Successful hysteroscopic cannulation and tubal transfer of cryopreserved embryos

Clinical trials comparing nonsurgical transfer techniques with laparoscopic directed methods are needed to determine the most successful and cost-effective approach for gamete and ET. We report the successful nonsurgical transfer of frozen-thawed embryos into the fallopian tube after our initial attempt resulting in an ongoing IUP. The process is relatively simple, safe, and avoids the risks of general anesthesia. Unlike US-guided tubal cannulation, this technique offers direct, clear visualization of the tubal ostium, assuring the desired catheter placement. As well, hysteroscopic guidance allows an accurate estimate of the depth of catheter insertion within the fallopian tube, which may be a critical factor in successful tubal deposition of gametes or embryos. Whether prolonged carbon dioxide exposure of the tubal microenvironment and/or direct endometrial trauma limits the efficacy of this technique remains to be determined. Finally, outpatient hysteroscopic directed tubal cannulation holds promise as a methodological technique that ultimately assists in the examination of the best site for embryo deposition (tubal versus uterine) and/or method of delivery (nonsurgical versus surgical).