Hysteroscopic Embryo Transfer or Implantation- Experience of a Decade: An Alternative Objective and Reliable Method for Embryo Transfer (HEED) and Implantation (SEED)

Aims: Here we present early experience using HEED and SEED along with a description of these procedures in more detail. There is also a new look at the endometrial cavity and the placement of embryo transfer or implantation while under direct visualization.
Study Design: Retrospective non-randomized and uncontrolled case series.
Place and Duration of Study: West Coast IVF Clinic, Inc. and LA IVF Lab, LLC, Beverly Hills, CA, USA, between June, 2002 and June, 2011.
Methodology: Embryo transfer was done using a mini flexible hysteroscope with an articulating tip. This was accomplished by either placing the embryo gently on the surface of the endometrium (HEED) in 35 patients undergoing IVF, or embedding the embryo just beneath the endometrial surface (SEED) in 24 patient starts using egg donation. Once pregnancy was confirmed with a positive serum hCG, they were followed up with transvaginal ultrasounds and serial serum hCG’s in the first trimester. They were then referred to their local obstetricians and final outcomes were recorded after deliveries.
Results: There were a total of 35 patients in the early (days 2 or 3) embryo transfer group (HEED) which resulted in 16(46%) total pregnancies, which included 2 biochemical pregnancies, 2 ectopics, 5 spontaneous miscarriages, and 3 multiple pregnancies. There were 7 (20%) live births. In the second group of patients with day 5 or 6 embryo implantations (SEED), there were a total of 24 patient starts, with 16(67%), 4, 0, 5, and 4 total, biochemical, ectopic and multiple pregnancies respectively. There were 7(29%) live births.
Conclusion: Hysteroscopic embryo transfer or implantation may increase successful pregnancies and decrease risks and side effects from IVF procedures. Further prospective, controlled and randomized studies are needed to determine effectiveness of these procedures.