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Live birth after transmyometrial embryo transfer in a patient with radical trachelectomy
Claire A Jones1, Justin Tan1, Pat Chronis-Brown2
1Division of Gynecologic Reproductive Endocrinology and Infertility, Department of Obstetrics Medicine, University of Toronto, Toronto, Ontario, Canada; Mount Sinai Fertility, Toronto, Ontario, Canada.
Objective:
To report the successful utilization of transmyometrial embryo transfer (TMET) in a patient with a history of radical trachelectomy.
Design:
Video article.
Setting:
Academic fertility center.
Patient(S):
A 39-year-old, para 1, woman with a history of radical trachelectomy and abdominal cerclage presented with secondary infertility. Her previous pregnancy was conceived naturally. Her first in vitro fertilization (IVF) cycle yielded only one day 7 euploid blastocyst. All attempts at performing mock embryo transfers, cervical dilatation, and hysteroscopy were unsuccessful because of absence of clinically identifiable cervical tissue. The euploid embryo was transferred into a gestational carrier; however, this resulted in a biochemical pregnancy. She underwent a second IVF cycle that yielded one day 5 euploid blastocyst. Given her history, TMET was planned. The patient included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites (e.g., PubMed, ScienceDirect, and Scopus) and other applicable sites.
Intervention(S):
Transmyometrial embryo transfer using the Towako catheter.
Main Outcome Measure(S):
Implantation, clinical pregnancy, and live birth.
Result(S):
After institutional and Health Canada approval of the Towako catheter, a transvaginal ultrasound-guided TMET was performed under sedation with intravenous midazolam and fentanyl. The day 5 euploid blastocyst from the second IVF cycle was transferred, and the patient's β-human chorionic gonadotropin levels 9 and 11 days after TMET were 86 and 262 IU/L, respectively. A single intrauterine pregnancy with cardiac activity of 119 beats/min was noted at a gestational age of 7 weeks and 2 days. The patient delivered a live singleton at 35 weeks and 2 days weighing 2,182 g.
Conclusion(S):
Transmyometrial embryo transfer is a useful clinical technique for transferring embryos in patients with acquired or congenital cervical issues in whom transcervical embryo transfer is either very difficult or impossible.
