Fluid within the endometrial cavity in an IVF cycle-a novel approach to its management

Headnote

Submitted January 30, 2002; accepted January 31, 2002

Fluid within the endometrial cavity before embryo transfer in IVF cycles is associated with failure of implantation. The etiology of endometrial fluid is surrounded in controversy but it is associated with hydrosalpinges, polycystic ovarian disease, and subclinical uterine infections.The current treatment consists of postponing embryo transfer. This of course has biological and psychological disadvantages; a decreased implantation rate from frozen embryo transfer, and frustration and disappointment for the couple. Removing the fluid with an embryo transfer catheter immediately before embryo transfer may be a successful method of treatment.

KEYWORDS: Endometrial cavity fluid; implantation; treatment.

CARDIFF, UK

INTRODUCTION

Many new developments have occurred in the treatment of infertility but successful intervention of the embryo implantation process still remains a great challenge. It has been noted that when fluid is identified before embryo transfer in the endometrial cavity, this has a negative effect on implantation rates. So strong is this effect that there have been no documented cases in the literature of an ongoing pregnancy in such a scenario. This series represents the first documented successful intervention in the management of excessive endometrial fluid at the time of embryo transfer.

CASE SERIES

Patient 1

A 29-year-old woman presented to the Cardiff Assisted Reproduction Unit with a 5-year history of primary infertility. This was believed to be of tubal etiology as she had a right partial salpingectomy for an ectopic pregnancy 3 years back.Arecent laparoscopy confirmed the tubal etiology by revealing pelvic adhesions and damage to the remaining tube. The patient's partner had a normal semen analysis.

In view of the laparoscopic finding the couple was offered IVF. A transvaginal ultrasound scan was performed immediately before the embryo transfer. After discussion with the patient who did not wish to postpone the embryo transfer, an empty embryo transfer catheter was inserted into the uterine cavity. During the procedure 5 mL of clear fluid was aspirated from the cavity and sent for microscopy, culture, and sensitivity including chlamydia screening. The specimen was subsequently found to be sterile. The uterus was rescanned after the aspiration and no fluid was demonstrated within the cavity. An uneventful embryo transfer...