177HYSTEROSCOPIC BLASTOCYST IMPLANTATION A NOVEL EMBRYO TRANSFER PROCEDURE

Abstract

Various techniques using different types of catheters have been advocated to increase pregnancy rates while reducing side effects from the embryo transfer procedure. However, all of these techniques are ‘blind’ procedures of catheter introduction into the uterus, and the problems of ‘lost embryos’ and the occurrence of ectopic pregnancies persist. A novel hysteroscopic-guided direct embryo transfer procedure with visually directed embryo implantation was developed to improve the current ‘blind’ embryo transfer procedures by increasing chances of success while eliminating tubal pregnancies and decreasing high-order multiple pregnancies from IVF related techniques. At West Coast Infertility Medical Clinic, 57 patients with average age of 28.43±4.54 were analyzed. Stimulation method: controlled ovarian hyperstimulation was initiated with Follitropin β; (Follistim®, Organon Pharmaceuticals, Inc.). Premature endogenous gonadotropin surge (i.e. the prevention of an LH surge) was controlled with ganirelix acitate (AntagonTM, Organon Pharmaceuticals, Inc., West Orange, NJ, USA.). Oocyte retrieval was performed in an office setting under local anesthesia and mild sedation, followed by routine IVF/ICSI, IVC. By Day 5–6, up to 2 best quality blastocyst stage embryos were transferred to patient’s uterus by ‘hysteroscopic embryo implantation’ procedure: a lightweight hybrid (rigid/flexible) mini hysteroscope (Napoli, Inc., Los Angeles, CA, USA) was used for visualization of the endometrial cavity. The scope incorporates a flexible distal end of 3mm in diameter with a straight-through operating channel. In addition, the optic filter is directly connected to a light source, decreasing the weight of the scope and giving a better feel for the scope. The transfer catheter (Napoli, Inc.) is polycarbon based with a tapered tip (to 500μm), beveled to 60°. During embryo transfer procedure, the catheter tip was inserted into a depth of 1mm from the surface of the endometrium under direct hysteroscopic visualization. The loaded embryos with 10μL medium was released underneath the endometrium to produce a ‘bubble’ cushion. Luteal phase support was provided (3000IU of hCG at Day 3 and Day 6 post-retrieval, separately). Pregnancies were determined by serum hCG concentration of 5IUmL−1 or more at Day 16 post-retrieval. Thirty out of 57 (52.6%) women became pregnant. Multiple pregnancy rate was 4 out of 30 (13.3%) and comprised only of twins, and no ectopic pregnancy was found. In conclusion, a newly developed instrument and embryo transfer procedure by mechanical implantation of the embryo was achieved. By implanting the embryos, we have reduced the number of embryos that are transfered, minimized the chances of ‘losing’ embryos, and eliminated ectopic pregnancies.