A CASE OF LIVE BIRTH AFTER EMBRYO TRANSFER WITH SIGNIFICANT FLUID IN ENDOMETRIAL CAVITY

IntroductionEndometrial cavity fluid (ECF) present during embryo transfer (ET) has been associated with lower clinical pregnancy rates due to failure of implantation. It occurs at an incidence of 2.9%-8.2%. Many gynaecologists will choose to abandon the cycle if ECF was detected before ET. Etiologies include tubal infertility, hydrosalpinges, polycystic ovarian disease and uterine infections. Case PresentationWe present a case of successful implantation despite significant ECF at ET. She was a 28 year old lady with a history of a laparotomy bowel resection at 4-months of age. Initial subfertility investigations showed 6cm endometriotic cyst, adenomyosis and blocked right fallopian tube. There was no hydrosalpinx. Her ovarian reserves were normal and her husband had terozoospermia. She declined surgery for endometriotic cyst and was keen for IVF. ET during fresh cycle was cancelled due to high risk of ovarian hyperstimulation syndrome. She was scheduled for a natural thaw cycle but ultrasound before ET showed significant ECF (Figure 1). Despite counseling about the lower chance of pregnancy, the couple was keen to proceed with the ET. She had a successful implantation, and later delivered at full term via normal vaginal delivery.Discussion and ConclusionECF has been associated with poorer ART outcomes. ECF can be quantified by measuring the anterior-posterior diameter of fluid seen within the uterine cavity on ultrasound. A large retrospective controlled study showed no significant difference between patients with ECF <3.5mm and the control group, and revealed no clinical pregnancy among patients with ECF ≥3.5mm.Although our patient had a significant ECF of ≥3.5mm at the time of ET, she declined to postpone the cycle as she was not keen for treatment of her endometriosis which was the likely cause of the ECF. Thus she made the decision to proceed with the transfer.This was a rare case of a successful pregnancy and subsequent live birth despite multiple factors not favoring this outcome. Hence, it is still plausible to consider and proceed with ET even in the presence of significant ECF after adequate counseling and discussion with the couple.