chapter  11
26 Pages

Cervical Stenosis and Techniques of Embryo Transfer

Since the initial description of postcoital testing and suggestion that cervical mucus was essential to sperm migration, cervical anatomy and function has been a focus of infertility evaluations. Early descriptions characterized the cervix as a mere conduit for the movement of sperm and seminal plasma. Later studies suggested a complex interaction of sperm and mucus with fertility predicated on the quality of this interaction.1 Postcoital testing evolved into an integral step in the early literature describing infertility evaluation and treatment. With the advent of evidence-based medicine and assisted reproductive technologies, emphasis has changed. The importance of cervical anatomy has come full circle. Assessment of cervical function by examining the interaction of cervical mucus and sperm as described by Sims and Huhner is no longer a core test. Though a subset of patients may benefit from this test, contemporary infertility evaluations focus instead on cervical anatomy and its impact on ease of passage of a variety of catheters. Easy, atraumatic access to the endometrial cavity transcervically for either intrauterine insemination or embryo transfer has emerged as the significant issue. Multiple factors may impact the process and ultimately the success of assisted reproductive technologies.2