Jones Claire A, Tan Justin, Chronis-Brown Pat, Zhu Amy, Pereira Nigel
Division of Gynecologic Reproductive Endocrinology and Infertility, Department of Obstetrics Medicine, University of Toronto, Toronto, Ontario, Canada; Mount Sinai Fertility, Toronto, Ontario, Canada.
Mount Sinai Fertility, Toronto, Ontario, Canada.
Fertil Steril. 2024 Dec;122(6):1152-1153. doi: 10.1016/j.fertnstert.2024.08.346. Epub 2024 Aug 31.
To report the successful utilization of transmyometrial embryo transfer (TMET) in a patient with a history of radical trachelectomy.
Video article.
Academic fertility center.
PATIENT(S): A 39-year-old, para 1, woman with a history of radical trachelectomy and abdominal cerclage presented with secondary infertility. Her previous pregnancy was conceived naturally. Her first in vitro fertilization (IVF) cycle yielded only one day 7 euploid blastocyst. All attempts at performing mock embryo transfers, cervical dilatation, and hysteroscopy were unsuccessful because of absence of clinically identifiable cervical tissue. The euploid embryo was transferred into a gestational carrier; however, this resulted in a biochemical pregnancy. She underwent a second IVF cycle that yielded one day 5 euploid blastocyst. Given her history, TMET was planned. The patient included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites (e.g., PubMed, ScienceDirect, and Scopus) and other applicable sites.
INTERVENTION(S): Transmyometrial embryo transfer using the Towako catheter.
MAIN OUTCOME MEASURE(S): Implantation, clinical pregnancy, and live birth.
RESULT(S): After institutional and Health Canada approval of the Towako catheter, a transvaginal ultrasound-guided TMET was performed under sedation with intravenous midazolam and fentanyl. The day 5 euploid blastocyst from the second IVF cycle was transferred, and the patient's β-human chorionic gonadotropin levels 9 and 11 days after TMET were 86 and 262 IU/L, respectively. A single intrauterine pregnancy with cardiac activity of 119 beats/min was noted at a gestational age of 7 weeks and 2 days. The patient delivered a live singleton at 35 weeks and 2 days weighing 2,182 g.
CONCLUSION(S): Transmyometrial embryo transfer is a useful clinical technique for transferring embryos in patients with acquired or congenital cervical issues in whom transcervical embryo transfer is either very difficult or impossible.
报告经子宫肌层胚胎移植（TMET）在一名有根治性宫颈切除术病史患者中的成功应用。
视频文章。
学术性生育中心。
一名39岁、有1次分娩史的女性，有根治性宫颈切除术和腹部宫颈环扎术病史，出现继发性不孕。她之前的妊娠是自然受孕。她的第一次体外受精（IVF）周期仅产生了1个第7天的整倍体囊胚。由于缺乏临床可识别的宫颈组织，所有进行模拟胚胎移植、宫颈扩张和宫腔镜检查的尝试均未成功。该整倍体胚胎被移植到一名妊娠载体中；然而，这导致了生化妊娠。她接受了第二次IVF周期，产生了1个第5天的整倍体囊胚。鉴于她的病史，计划进行TMET。本视频中的患者同意发布该视频并在网上发布，包括社交媒体、期刊网站、科学文献网站（如PubMed、ScienceDirect和Scopus）以及其他适用网站。
使用Towako导管进行经子宫肌层胚胎移植。
着床、临床妊娠和活产。
在机构和加拿大卫生部批准Towako导管后，在静脉注射咪达唑仑和芬太尼镇静下进行经阴道超声引导的TMET。移植了第二次IVF周期的第5天整倍体囊胚，TMET后9天和11天患者的β-人绒毛膜促性腺激素水平分别为86和262 IU/L。在孕7周2天时发现单胎宫内妊娠，胎心搏动为119次/分钟。患者在35周2天时分娩了一名体重2182 g的活产单胎。
经子宫肌层胚胎移植是一种有用的临床技术，可用于在经宫颈胚胎移植非常困难或不可能的后天性或先天性宫颈问题患者中移植胚胎。
