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• W4387398614 abstract "INTRODUCTION The success of any in vitro fertilization (IVF) treatment depends on the quality of oocytes, sperms, embryos, and a receptive endometrium. A lot has gone into improving the quality of gametes and finding alternatives when the quality of the gamete cannot be improved. The interaction between the embryo and the intrauterine environment largely determines the success or failure of implantation.[1] However, this interaction is not fully understood despite advances in reproductive medicine. It is known, however, that any form of uterine pathology is likely to affect endometrial receptivity. Fluid in the endometrial cavity has been associated with adverse pregnancy outcomes.[1] Cycle cancelation and freezing the resulting embryos are a treatment option. However, cycle cancelation can add to the emotional roller coaster couples undergoing IVF face. Having an individualized approach in the management of fluid in the endometrial cavity prior to embryo transfer will help to reduce cycle cancelation rate. Case 1 A 33-year-old nullipara presented to our clinic with a 4-year history of infertility. Baseline transvaginal ultrasound scan done revealed multiple fibroids for which she had an abdominal myomectomy. She was seen again 7 months postabdominal myomectomy. Preliminary tests were done. Anti-Mullerian Hormone level was 1.35 ng/mL. Hysterosalpingogram done prior to presentation showed blocked tubes with no hydrosalpinx. On day 8 of ovarian stimulation, fluid measuring about 4 mm was noticed in the endometrial cavity; however, endometrial thickness was 8 mm. On day 10 of stimulation, endometrial fluid was drained, and 1 mL of autologous platelet-rich plasma (PRP) was instilled into the endometrial cavity under ultrasound guidance. Autologous PRP was prepared in our laboratory, and 15 mL of the patient’s blood sample was collected and put in a universal bottle containing 3 mL of acid citrate dextrose anticoagulant and then gently mixed. The sample was centrifuged for 12 min at 1200 rpm and supernatant was removed and put in another tube. Test tube containing the supernatant was then centrifuged for 7 min at 3000 rpm. A total of 1 mL of the PRP was then drawn using an insulin syringe and instilled into the patient’s endometrial cavity using an embryo transfer catheter. On the day of embryo transfer, transvaginal ultrasound scan still revealed fluid in the endometrial cavity. This was drained about 2 h prior to embryo transfer using a Wallace catheter. Two hatching blastocysts were transferred, and the patient conceived with the treatment cycle. Case 2 A 42-year-old nullipara presented to our clinic with a 4-year history of infertility. Prior to the presentation, she had an abdominal myomectomy and also complained that her menstrual flow was scanty. A hysteroscopic scissors adhesiolysis was done. She was prepared as an ovum recipient because her ovarian reserve was low (Anti-Mullerian Hormone <0.01 ng/mL). On the ninth day of commencing estradiol tablets, ultrasound scan revealed an endometrium that was 5.5-mm thick with fluid that measured 3.1 mm. Endometrial fluid was drained and sent for culture, and 1 mL of autologous PRP was instilled into the endometrial cavity (the PRP was prepared using the patient’s blood sample as described in Case 1). Endometrial fluid cultured Enterococcus faecalis sensitive to amoxicillin; which was prescribed and used by the patient for a week based on the culture and sensitivity result. On the 18th day on progynova, 1 mL of granulocyte colony-stimulating factor (GCS-F) (manufactured by Dong-A ST CO, Limited 493 Nongongro Nongong-eup, Dalseong-gun, Daegu, South Korea) was instilled into the endometrial cavity. Follow-up scan done after 48 h revealed that the endometrial thickness had increased by 1 mm. The endometrial thickness increased over time; however, the fluid persisted. On the day of embryo transfer, we drained the endometrial fluid about 20 min prior to embryo transfer using the Wallace transfer catheter. Three embryos were transferred (all expanded blastocysts), and she conceived with the treatment cycle. DISCUSSION The presence of endometrial fluid has been associated with deleterious pregnancy outcomes in patients undergoing IVF/intracytoplasmic sperm injection treatment cycles.[1] The presence of endometrial fluid remains a challenge to clinicians, because the pathology is poorly understood. The presence of fluid in the endometrial cavity has been associated with the presence of hydrosalpinx.[2] Another study associated it with tubal infertility.[3] Subclinical intrauterine infection has been implicated as a cause of excessive fluid in the endometrial cavity.[4] Patients with polycystic ovarian syndrome are reported to be at a high risk of developing endometrial fluid during controlled ovarian hyperstimulation.[5] A recent study has reported an association between previous myomectomy and endometrial fluid presence during IVF stimulation.[6] The two cases reviewed that both had abdominal myomectomy done. Severe endometriosis and previous cesarean procedure have also been associated with the development of endometrial fluid.[6] The presence of excessive fluid inside the cavity could have adverse effects on cell proliferation or interfere with the very early stages of embryo implantation such as apposition and attachment.[7] PRP contains multiple proteins, which allow PRP to participate in cell proliferation, migration, tissue growth, healing, and angiogenesis.[8] This was why it was used in the cases discussed. GCS-F was used for one of the patients because of its potential effectiveness in improving endometrial thickness.[9] The incidence of fluid in the endometrial cavity may be higher in African countries when compared with non-African countries because of the higher predisposition of African women to develop uterine fibroids and a need for myomectomy. Prior myomectomy may place a woman at risk of fluid in the endometrial cavity. There is a need to have the true incidence of fluid in the endometrial cavity in the African population undergoing IVF. In addition to the freezing-all option, drainage of fluid prior to embryo transfer and the use of PRP and GCS-F can be considered as options in the management of women with fluid in the endometrial cavity. Further research is needed to determine whether the time interval between the drainage of endometrial fluid and embryo transfer is of any significant importance. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest." @default.
• W4387398614 created "2023-10-07" @default.
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• W4387398614 date "2022-01-01" @default.
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• W4387398614 title "Fluid in the endometrial cavity in in vitro fertilization (IVF) treatment cycle: Other treatment options" @default.
• W4387398614 doi "https://doi.org/10.4103/ajrge.ajrge_15_22" @default.
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