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

Objective: To evaluate the place of cervical dilatation performed at the in itial visit in an IVF-ET cycle in patients with known cervical stenosis. Design: Retrospective study. Setting: A tertiary care assisted conception unit. Patient(s): Fifty-seven patients who failed to conceive after a previous ET attempt and in whom the ET was classified as "difficult." Intervention(s): Cervical dilatation under general anesthesia after pituita ry suppression and before gonadotropin stimulation. Main Outcome Measure(s): Ease of the ET procedure and clinical pregnancy ra ts. Result(s): Eighteen (31.6%) of 57 women who failed to conceive after a prev ious attempt at IVF-ET achieved a clinical pregnancy after cervical dilatat ion. In 40 patients (70.2%), the subsequent ET was classified as "easy," wh ereas in the other 17 (29.8%), it remained difficult. The pregnancy rate wa s significantly higher when the ET was easy than when it was difficult (40% versus 11.8%, P<.05). Conclusion(s): In patients with cervical stenosis and a previous difficult ET, cervical dilatation during the initial visit leads to an easier subsequ ent ET and improves the pregnancy rate. (Fertil Steril(R) 1999;72:610-12. ( C) 1999 by American Society for Reproductive Medicine.).