P-417 Transmyometrial embryo transfer as a reliable alternative to challenging transcervical embryo transfer

Abstract

Abstract Study question Can transmyometrial embryo transfer be a reliable alternative to challenging transcervical embryo transfer Summary answer In selected cases, where transcervical embryo transfer is impossible, transmyometrial embryo transfer is a suitable alternative. What is known already Transmyometrial embryo transfer (TMET) can be a last resort option for challenging transcervical embryo transfer (ET). Indications for TMET include; failure to access the uterus transcervically due to previous cervical surgery, stenosed cervix which will not dilate or due to challenging cervical anatomy. This technique is done by passing a long needle through the myometrium to enter the uterine cavity. This can be a less traumatic option than multiple attempts at ET with the added consequences of using a tenaculum. This centre has been performing TMET since 2004. Study design, size, duration This was a retrospective audit looking at TMET cases from 2004 to 2023. 125 cases were recorded and reviewed. Participants/materials, setting, methods The results are from a single centre unit which receives referrals for TMET from outside units. This was an audit and cases were initially found by reviewing all cases of embryo transfer from 2004. Where TMET had been recorded, the notes were then collected to ascertain patient demographics, reasons for transmyometrial embryo transfer, embryo grading and pregnancy outcomes. Main results and the role of chance Since 2004, 125 cases of TMET were recorded. 16 notes were excluded as there was unclear documentation on the type of embryo transfer, leaving 109 cases. There were 23 positive pregnancy tests, 6 documented scans showing a fetal heart at 7 weeks and three documented live births. Indication for TMET was mainly a failure to enter the uterine cavity due to stenosed cervix. In all cases of TMET, patient’s had undergone multiple attempts at accessing the uterine cavity, along with multiple attempts at hysteroscopy and dilatation. Only after trying all other options was TMET used, and mainly as a last resort measure. All cases were planned and used frozen blastocysts. There were no complications to TMET. Due to the last resort nature of TMET and the reasons for undergoing assisted reproductive technology it is unlikely these pregnancies were by chance. Limitations, reasons for caution Due to the length of time this centre has been doing TMET the documentation from the earlier cases was poor and births could have been missed due to poor follow up. Training in TMET is difficult due to the low numbers per year. Wider implications of the findings TMET remains a safe and reliable alternative option when facing a challenging transcervical embryo transfer and should be used as a last resort measure. Trial registration number not applicable