title: Successful pregnancy following novel IVF protocol and transmyometrial embryo transfer after radical vaginal trachelectomy.
abstract: Radical vaginal trachelectomy in patients with early-stage cervical cancer is an oncologically safe procedure in well-selected patients. Successful pregnancy in a patient with radical vaginal trachelectomy is possible, with two-thirds of pregnancies resulting in live birth. However, it presents a great challenge for assisted reproductive techniques and reproductive medicine in cases with subsequent severe cervical stenosis. This is a report of a 38-year-old patient who underwent radical vaginal trachelectomy at the age of 33 years for early stage (IA2) adenocarcinoma and subsequently presented with infertility due to cervical factors. The patient underwent ovarian stimulation using a novel SMART (Stimulation with Minimal Adverse effects, Retrieval and Transfer)-IVF protocol. As it was impossible to perform transcervical embryo transfer with an almost absent severely stenotic cervical opening, a transmyometrial embryo transfer under ultrasound guidance was performed. This resulted in a successful singleton full-term pregnancy delivered by Caesarean section at gestational age 37 weeks. As far as is known, this is the first reported case of successful pregnancy conceived by IVF with transmyometrial embryo transfer for a patient who had previously undergone radical vaginal trachelectomy.
authors: University of Montreal, Department of Obstetrics and Gynecology, Saint Luc Hospital, Montréal, Québec, Canada.
authors: Wael
authors: W
authors: Jamal
authors: Simon J
authors: SJ
authors: Phillips
authors: Robert
authors: R
authors: Hemmings
authors: Louise
authors: L
authors: Lapensée
authors: Bernard
authors: B
authors: Couturier
authors: François
authors: F
authors: Bissonnette
authors: Isaac Jacques
authors: IJ
authors: Kadoch
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D002584:Cervix Uteri / Q000601:surgery*; D004624:Embryo Transfer / Q000379:methods*; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D014463:Ultrasonography / Q000379:methods; D002583:Uterine Cervical Neoplasms / Q000601:surgery*