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Assisted Reproduction Techniques


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difficulty, then we will plan how to overcome it, either by dilating the cervix or using a special transfer catheter. That way, when we get to the real embryo transfer, we will be ready, and your transfer will be easy.

      3  Q3 What will happen if my embryo transfer turns out to be difficult on the day of the treatment? A3. We will try using different catheters or techniques to make it easy, but if we couldn’t, we will freeze the embryos and then work out a plan to overcome the tight cervix (which may involve dilating it or using special catheters) and then do the embryo transfer on a later date. Studies have shown that the pregnancy rate from frozen embryos is as good as fresh embryos. Our aim is to give you the highest pregnancy rate through an easy transfer, and if that could not be done on the planned date, then it is better to freeze the embryos.

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      2 2 Valle RF, Sankpal R, Marlow JL, Cohen L. Cervical stenosis: a challenging clinical entity. J Gynecol Surg. 2002 Dec 1; 18(4):129–43.

      3 3 Wood MA, Kerrigan KL, Burns MK, Glenn TL, Ludwin A, Christianson MS, et al. Overcoming the challenging cervix: identification and techniques to access the uterine cavity. Obstet Gynecol Surv. 2018; 73(11):641–9.

      4 4 Groutz A, Lessing JB, Wolf Y, Yovel I, Azem F, Amit A. Cervical dilatation during ovum pick‐up in patients with cervical stenosis: effect on pregnancy outcome in an in vitro; fertilization‐embryo transfer program. Fertil Steril. 1997; 67(5):909–11.

      5 5 Glatstein IZ, Pang SC, McShane PM. Successful pregnancies with the use of laminaria tents before embryo transfer for refractory cervical stenosis. Fertil Steril. 1997; 67:1172–4.

      6 6 Abusheikha N, Lass A, Akagbosu F, Brinsden P. How useful is cervical dilatation in patients with cervical stenosis who are participating in an in vitro; fertilization‐embryo transfer program? The Bourn Hall experience. Fertil Steril. 1999; 72:610–2.

      7 7 Pabuccu R, Ceyhan ST, Onalan G, Goktolga U, Ercan CM, Selam B. Successful treatment of cervical stenosis with hysteroscopic canalization before embryo transfer in patients undergoing IVF: A case series. J Minim Invasive Gynecol. 2005; 12:436–8.

      8 8 Tomás C, Tikkinen K, Tuomivaara L, Tapanainen JS, Martikainen H. The degree of difficulty of embryo transfer is an independent factor for predicting pregnancy. Hum Reprod. 2002 Oct 1; 17(10):2632–5.

      9 9 Agameya A‐F, Sallam HN. Does a difficult embryo transfer affect the results of IVF and ICSI? A meta‐analysis of controlled studies. Fertil Steril. 2014; 101(2):e8.

      10 10 Sharif K, Serour GI. Dummy Embryo Transfer. In: Kovacs G, Salamonsen L, editors. How to Prepare the Endometrium to Maximize Implantation Rates and IVF Success. Cambridge: Cambridge University Press; 2019. p. 104–8.

      11 11 Prapas N, Prapas Y, Panagiotidis Y, Prapa S, Vanderzwalmen P, Makedos G. Cervical dilatation has a positive impact on the outcome of IVF in randomly assigned cases having two previous difficult embryo transfers. Hum Reprod. 2004; 19:1791–5.

      12 12 Visser DS, Fourie F, Kruger HF. Multiple attempts at embryo transfer: effect on pregnancy outcome in an in vitro; fertilization and embryo transfer program. J Assist Reprod Genet. 1993; 10:37–43.

      13 13 Mains L, Van Voorhis BJ. Optimizing the technique of embryo transfer. Fertil Steril. 2010; 94(3):785–90.

      14 14 Serhal P, Ranieri DM, Khadum I, Wakim RA. Cervical dilatation with hygroscopic rods prior to ovarian stimulation facilitates embryo transfer. Hum Reprod. 2003; 18(12):2618–20.

      15 15 Kato O, Takatsuka R, Asch RH. Transvaginal‐transmyometrial embryo transfer: the Towako method; experience of 104 cases. Fertil Steril. 1993; 59:51–3.

      16 16 Kato O. Four years’ experience of transmyometrial embryo transfer. IXth World Congress on In vitro Fertilisation and Alternate Assisted Reproduction, Vienna. J Assist Reprod Genet. 1995; 12 (Supple:11S).

      17 17 Sharif K, Afnan M, Lenton W, Bilalis D, Hunjan M, Khalaf Y. Transmyometrial embryo transfer after difficult immediate mock transcervical transfer. Fertil Steril. 1996; 65(5):1071–4.

      18 18 Sharif K, Kato O. Technique of transmyometrial embryo transfer. Middle East Fertil Soc J. 1998; 3(2):124–9.

      19 19 Jamal W, Phillips SJ, Hemmings R, Lapensée L, Couturier B, Bissonnette F, et al. Successful pregnancy following novel IVF protocol and transmyometrial embryo transfer after radical vaginal trachelectomy. Reprod Biomed Online. 2009; 18(5):700–3.

      20 20 Wong I, Justin W, Gangooly S, Sabatini L, Al‐Shawaf T, Davis C, et al. Assisted conception following radical trachelectomy. Hum Reprod. 2008 Dec 18; 24(4):876–9.

      21 21 Yang YS, Melinda S, Ho HN, Hwang JL, Chen SU, Lin HR, et al. Effect of the number and depth of embryos transferred and unilateral or bilateral transfer in tubal embryo transfer (TET). J Assist Reprod Genet. 1992; 9:534–8.

      22 22 Maxwell SM, Melzer‐Ross K, McCulloh DH, Grifo JA. A comparison of pregnancy outcomes between day 3 and day 5/6 embryo transfers: does day of embryo transfer really make a difference? J Assist Reprod Genet. 2015; 32:249–54.

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