Читать книгу Assisted Reproduction Techniques - Группа авторов - Страница 219

Challenge: Patient with cervical stenosis presenting for IVF.

Background:

 Cervical stenosis occurs in about 1% of cases presenting for IVF.

 Some are associated with severe dysmenorrhea or even amenorrhea, but most are asymptomatic.

 Could be caused by DES exposure in utero or previous cervical surgery but most are of unknown etiology.

Management options:

 Take history of previous cervical surgery or difficult or painful cervical instrumentation.

 Perform mock ET to identify cases and plan action.

 Cervical dilatation at the start of the IVF cycles will make ET easier and increase the pregnancy rate.

 Cervical dilatation at the time of oocyte retrieval makes ET easier but does not seem to increase the pregnancy rate.

 Transmyometrial ET could overcome the most difficult or impossible cases as it bypasses the cervix and leads to a pregnancy rate similar to easy transcervical transfer.

 Tubal ET is an alternative in cases with normal fallopian tubes but requires laparoscopy and general anesthesia.

 Hysteroscopic canalization of the cervix has been reported but should only be reserved for cases associated with amenorrhea or significant dysmenorrhea due to cervical stenosis.