What is "HEED" (Hysteroscopic Endometrial Embryo Delivery)?

It refers to visually confirmed placement of the embryo(s) at a specific area on the surface of the uterus.

What is the difference between SEED and HEED?

HEED can also be used for earlier (day 2 or 3) embryos as well as the more advanced embryos; This is specially advantageous in situations where the number of embryos are limited, or embryo quality is of concern. It is particularly useful in patients with advanced reproductive age, or when egg production is low, or in patients with poor sperm parameters.

What is the advantage(s) of "HEED"?

Patients will actually see the process on video monitor.

The entry into the uterus is not always easy, as the non-stirrable tip of the catheter must usually go through different curvatures in the cervical canal and the uterine cavity while minimizing injury to the lining of the uterus, before it reaches the final destination. The flexible hysteroscope has a stirrable tip, helping guide the endoscope in a gas expanded uterine cavity. The slightly expanded uterine cavity also helps avoid contact between the hysteroscope and uterine surface. The final destination of the tip of the catheter is visually confirmed.

This more precise placement and lower volume of transfer fluid may help reduce incidence of ectopic pregnancies even further. It may also reduce chances placenta previa, where the after birth is lying over the uterine opening.

Presence of uterine contraction at the time of transfer that are otherwise not noticeable by using the “Blind” embryo transfer technique, can be visually confirmed and embryo transfer deferred.

Precise and visually confirmed placement, may reduce percentage of multiple pregnancies, by reducing number of embryos transferred because of the less uncertainty of the placement of embryos with the “Blind” technique.

What is the disadvantage(s) of this procedure?
Since the embryo(s) are laid on top of the uterine surface, due to inherent uterine contractions over the next few days after the embryo delivery and prior to their natural implantation in the uterine cavity, the embryo(s) may be expelled either into the fallopian tube (causing ectopic pregnancy) or out of the uterus, as they do with the current “blind” embryo transfer technique.

Possible scratching of the lining of the uterus so that pregnancy may not ensue.

How is it done?

It is done in an office setting, using a special fiberoptic scope and camera plus a special tubing, and it takes approximately two minutes to perform.