Correlation between Hysterosonography and Hysteroscopy in the Diagnosis of Submucosal Fibroids in Women Attending the Gynaecological Endoscopic Surgery and Human Reproductive Teaching Hospital (CHRACERH)

Background: Submucosal myomas can be responsible for abnormal bleeding, spontaneous abortions or even infertility. Objectives: This study aimed to study the correlation between the diagnosis and classification of submucosal fibroids at hysterosonography and at hysteroscopy at Gynaecological Endoscopic Surgery and Human Reproductive Teaching Hospital (CHRACERH), Yaoundé, Cameroon. Methodology: We conducted a hospital-based cross-sectional study with retrospective data collection. Included were the files of patients in whom a hysteroscopy for uterine cavity evaluation was done from the 1st of January 2020 to the 31st of July 2022. The data collected were analysed using SPSS version 25 and Microsoft Excel 2013. Hysterosonographic findings were compared to those of hysteroscopy using Cohen’s kappa inter-observer agreement test. Results: A total of 104 women had available hysterosonography results prior to diagnostic hysteroscopy. The ages of the participants ranged from 26 to 65 years with a mean age of 39.92 ± 7.02 years. A total of 69 submucosal fibroids were identified at hysterosonography and 47 (68.1%) were found at hysteroscopy. There was agreement between the two methods in 13/17 (76.5%) cases of FIGO 0 fibroids, 21/30 (70.0%) of FIGO 1 fibroids and 13/22 (59.1%) of FIGO 2 fibroids. The overall agreement was moderate with a kappa coefficient of 0.478 (p Conclusion: The results present hysteroscopy as the gold standard for the diagnosis of submucosal myomas, but clinicians need to recognize utility of hysterosonography in certain situations.

Laparoscopy combined with hysteroscopy in the treatment of Robert’s uterus accompanied by adenomyosis:A case report

BACKGROUND Gynaecologists should be aware of a rare obstructive Mullerian duct abnormality like Robert’s uterus and perform further surgery when necessary.CASE SUMMARY We report a 41-year-old mother of two children with Robert’s uterus who was examined and treated by laparoscopy and hysteroscopy.Unlike the existing cases reported in the literature,this patient had a late onset of Robert’s uterus symptoms.Due to right tubal ectopic pregnancy 3 years previously,the patient was treated with right salpingectomy and left tubal ligation but suffered aggravated left lower abdominal pain.She was examined and treated by laparoscopy and hysteroscopy,and is completely asymptomatic at 5-year followup.CONCLUSION The typical obstructive Mullerian abnormality requires further surgery.Combined laparoscopy and hysteroscopy is an effective,minimally invasive technique with better recovery outcomes than traditional transabdominal procedures.

Live birth after hysteroscopy performed inadvertently during early pregnancy:A case report and review of literature

Generally, hysteroscopy is not appropriate for pregnant women without an indication. What if a patient undergoes hysteroscopy accidentally during the early gestational period? We here report a rare case of a woman who continued pregnancy after a diagnostic hysteroscopy was performed in early pregnancy and delivered a healthy baby. The patient had a history of infertility and oligomenorrhea, probably due to a previous induced abortion. A hysteroscopy was performed after the end of her "menstruation" for assessment of her uterine cavity. Early pregnancy, instead of the expected intrauterine adhesions, was suspected, and the procedure was immediately ceased. Subsequent tests confirmed the diagnosis of pregnancy. She had a fullterm delivery by elective caesarean section. The success of this case was attributed to the use of vaginoscopic techniques in hysteroscopy and correct judgment and decision-making during the procedure. This case report provides some useful methods and experience that might be helpful when a similar situation occurs in clinical practice.

Effectiveness and safety of ultrasound-guided intramuscular lauromacrogol injection combined with hysteroscopy in cervical pregnancy treatment:A case report

BACKGROUND Cervical pregnancy is increasing in morbidity,and a definite diagnosis in early stages is challenging due to its specific onset site.Surgery is the mainstay of treatment for cervical pregnancy,but it may result in the loss of natural fertility.Therefore,it is a great challenge to pursue a safe and effective treatment for cervical pregnancy.CASE SUMMARY We report the case of a cervical pregnancy successfully treated by ultrasoundguided cervical-intramuscular lauromacrogol injection combined with hysteroscopy.A 23-year-old woman with minor irregular vaginal bleeding was admitted to our department with suspected ectopic pregnancy.Transvaginal ultrasound revealed a gestational sac(approximately 22 mm x 13 mm)situated in the cervical canal with a yolk sac and blood flow signals.No cardiac activity was detected.Serum beta progesterone was 17.06 ng/m L,and serum beta human chorionic gonadotropin(β-HCG)was 5077.0 IU/L.The patient was diagnosed with cervical pregnancy.She was treated by ultrasound-guided cervicalintramuscular injections of lauromacrogol(3 m L)in combination with aborting under hysteroscopic visualization.A gradual decrease inβ-HCG levels and normal ultrasound findings were observed.Postoperative pathologic examination showed the presence of villi and changes in the endometrium in the secretory phase.The patient was discharged on day 6,and herβ-HCG level was 0.67 m IU/m L after 1 wk.There was no statistical difference between baseline and 1-week postoperative data in terms of serum indices including liver function,renal function,and routine blood analysis after treatment.The patient subsequently became pregnant 2 mo later and no abnormalities were detected on routine screening during pregnancy.CONCLUSION Ultrasound-guided cervical-intramuscular lauromacrogol injection combined with hysteroscopy may be effective and safe in the treatment of cervical pregnancy.

Effects of operative hysteroscopy with anti-adhesive solution in the patients who have abnormal uterine bleeding or intrauterine lesions

Objective: The purpose of this study was to evaluate the efficacy, safety, and benefits of hysteroscopic surgery in the treatment of dysfunctional uterine bleeding (DUB) or intrauterine lesions causing uterine bleeding. Methods: This study prospectively enrolled 100 patients who underwent operative hysteroscopy in tertiary referral university center because of uterine bleeding due to endometrial polyps or uterine submucosal leiomyomas diagnosed by transvaginal ultrasonogram. Indications for the operative hysteroscopies included abnormal uterine bleeding (AUB), ultrasound findings indicative of intrauterine lesions, and DUB. After operative hysteroscopic management, we inserted anti-adhesive solution, sodium hyaluronate and carboxymethyl cellulose into the uterine cavity. Results: Operative hysteroscopy was a successful procedure in 100 of 100 cases (100%) but it needed to be repeated in three cases with large uterine submucosal leiomyoma and after two endometrial polypectomy. Mean duration of the procedure was 23.2 minutes (range 5 - 67) and postoperative hospital stay was 7 hours (range 3 - 48). Most common indication was DUB (39%), submucosal leiomyoma was 21%, and endometrial polyp was 17%. There were five cases with postoperative uterine bleeding and none with fluid overload syndrome. During postoperative follow-up (3 - 28 months) the majority of patients (90/100, 90%) were free of symptoms. Conclusion: Hysteroscopic procedure is an effective and safe method for the management of benign intracavitary pathology or the treatment of dysfunctional uterine bleeding. Although sodium hyaluronate and carboxymethyl cellulose seems to be effective in the prevention of adhesion in uterine cavity, further study will be needed to prove the effectiveness of anti-adhesive solution.

Endometrial Evaluation by Transvaginal Ultrasonography Saline Infusion Sonohysterography, Hysteroscopy versus Endometrial Office Bipsy in Perimenopausal Bleeding: A Comparative Study

Postmenopausal bleeding is a very common and alarming symptom accounting for 5 percent of all gynecological outpatients’ clinic attendances. This cross-section study was conducted in the Department of Obstetrics and Gynecology at University Hospitals and included 176 patients with perimenopausal bleeding who attended a patient clinic during the period from January 2017 to May 2019. All patients were subjected to transvaginal ultrasound, saline sonohysterography and out-patient endometrial sampling using pipelle;all the results were compared to histopathology obtained by hysteroscopic guided biopsy and/or hysterectomy. Result: In comparing the validity of TVS and SHG we found highly significant decrease in malignancy assessment in the TVS method compared to hysteroscopic-guided biopsy. According to the validity of pipelle in detection of malignant lesion, it was found to detect 80 cases out of 88 cases of malignancy with sensitivity 90.9%, specificity 100% and 95.45% accuracy with respect to histopathology by hysteroscopy guided biopsy and/or hysterectomy. Combination tests were done between SHG and pipelle and we found that the validity of combination tests in detecting malignancy improves the sensitivity and specificity in detection of malignancy sensitivity = 100% and specificity = 100% and this was found to be as an effective method in detection of malignancy. Conclusion: When SHG combined to outpatient endometrial sampling “pipelle”, the results were the same as hysteroscopy.

A Comparative Observational Study of the Use Transvaginal Ultrasound and Hysteroscopy for the Detection of Uterine Cavity Pathologies in Women with Abnormal Uterine Bleeding

Background: 70% of all gynecological consultations are for abnormal uterine bleeding. Any approach to optimal management begins with an appropriate diagnosis. 40% of premenopausal women with abnormal uterine bleeding were found to have some intrauterine pathology. This study aims to compare the diagnostic value of transvaginal ultrasonography in comparison to hysteroscopy in detecting uterine abnormalities in patients with abnormal uterine bleeding. Methods: Retrospective observational cross sectional study of 250 women presented with abnormal uterine bleeding. The patients who fulfilled the selection criteria and have been sequentially investigated by transvaginal ultrasound (TVS) and hysteroscopy were included. Results: 90% of patients were from 35 - 49 yrs. 81.2% of patients have body mass index above 25 kg/m2. Transvaginal ultrasound (TVS) compared well with high sensitivity as regards normal endometrium. (TVS) missed 4 patients of endometrial polyps and one patient of sub mucous fibroid. Three patients of adenomyosis were only diagnosed by (TVS);they were reported as being normal by hysteroscopy. Conclusion: (TVS) is considered as an excellent approach to the initial evaluation of uterine pathologies in patients with abnormal uterine bleeding.

Diagnosis and treatment of diverticulum of the uterus in pregnancy through hysteroscopy and methotrexate: a case report

A 27-year-old patient was diagnosed by hysteroscopy with uterine diverticulum in pregnancy and admitted to the hospital. Under the guidance of hysteroscopy combined with methotrexate, the scraping of the uterus was done and operation successfully completed. The management of this case showed that hysteroscopy was a kind of valuable approach to the diagnosis and treatment of uterine diverticulum and curettage of the uterus under hysteroscope combined with drug was a safe, effective and conservative treatment.

Comparison of Transvaginal Ultrasound, Saline Infusion Sonohysterography versus Diagnostic Hysteroscopy in Evaluation of Endometrial Cavity Pathology amongst Women with Abnormal Uterine Bleeding in Low Resource Setting

Introduction: Hysteroscopy is currently the gold-standard protocol for evaluating patients with abnormal uterine bleeding (AUB). Unfortunately, though accurate, its adoption in low-resource countries such as in Africa is limited due to lack of equipment and qualified personnel. As such, there is a need for an alternative diagnostic procedure that is as accurate as hysteroscopy, but also affordable, easy to administer, and acceptable by women with endometrial pathologies. Transvaginal Sonography (TVS) and Saline Infusion Sonohysterography (SIS) are proposed. However, their diagnostic accuracy versus hysteroscopy has not been determined in low resource setting. Objective: To compare the diagnostic efficacy of TVS and SIS versus diagnostic hysteroscopy in evaluation of endometrial pathology among pre-menopausal and post-menopausal women and to determine the etiology of AUB amongst these women. Methodology: A prospective cohort study was done at a hospital in Nairobi, Kenya between May and September 2019. Forty patients with AUB were recruited using consecutive sampling, and women who consented were recruited. The etiology of AUB was recorded. All participants underwent TVS, SIS and Diagnostic Hysteroscopy (DH) evaluation in the first half of the menstrual cycle and the findings recorded on a patient’s information sheet. The sociodemographic and bleeding characteristics of patients and the outcomes of TVS, SIS, and DH evaluations were also recorded and the data was analysed using version 5 of the Software for Statistics and Data Science (STATA). Summary statistics on the etiology of AUB were presented and the sensitivity of TVS and SIS versus DH as the gold-standard evaluated using two by two tables and the ROC curve. Results: The mean age of participants was 38.1 ± 8.8 years, range of 25 - 71 years. Heavy Menstrual Bleeding (HMB) was reported in 70.0% of participants, while about 12.0%, 7.5%, and 7.5% had post-menopausal bleeding, amenorrhea, and hypomenorrhea. The incidence of submucosal fibroids and endometrial polyps was 17.5% and 15.0% via TVS, 47.5% and 20.0% via SIS and 52.5% and 20% via DH respectively. The overall sensitivity, specificity, Positive Predictive Value (PPV), Positive Predictive Value (NPV), and diagnostic accuracy of SIS were 92.1%, 83.3%, 96.9%, 62.5%, and 90.0% while TVS was 38.2%, 100%, 100%, 22.2%, and 47.5%. The sensitivity, specificity, PPV, and NPV of TVS in diagnosis of endometrial polyp were 75.0%, 100%, 100%, and 94.0%. SIS did better with a sensitivity, specificity, PPV, and NPV of 100%, 100%, 100%, and 100%. Conclusion: Our data suggests SIS had a higher diagnostic accuracy than TVS and showcased a comparable diagnostic accuracy to hysteroscopy. SIS is more suitable safe alternative technique for investigating AUB in pre/post-menopausal women in low resource setting where hysteroscopy is unavailable or unaffordable.

Spontaneous Resolution of Traumatic AV Malformation of the Uterus Following Hysteroscopic Cold Knife Evacuation of Retained Products of Conception

Uterine myometrial arteriovenous malformations (AVM) are reported on color doppler ultrasonography as mosaic pattern of blood flow with different peak systolic velocities (PSV) at different places. High PSV within the AVM may require arterial embolization as treatment. However, we present a case of traumatic AVM with incomplete abortion managed by hysteroscopic cold knife evacuation. This case report is of a young patient with off and on vaginal bleeding for 3 1/2 months following 2nd trimester spontaneous abortion. She had undergone dilation and evacuation (D & E) for incomplete abortion. Now the bleeding was heavy and intermittent not responding to medications. The subsequent TVS examination shows incomplete abortion with myometrial AVM with high PSV. Hysteroscopic cold knife removal of products of conception resulted in immediate resolution of Uterine AVM.

Application of Comprehensive Health Education in Nursing of Patients with Metrorrhagia and Metrostaxis Treated by Hysteroscopic Electrotomy

Objective:To explore the application of health education in the nursing care of patients with metrorrhagia and metrostaxis after hysteroscopic electrotomy and the effect on the occurrence of disease complications.Methods:Totally 70 patients admitted from March 2018 to March 2019 were randomly divided into two groups.The control group was given routine nursing,while the observation group was given comprehensive health education combined with routine nursing.The unhealthy emotions(anxiety and depression)of patients were assessed using Hamilton Depression Scale(HAMD)and Hamilton Anxiety Scale(HAMA).The incidence of complications,and surgical related matters were recorded and compared between two groups after nursing interventions.Results:A lower HAMD score,A lower HAMA score,a shorter hospitalization time,a shorter operation time and a less intraoperative bleeding volume,a lower incidence rate of complications(massive bleeding and uterine perforation),and a higher degree of patients’cooperation in surgery were shown in observation group compared with control group after nursing intervention(P all<0.05).Conclusion:The application of health education in the nursing of metrorrhagia and metrostaxis patients can relieve the patients’anxiety and depression,improve their understanding and mastery of relevant disease knowledge and their ability to cope with bleeding and their self-health care,as well as reduce the incidence of complications and the length of hospital stay and promote the rehabilitation of patients.Therefore,it is worthy of clinical application.

Hysteroscopic septum resection in patients with recurrent abortions and infertility

Objective: The aim of this study was to assess the achievement of pregnancy as well as the reproductive outcome after hysteroscopic septum resection in women with recurrent abortions or infertility. Design: retrospective, clinical trial. Setting: University hospitals. Patient(s): Fourty women with a diagnosis of uterine septum who had a history of pregnancy loss or infertility. They were randomized into two groups. Group I includes 18 infertile women and group II includes 22 recurrent miscarriage women. Intervention(s): Hysteroscopic metroplasty was performed on all patients in both groups. Result(s): 40 patients who were diagnosed with a partial septate uteri had hysteroscopic septum resection and were divided into two groups: Group I (18 patients) presented with infertility and Group II (22 patients) with recurrent abortions. The mean post-operative follow up period was 24 months. Group I, 12 patients (66.6%) and Group II, 17 patients (77.2%) achieved pregnancy, with respective abortion rates of 2 (11.1%) and 4 (18.1%). Conclusion(s): Using hysteroscopy to perform metroplasty on septate uteri makes the procedure safer, easier, and less complicated. This procedure is recommended for all cases diagnosed with an uterine septum.

Relationship between Hysteroscopic Findings and Leukaemia Inhibitory Factor in Mid-secretary Endometrium

Objective To explore the potencial relationship between hysteroscopic findings,and the concentrationa of leukaemia inhibitory factor (LIF) in uterine flushing as well as the expression of LIF in the endometriumMethods Hysteroscopy was carried out among 64 infertile female patients and uterine flushing was collected for LIF assay in the mid-secretory phase. All subjects were classified according to the appearance of the glandular openings and the blood vessels on the endometrium surface into Group I and Group II. An ELISA kit specific for human LIF was used for LIF assay.Results The median LIF concentrations measured in Group I and Group II -were 14. 375±15. 155pg/mL and 61. 696+ 44. 127 pg/mL. The difference of LIF concentration was statistically significant (P< 0. 05) between Group I and Group II. But no significant difference between Group II and the proliferative endometrium (11. 02± 11. 07 pg/mL) was found. The average expression of LIF mRNA in Group I was 0. 93± 0. 20, and 1. 55± 0. 08 in Group II. The expression of LIF mRNA in the endometrium from Group I was much lower than that from the decidua of early pregnancy (1. 65±0. 18) , while no significant difference was observed between Group II and the decidua of. early pregnancy.Conclusion There is a strong relationship between endoscopic findings and the concentration of LIF. Our data suggested that the hysteroscopic appearance of the mid-secretory endometrium and measurement of LIF in uterine flushing are better evaluation factors for the uterine receptivity.

Recurrent Miscarriage: Hysteroscopy-Assisted Management

Objective: To apply office hysteroscopy in assessment/management of patients with recurrent miscarriage, thus to/or not to recommend office hysteroscopy as a routine procedure in such cases. Study design: Retrospective analysis. Setting: University hospital’s outpatient abortion clinic. Subjects & Methodology: Patients’ records during the period between March 2015 and January 2017 for subjects with at least 2 previous miscarriages, who had undergone office hysteroscopy were reviewed. Results: Cases with 2 previous miscarriages (n = 95) were assessed and compared with those with 3 or more miscarriages (n = 105). Abnormal uterine findings were diagnosed in 24.1% of the former, and 43.8% of the latter group. The prevalence of uterine lesions among cases with 2 recurrent miscarriages was 42.1%;meanwhile, for subjects with 3 or more consecutive miscarriages, it was 43.8%. Conclusion: In addition to safety profile, simplicity and outpatient basis of use, outpatient hysteroscopy in recurrent miscarriages would be an added-value to practitioners as a diagnostic and therapeutic tool.

Prophylactic Antibiotic Treatment during Hysteroscopy: A Systematic Review

Background: Overall, the use of antibiotics is increasing. We noticed different practices amongst different hospitals in their prophylactic use of antibiotics during operative hysteroscopy. This review investigates whether there is sufficient evidence to recommend antibiotic prophylaxis in operative hysteroscopy. Methods: We performed a systematic search in “Pubmed” using “hysteroscopy” and “antibiotic” and “prophylaxis” as search items. We found 16 hits of which 4 were suitable to include in our review. Findings: In an included Cochrane review no conclusion was drawn since no articles could be included. A prospective study by Nappi?et al.?[1]?support the recommendation of the American College of Obstetricians and Gynaecologists not to prescribe routinely antibiotic prophylaxis in cases of hysteroscopic surgery. Bhattacharya?et al. conducted a prospective study that was ended prematurely. They conclude that there is no convincing evidence that prophylactic antibiotics are of value in hysteroscopy. A review by Morrill?et al. yielded no new data. Conclusion: We did not find a significant increase in clinical relevant infectious symptoms after hysteroscopy in women treated with or without antibiotic prophylaxis, although data are insufficient to draw a definite conclusion. Therefore, we suggest a prospective study is mandatory on this topic.

False contouring effect of the uterine wall during hysteroscopy a lesson from immediate hydrosonography

A 42 years old woman suffering from repeated events of intensive vaginal bleeding during the week off birth control pills was referred for diagnostic hysteroscopy. The patient underwent hysterohy drosonoscopy, a 3-step procedure, including a transvaginal ultrasound scan, a diagnostic hysteroscopy and immediate hydrosonography. A3 cmintramural myoma was detected by the ultrasound scan without impinging onto the uterine cavity as visualized by diagnostic hysteroscopy. However, continuous hydrosonographic evaluation of the uterus, performed immediately afterwards, unveiled a fibroid with a significant intracavitary portion. A falsely normal cavity could be appreciated by high pressured hysteroscopy, while during the gradual fall of the intracavitary pressure a significant lesion could be revealed encroaching into the lumen. In the absence of an agreed distention pressure range during hysteroscopy, an immediate hydrosonography may serve as an auxiliary tool to follow the uterine wall contour as distention pressure declines during the eventual escape of the distention fluid from the lumen. Uterine wall contour is heavily dependent on the distension pressure and guidelines for intrcavitary pressure during hysteroscopy are evidently needed.

Chromohysteroscopy—A new technique for endometrial biopsy in Abnormal Uterine Bleeding (AUB)

Objective: To evaluate the role of chromohysteroscopy in improving diagnostic accuracy of endometrial biopsy in cases of AUB. Design: Cross sectional interventional study. Materials and Methods: This study was conducted on 60 women with AUB in Dept. of Obst. & Gyne at King George Medical University, Lucknow over a period of one year. All cases underwent diagnostic hysteroscopy followed by chromohysteroscopy using 2% methylene blue dye. Hysteroscopic guided biopsy was taken from stained and unstained areas followed by an endometrial aspiration biopsy from whole uterine cavity. The histopathology results of three samples were compared and analyzed in relation with staining pattern and type of AUB. Data analysis was done on SPSS version 15 of windows 2007. Results: Out of 60 cases, 11cases were found to have non hormonal pathology after chromohysterosopic biopsy. Eight (72.72%) cases were diagnosed by stained endometrial tissue, one (9.09%) by unstained tissue and three (27.27%) by endometrial aspiration. The diagnostic ability of stained tissue biopsy was significantly higher (p = 0.006) than unstained biopsy and endometrial aspiration. Conclusion: Chromohysteroscopy is a simple and effective technique for diagnosing endometrial pathology in cases of AUB.

Uterine Arteriovenous Malformations: Therapeutic Strategies and the Place of Hysteroscopy

Uterine arteriovenous malformations (UAVMs) are not common and are not well known. They are mainly manifested by hemorrhages that can be life-threatening. Their diagnosis is based mainly on ultrasound coupled with Doppler flow, as well as pelvic magnetic resonance imaging and angiography. In the absence of a consensus, and based on our experience, we discuss the place of hysteroscopy in the therapeutic strategy of UAVM. We reported 3 cases of UAVM, and we performed a review of the literature concerning the diagnosis and treatment of this pathology. We finally collected the advantages of the embolization-hysteroscopy sequence. In fact, the data suggest that hysteroscopy is a feasible and safe alternative treatment modality for UAVM. We believe that the resection of UAVM can be done under optimal conditions with a reduced risk of bleeding. Hysteroscopy would allow for optimal evaluation of the uterine cavity after treatment as well as the possibility of applying an anti-adhesive gel. In addition, the combination of hysteroscopy and embolization would require less healing time and shorter follow-up than embolization alone. It could also reduce the number of patients lost to follow-up.

An old uterine rupture repaired 2 months postpartum using laparoscopy aided by hysteroscopy: A case report

With an incidence of 0.005%,unscarred uterine rupture is extremely rare.It is difficult to diagnose uterine rupture because of the absence of characteristic clinical symptoms.Here,we report a rare case of a 31-year-old woman with a uterine rupture that was accurately diagnosed and repaired by laparoscopy and hysteroscopy on postpartum day 69.The patient recovered uneventfully and was discharged on postoperative day 4.Three months after surgery,pelvic magnetic resonance imaging was performed,which confirmed wound repair.In women with a stable condition,laparoscopy with hysteroscopy could be an alternative choice for the diagnosis and treatment of suspected uterine rupture;however,more substantial studies are needed to confirm this surgical approach.

Office Hysteroscopy in Difficult Embryo Transfer;Case Report of Three Cases

Objectives: To facilitate embryo transfer technique in cases with previous failed or difficult transfer using office hysteroscopy. Study Design: Case report of 3 cases of previous difficult embryo transfer (ET). Methods: Hysteroscopic assisted insertion of cervical stent at the end of withdrawal bleeding in the stimulation cycle. This stent was used as a track for embryo transfer catheter. Results: One case cancelled before (embryo transfer) ET and the other 2 cases didn’t get pregnant in spite of easy embryo transfer. Conclusion: This hysteroscopic assisted ET technique may facilitate ET technique in cases with difficult embryo transfer due to deformed cervix.