancy rate following TMET is similar to that with easy transcervical transfer [15–17]. The advantages of TMET include the ability to transfer embryos regardless of the severity of cervical stenosis, such as cases of post radical trachelectomy (Case History 2) [19,20]. It could also be performed with minimal or no sedation and provides an immediate solution to cases of cervical stenosis discovered for the first time at ET [18]. However, it requires special expertise and catheters that may not be available in every center.