Michael N. Kamrava, MD

     “Good afternoon, my name is Hugo Verhoeven from the Centre for  Reproductive Medicine in Dusseldorf, and I’m on the Editorial Board of  OBGYN.net.  I am reporting today from the ASRM meeting in Seattle, and  it’s a great pleasure for me talking this morning with Michael Kamrava,  he is the Medical Director of the West Coast Infertility Medical Clinic  in Beverly Hills, California. 
 
 He told me before that he prefers to do a hysteroscopic embryo transfer  because he was quite frustrated with all other techniques he used.   Michael it is a pleasure for me talking to you.  So maybe you will  repeat to our listeners why you switched from the conventional embryo  transfer methods to the hysteroscopic methods?”
 
 

    “It’s my  pleasure too, thank you.  It was basically just as you said, our  frustration with the blind embryo transfers because we can’t quite guide  the blind, plastic tube inside the uterus.  Also that scientifically  the embryo when we put it in with a blind transfer it has a shell around  it that doesn’t allow the embryos to stick to the lining of the uterus  right away.  And so there’s a real chance that that embryo can either  get inside the fallopian tube, that’s why sometimes we have the tubal  pregnancies from this procedure, or sometimes that embryo just falls out  of the uterus, right after we put it in. 
 
 I was thinking about it and in Mother Nature what happens is that that  embryo hatches out of that shell by around day five or six and then it  actually digs inside the lining of the uterus.  That’s how it attaches  to the uterus.  So we thought, well why not mimic Mother Nature if we  can to actually implant the embryo inside the lining and this way we  will eliminate any chance that that embryo is going to move from the  place that you put it.  So we have eliminated tubal pregnancies and we  have increased the pregnancy rates because there is much less chance of  the embryo falling out of the uterus after you put it in.”
 
 

   “So the important point is already that you’re doing a transferral blastocyst on day five, correct?”
 
 

   “Okay.  What instruments are you using?”
 
 

   “The  instrument is of two components: one is a combination of a rigid,  flexible mini-hysteroscope and the other one is the transfer tubing that  goes through the hysteroscope to deliver and implant the embryo inside  the lining of the uterus.”
 
 

   “What is the diameter of the device that you are entering into the cervical canal?”
 
 

   “Roughly about three millimetres.”
 
 

    “Actually, right.  For some patients that is a little bit big.  That’s  why we have to make some preparation for the patients and in all the  patients, before we actually start the whole procedure, like at least a  month or so before, and sometimes more if we have time, we actually  dilate the cervix to make sure…”
 
 

   “For hysteroscopy you dilate the cervix…yes, okay.”
 
 

   “…hysteroscopic, right…procedure to make sure it stays open.”

   “And as a distension medium you probably use CO

   “We use a gas for the distension, right.”

   “There’s no toxicity of the gas for the embryos?”

   “For this one we actually use nitrous oxide for the distension instead of CO

.  It is an inert gas, that doesn’t affect the embryos.”

   “Okay.  So  what are you doing exactly: you are bringing the hysteroscope and you  told me before you’re imitating the implantation, so you do not do a  transfer, you do an implantation of the embryo.  What are you doing?”

   “Right,  exactly.  What we do is introduce the hysteroscope, and as you introduce  it inside the cervix you can actually see it on a screen.  So you can  actually guide the tip of the hysteroscope as you go in, so in difficult  transfers it has helped actually quite a bit because you will minimise  injury to the lining of the uterus as you introduce it because you can  see it on the direct visualisation. 
 
 Then, as you go in you can see the inside cavity of the uterus expand  very nicely so there is very little chance of the instrumentation to  damage the inside lining of the uterus because of the expansion and the  narrow diameter of the hysteroscope.  And then we go all the way up in  the top of the uterus in the fundus and then the hysteroscope is already  loaded with the embryo, and then we advance the tip of the catheter  through the hysteroscope and then go just slightly inside the lining of  the endometrium of the uterus and then release the embryo.”

   “That means you’re really bringing the catheter into the endometrium?”

   “Right, correct.  It goes directly inside the endometrium."

   “There’s  no bleeding. We’ve done over 150 patients so far, and there’s been no  bleeding.  There has been, initially in the first few patients, there  was one patient who had a slight scratching of the lining of the uterus  and we simply picked another place to implant the embryo and that  patient did actually get pregnant.  No problems.”

   “Do we have an improved pregnancy rate using this technique?”

   “We have  looked at that, and in our own hands, in comparison with the blind  procedure we have eliminated tubal pregnancies, that is zero ectopic  pregnancies and the pregnancy rate by itself is about 70% higher than  what we had with the blind procedure.”

   “Seventy  percent higher.  Before we used to run on average, from all the  patients, all ages and all different reasons for doing the in vitro,  about 18% - 20% and right now we are running actually about 34% - 35%.”

   “That’s quite  interesting data.  My final question is: you’re certainly trying to  improve your technique and to find other possibilities to make the  implantation rate higher – what are you thinking about?”

 “I think you know at this point having come this far, I think this  procedure now can be repeated in different hands to give similar results  because it is not left to a chance.  And I think the next step really  in our attempts at improving the results would be to optimise the egg  development and the quality of the eggs.”

   “Well Michael, thank you very much for this very interesting interview.  I wish you all the best, thank you very much.”

Articles

58th Annual Meeting - Seattle, Washington - October 2002

Hysteroscopic Embryo Implantation

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Michael N. Kamrava, MD

Articles

Hysteroscopic Embryo Implantation

Hysteroscopic Embryo Implantation Video