Embryo transfer is one of the most crucial step for successful In Vitro fertilisation procedure outcome. Almost all embryo transfer is done through trans cervical route for successful transfer of embryos in the uterine cavity for eventual implantation and positive pregnancy test.. Around 3-5 percent of all embryo transfer is difficult for various reasons like cervical stenosis, angulation between cervix and uterus, previous surgery on cervix etc. Infertility specialists around the globe try to overcome the situation by doing the procedure under sedation, or prior Hysteroscopy and dilatation of cervix or recanalisation of cervix by endoscopic approach. Any traumatic delivery of embryos or bleeding invariable lead to failure of costly treatment. Alternative method includes transmyometrial transfer of embryos with overall success of around 15-20 percent But this transmyometrial transfer ( TMET) is hardly practiced by infertility practitioners around globe due to its complicated application which needs extreme precision, skill and ultrasound knowledge.
Dr. Sudip Basu, a reputed infertility consultant of renowned Srishti clinic achieved this rare feat by achieving pregnancy and successfully delivery of a healthy male baby, probably first of its kind in Eastern India and second such in India. According to him, this is a unique example where our specialists are skilled at par with specialist form other states of India or in fact globally. This is usually done by Towako method where special TMET needle ( Cook) – approximate length 18 cm, is introduced through uterine muscle under transvaginal ultrasound guidance and placed mm beyond the uterine cavity. Then a special catheter ( approximately 18 cm long) preloaded with embryos is fed through this needle and transferred in the cavity. Whole process is done under sedation and patient can be discharged same day. The process needs extreme finesse and Co ordinated approach by all team members. The long catheter is supported by two hands of embryologist ( coming out of embryology room to transfer room) within very short time while clinician steadies the needle under ultrasound guidance. Even few mm movement means abandoning the procedure. It is extremely difficult to procure this special needle and catheter ( due to lack of demand) and cost a fortune.
Dr. Basu further added that while getting trained in Uk for seven years at a tertiary referral centre, I did not see single such procedure while treating more than four thousand IVF patients. When I went to Japan for an international conference, I wanted to visit the centre where from this special technique developed but they were so secretive, they did not allow me. So I had to try on my own. Previously I have tried four times, two times it failed but once it resulted in pregnancy but that pregnancy miscarried. Fourth time I got lucky. This particular patient had a prior hysteroscopy to overcome the acute angulation problem between neck of the womb and uterine body but on the date could not negotiate the routine ET catheter transcervically. As the embryos were already thawed, we did not have any other option than going for this extraordinary approach. We are happy for this Bangladeshi couple who now proud parent of a healthy boy. I think it is time for rejoice and celebration and admitting the fact quality medical care is possible in Kolkata too.
