The use of hygroscopic cervical rods (Dilapan-S TM) in patients with cervical stenosis undergoing in vitro fertilization

Abstract

Objective: To assess the value of cervical dilatation with hygroscopic cervical rods (Dilapan-S TM) in patients with cervical stenosis prior to starting gonadotrophin stimulation.Design: retrospective study.Materials/Methods: 54 patients undergoing embryo transfer after IVF or IVF/ICSI treatment that either failed to conceive after previous difficult embryo transfer, or were noted to have cervical stenosis at the time of the mock embryo transfer, were included in the study. Embryo transfers were performed using the Edwards-Wallace catheter and graded as follows: Grade 1: easy, Grade 2a: difficulty in negotiating the cervical canal with or without blood on the catheter, and the necessity to use a hard catheter, Grade 2b: 2a plus necessity to use a volsellum, Grade 3: inability to negotiate the internal os. A Dilapan-S TM rod was placed intracervically under ultrasound control prior to starting gonadotrophin stimulation as an outpatient procedure (Day 4,5 of the period). The rod was left in situ for a period of 4 hours. All patients were given antibiotic prophylaxis. Chi-square and Fisher exact test were used when appropriate.Results: Dilapan insertion was considered easy in 42 patients, difficult in 11 and not possible in 1 patient. The procedure was well tolerated. Of the 54 patients who originally had grade 2a, 2b or grade 3 transfer, 43 patients (79.5%) had subsequent easy embryo transfer. Of the 37 patients who originally had a grade 2a transfer, Dilapan insertion did not improve the subsequent ET grading in 9 (16.5%) of those patients, nor did it improve the ET grading in the one patient out of 10 who originally had a grade 2b embryo transfer. Of the 7 patients who originally had a grade 3 transfer (1.8%) only 1 patient (1.8%) showed no improvement in the subsequent embryo transfer grading. The difference was statistically significant. Thirty patients managed to conceive giving a clinical pregnancy rate of 55%.Conclusions: Cervical dilatation using hygroscopic dilators in patients with cervical stenosis is an effective outpatient procedure leading to an easier embryo transfer and improved pregnancy rate.Supported by: none. Objective: To assess the value of cervical dilatation with hygroscopic cervical rods (Dilapan-S TM) in patients with cervical stenosis prior to starting gonadotrophin stimulation. Design: retrospective study. Materials/Methods: 54 patients undergoing embryo transfer after IVF or IVF/ICSI treatment that either failed to conceive after previous difficult embryo transfer, or were noted to have cervical stenosis at the time of the mock embryo transfer, were included in the study. Embryo transfers were performed using the Edwards-Wallace catheter and graded as follows: Grade 1: easy, Grade 2a: difficulty in negotiating the cervical canal with or without blood on the catheter, and the necessity to use a hard catheter, Grade 2b: 2a plus necessity to use a volsellum, Grade 3: inability to negotiate the internal os. A Dilapan-S TM rod was placed intracervically under ultrasound control prior to starting gonadotrophin stimulation as an outpatient procedure (Day 4,5 of the period). The rod was left in situ for a period of 4 hours. All patients were given antibiotic prophylaxis. Chi-square and Fisher exact test were used when appropriate. Results: Dilapan insertion was considered easy in 42 patients, difficult in 11 and not possible in 1 patient. The procedure was well tolerated. Of the 54 patients who originally had grade 2a, 2b or grade 3 transfer, 43 patients (79.5%) had subsequent easy embryo transfer. Of the 37 patients who originally had a grade 2a transfer, Dilapan insertion did not improve the subsequent ET grading in 9 (16.5%) of those patients, nor did it improve the ET grading in the one patient out of 10 who originally had a grade 2b embryo transfer. Of the 7 patients who originally had a grade 3 transfer (1.8%) only 1 patient (1.8%) showed no improvement in the subsequent embryo transfer grading. The difference was statistically significant. Thirty patients managed to conceive giving a clinical pregnancy rate of 55%. Conclusions: Cervical dilatation using hygroscopic dilators in patients with cervical stenosis is an effective outpatient procedure leading to an easier embryo transfer and improved pregnancy rate. Supported by: none.