Sills E Scott, Palermo Gianpiero D
Georgia Reproductive Specialists LLC; Atlanta, Georgia USA.
BMC Pregnancy Childbirth. 2002 Nov 26;2(1):9. doi: 10.1186/1471-2393-2-9.
We present a case of primary infertility related to extreme cervical stenosis, a subset of cervical factor infertility which accounts for approximately 5% of all clinical infertility referrals. CASE PRESENTATION: A 37 year-old nulligravida was successfully treated with ovulation induction via recombinant follicle stimulating hormone (FSH) and direct intraperitoneal insemination (IPI). Anticipating controlled ovarian hyperstimulation with in vitro fertilization/embryo transfer (IVF), the patient underwent hysteroscopy and cervical recanalization, but safe intrauterine access was not possible due to severe proximal cervical stricture. Hysterosalpingogram established bilateral tubal patency and confirmed an irregular cervical contour. Since the cervical canal could not be traversed, neither standard intrauterine insemination nor transcervical embryo transfer could be offered. Prepared spermatozoa were therefore placed intraperitoneally at both tubal fimbria under real-time transvaginal sonographic guidance using a 17 gage single-lumen IVF needle. Supplementary progesterone was administered as 200 mg/d lozenge (troche) plus 200 mg/d rectal suppository, maintained from the day following IPI to the 8th gestational week. A singleton intrauterine pregnancy was achieved after the second ovulation induction attempt. CONCLUSIONS: In this report, we outline the relevance of cervical factor infertility to reproductive medicine practice. Additionally, our andrology evaluation, ovulation induction approach, spermatozoa preparation, and insemination technique in such cases are described.
我们报告一例与极度宫颈狭窄相关的原发性不孕症病例，宫颈因素不孕症的这一亚型约占所有临床不孕症转诊病例的5%。病例介绍：一名37岁未孕女性通过重组促卵泡激素（FSH）诱导排卵及直接腹腔内授精（IPI）成功治疗。预期进行体外受精/胚胎移植（IVF）控制性卵巢过度刺激，患者接受了宫腔镜检查及宫颈再通术，但由于严重的宫颈近端狭窄无法实现安全的子宫内通路。子宫输卵管造影显示双侧输卵管通畅，并确认宫颈轮廓不规则。由于无法穿过宫颈管，既不能进行标准的子宫内授精，也不能进行经宫颈胚胎移植。因此，在实时经阴道超声引导下，使用17号单腔IVF针将制备好的精子放置于双侧输卵管伞端腹腔内。补充孕激素采用200mg/d含片（锭剂）加200mg/d直肠栓剂，从IPI后一天开始维持至妊娠第8周。在第二次诱导排卵尝试后实现了单胎宫内妊娠。结论：在本报告中，我们概述了宫颈因素不孕症在生殖医学实践中的相关性。此外，还描述了此类病例中的男科评估、排卵诱导方法、精子制备及授精技术。
