title: In vitro fertilization outcome relative to embryo transfer difficulty: a novel approach to the forbidding cervix.
abstract: OBJECTIVE
  To assess the impact of ET difficulty on IVF outcome and to optimize the ET procedure.
  
  
  METHODS
  Retrospective analysis of IVF outcome by ET catheter type and ET difficulty. Prospective treatment and follow-up of patients with a history of extremely difficult cervical passage.
  
  
  METHODS
  Large university-based IVF program.
  
  
  METHODS
  All patients < 40 years of age undergoing IVF-ET from September 1995 to May 1998.
  
  
  METHODS
  Surgical correction of cervical stenosis.
  
  
  METHODS
  Pregnancy and embryo implantation rates.
  
  
  RESULTS
  Only 0.6% of ETs were "extremely difficult." Pregnancy rates were not statistically significantly different among ETs graded easy, moderate, and difficult. In contrast, no pregnancies occurred in the rare "extremely difficult" ET group. Eight patients with a history of extremely difficult cervical passage underwent surgical correction of their cervical stenosis. Twelve postoperative IVF-ET in these women resulted in eight clinical pregnancies, six of which were multiple gestations. The embryo implantation rate of these cycles was 42.2%.
  
  
  CONCLUSIONS
  Patients with a history of extremely difficult ET may benefit from hysteroscopic evaluation and possible modification of their cervical canal before a future IVF attempt.
authors.affiliation: New York University Program for In Vitro Fertilization, Infertility, and Reproductive Surgery, New York University Medical Center, New York 10016, USA. Nnoyes01@aol.com
authors.forename: N
authors.initials: N
authors.lastname: Noyes
authors.forename: F
authors.initials: F
authors.lastname: Licciardi
authors.forename: J
authors.initials: J
authors.lastname: Grifo
authors.forename: L
authors.initials: L
authors.lastname: Krey
authors.forename: A
authors.initials: A
authors.lastname: Berkeley
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000473:pathology* / Q000601:surgery*; D004624:Embryo Transfer / Q000379:methods*; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D015907:Hysteroscopy; D011247:Pregnancy / Q000706:statistics & numerical data*; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple