Laparoscopic transabdominal isthmic cerclage in a case of cervical agenesis and a successful pregnancy with ICSI

Abstract

The objective was to construct a laparoscopic transabdominal isthmic cerclage in a patient with cervical agenesis at Kadir Has University, Metropolitan Florence Nightingale Hospital. A 39-year-old woman diagnosed with primary infertility due to cervical agenesis was admitted to our hospital because of recurrent assisted reproductive technique (ART) failures. She underwent three operations for acute abdominal pain due to endometriosis and pyometra. There was a tiny fistula-like opening at the level of the isthmus, through which menstrual blood passed. Three intracytoplasmic sperm injection (ICSI) attempts with transmyometrial transfer had failed at three different IVF centres. We performed a laparoscopic transabdominal isthmic cerclage to prevent a miscarriage due to a clinical condition similar to cervical insufficiency and then an ICSI procedure was performed. We delivered a healthy baby weighing 3,200 g by Caesarean section. We left the cerclage in place for subsequent pregnancies. To the best of our knowledge, this is the first report of laparoscopic isthmic cerclage for the prevention of a clinical condition similar to cervical insufficiency in cervical agenesis that has resulted in a term pregnancy after ICSI. © 2006 Springer-Verlag.