Fluoroscopically guided cervical dilatation in patients with infertility

Uterine cervical stenosis of either congenital or acquired etiology is a contributing factor in fertility. In such patients it is technically difficult to traverse the tortuous or stenotic cervical canal, precluding diagnostic procedures such as endometrial biopsy and hysterosalpingography, as well as therapies such as in vitro fertilization and embryo transfer (IVF-ET) or insemination. The standard method of dilatation with successively larger dilators may be difficult and traumatic, causing false channels or perforation of the uterus. Fifteen patients were referred for cervical dilatation because of inability to gain access to the uterine lumen. Under fluoroscopic guidance, the cervix was cannulated and the endocervical canal dilated with an angioplasty balloon. Five women had simultaneous fallopian tube recanalization. Only one woman had mild postoperative vaginal bleeding that subsided spontaneously at 48 hours. No patients experienced pain requiring narcotics, and no infections occurred. Five women conceived, one after IVF-ET, two with intrauterine inseminations, and two spontaneously. In those who did not conceive, the cervix was easily cannulated after the procedure. Cervical dilatation may provide options for treatment that would otherwise not be available to a select group of infertile women with cervical stenosis.