In vitro fertilization outcome relative to embryo transfer difficulty: a novel approach to the forbidding cervix

Objective: To assess the impact of ET difficulty on IVF outcome and to opti mize the ET procedure. Design: Retrospective analysis of IVF outcome by ET catheter type and ET di fficulty. Prospective treatment and follow-up of patients with a history of extremely difficult cervical passage. Setting: Large university-based IVF program. Patient(s): All patients <40 years of age undergoing IVF-ET from September 1995 to May 1998. Intervention(s): Surgical correction of cervical stenosis. Main Outcome Measure(s): Pregnancy and embryo implantation rates. Result(s): Only 0.6% of ETs were "extremely difficult." Pregnancy rates wer e not statistically significantly different among ETs graded easy, moderate , and difficult. In contrast, no pregnancies occurred in the rare "extremel y difficult" ET group. Eight patients with a history of extremely difficult cervical passage underwent surgical correction of their cervical stenosis. Twelve postoperative IVF-ET in these women resulted in eight clinical preg nancies, six of which were multiple gestations. The embryo implantation rat e of these cycles was 42.2%. Conclusion(s): Patients with a history of extremely difficult ET may benefi t from hysteroscopic evaluation and possible modification of their cervical canal before a future IVF attempt. (C) 1999 by American Society for Reprod uctive Medicine.