**6. Hysteroscopic embryo transfer**

As a trial of improving implantation rate following IVF/ICSI, some scattered papers described hysteroscopically-guided embryo transfer. Principally, hysteroscopic approach was selected in difficult cases of embryo transfer (44).

#### **6.1. A new hysteroscopic tubal embryo transfer catheter was developed**

Catheterization was performed in 60 patients at hysteroscopic insemination into tube, using 3 French catheters, in which the distal 3,4, and 5 cm tapered to 2 French. Hysteroscopic tubal embryo transfer and conventional IVE-ET were performed in 30 patients with normal tubes, who failed to achieve pregnancy after 2 IVF-ET trials. The success rate of complete insertion with the catheter tapering at the distal 3 cm was significantly higher than that at the distal 5 cm. Since we obtained the highest success rate of insertion with the catheter tapering at the distal 3 cm, we selected this catheter for the h-TEST. The rate of pregnancy in h-TEST was significantly higher than that in conventional ET (45).
