DE102021001654A1 - Device and method for implanting a fertilized egg or embryo - Google Patents

Abstract

A device (11) for inserting an embryo, in particular in a fallopian tube (5) of a woman, comprises an endoscope device (12) with an endoscope tube (13) and an endoscope head (14), which is suitable through the vagina (2), the cervix (3, 4) and the uterus (8, 9) of a woman and at least partially into a fallopian tube (5) of the woman. An embryo can then be brought to the endoscope head (14). The device (11) also includes a lock device (16) which is suitable for being used in or on the cervix (3, 4) and has a passage (17) for the endoscope tube (13) and the endoscope head (14). .

Description

The present invention relates to devices for inserting an embryo, in particular into a fallopian tube, as well as methods and uses for such a device.

In the field of artificial insemination in mammals, fertilization of the ovum by a spermatozoon often occurs outside the body in vitro, first to form a pronucleus cell and further to form a zygote with fused pronuclei. The fertilized egg must then be placed in the woman's body at an appropriate stage of development, usually as a blastocyst, in order to develop into an embryo and fetus.

It is desirable to achieve reliable implantation of the blastocyst in the uterus, and thereby pregnancy. The blastocyst is usually placed on or in the mucous membrane of the uterus (endometrium) with the help of a catheter passed through the vagina into the uterus. Subsequent nidation, in which the blastocyst penetrates the upper layer of the uterine lining and is covered by an epithelium, is not always successful.

In the past, in the veterinary field in cattle, fertilized oocytes were implanted using suitable endoscopes at a site between the cow's cervix and the ovary to simulate a natural fertilization pathway of the zygote or blastocyst in the animal's body.

In humans, in the 1980s, in the absence of suitable non-invasive instruments, procedures were performed through the abdominal wall of women to implant blastocysts in the fallopian tube. The method is known in particular as ZIFT (zygote intrafallopian transfer). However, experts have abandoned this treatment due to the risks associated with the necessary laparoscopy.

Against this background, it is an object of the present invention to provide measures for improving the implantation possibilities of embryos in a woman's body.

Accordingly, an apparatus according to independent claim 1 is proposed. A use of the device and a method using the device are also described. Further advantages or developments are the subject of the dependent claims. The invention also consists in the design of the lock device. One can, for example, speak of a cervical sluice.

In particular, the combination of an endoscope device and a sluice device enables a non-invasive intervention to place the blastocyst/embryo in the fallopian tube. Furthermore, the device allows an examination of the patency of the fallopian tubes.

The lock device is preferably designed in such a way that it can be inserted into the cervix via the vagina and after gynecological adjustment, for example with the aid of a colposcope. The lock device then enables the endoscope device to be easily guided through into the uterus without irritating or injuring tissue. In embodiments, the sheath device is designed like a tubular stent.

The cross section of the passage of the sluice device is matched to the cross section of the endoscope device and allows an axial and rotational movement of the elements of the endoscope device relative to the sluice device seated in the cervical os.

The endoscope device preferably has an instrument channel through which medical instruments and/or a container with the embryo can be guided to the endoscope head end.

The lock device is made of a soft plastic material, for example. In embodiments, the lock device is at least partially made of a material that can be used medically as a stent material in biliary stents. Manufacturing from polyethylene (PE), polytetrafluoroethylene (PTFE), polyetheretherketone (PEEK) or silicone is conceivable. Such polymeric materials have proven to be medically acceptable and suitable for use in the uterus.

The lock device can alternatively or additionally be designed in the manner of a bile duct prosthesis, in particular as a bile stent.

By inserting the embryo, in particular the blastocyst, in the fallopian tube, the fertilized egg cell is brought (back) to the body at a position where an interaction of the blastocyst or zygote with the body (fallopian tube) would also be possible in a natural reproductive process. It is known from earlier studies that the insertion of embryos in fallopian tubes leads to a higher probability of nidation in the uterus than with today's usual transfer of the blastocyst directly into the uterus. The proposed method can be based on previous ones Laparoscopic interventions are referred to as EZIFT or eZIFT (endoscopic zygote intrafallopian transfer).

An embryo is understood in particular to be a fertilized egg cell capable of reproduction (zygote). In this case, the embryo can comprise a plurality of cells, preferably at least four cells. The term embryo is also used for a blastocyst stage.

Compared to earlier laparoscopies, the proposed device allows positioning in the fallopian tube without invasive measures on the woman's body.

The endoscopy device employed or used in the method corresponds in particular to the endoscopy device specified in more detail in the device claims and described below.

The use of an endoscopy device intended for lung examinations by the manufacturer Olympus, which is available for example under the designation BF-MP 190F, is conceivable. Furthermore, a ring-shaped and flexible sluice device adapted to it is then used.

Further refinements of the invention are the subject matter of the subclaims and of the exemplary embodiments described below. The invention is explained in more detail below using exemplary embodiments with reference to the enclosed figures.

• 1: eine schematische Darstellung eines weiblichen Unterleibs;
• 2: eine schematische Darstellung einer Ausführungsform für eine Endoskopievorrichtung mit einer Schleuseneinrichtung zur Verwendung im Rahmen einer künstlichen Befruchtung.
• 3: eine schematische Querschnittsansicht der Ausführungsform aus 2, bei der die Schleuseneinrichtung im Muttermund steckt und der Endoskopschlauch hindurchgeführt ist.
• 4: eine schematische Ansicht einer Ausführungsform für eine Portioschleuse.

It shows:

• 1 : a schematic representation of a female abdomen;
• 2 1: a schematic representation of an embodiment of an endoscopy device with a lock device for use in the context of artificial insemination.
• 3 : a schematic cross-sectional view of the embodiment 2 , in which the lock device is in the cervix and the endoscope tube is passed through.
• 4 : a schematic view of an embodiment for a cervical sluice.

the 1 shows the abdomen 1 of a woman. A dashed curve with a marked end point 10 is drawn in, which represents the path from the vagina 2 via the inner and outer cervical os 4, 3 (cervical canal) and the uterine body 9 into the right fallopian tube 5. It is desirable to move an in vitro conceived embryo to position 10 along the plotted curve to improve the chance of nidation.

A set of instruments consisting of an endoscopy device and a lock device is used for this purpose. the 2 shows a schematic representation of such a device. The device 11 for inserting an embryo into a fallopian tube 5 of a woman comprises an endoscopy device 12 which is basically suitable for bronchoscopy, for example, and an annular lock device 16 which can be inserted into the cervix 3 , 4 . The endoscope device 12 comprises an endoscope tube 13 and an endoscope head 14, it being possible for an embryo to be guided to the endoscope head 14. Furthermore, a handling part 15 is provided for operation. The total length to be bridged with the aid of the endoscope device 12 is about 40-60 cm. Shorter lengths are also possible.

The lock device 16 has a passage 17 through which the endoscope head 14 and the tube 13 can be passed, so that when passing through the cervix 3, on the one hand no irritation of the tissue occurs and on the other hand the propulsion into the uterus 1 through the cervix 8 is facilitated .

In the 3 a schematic cross-sectional view of the endoscope tube 13, 14 guided through the annular lock device 16 is shown. It can be seen that the passage 17 offers a certain amount of play in relation to the outer diameter of the hose 13 and the head 14 . An instrumentation channel is indicated by a dotted line and channels for image acquisition (lenses and light guides) are indicated by hatched lines. The embryo to be implanted can be brought to the endoscope tip in a targeted manner through the instrumentation channel to position 10 in the fallopian tube 5 and implanted.

4 shows a section of the uterus 1 (left) and a sluice device designed as a small tube or a cervical sluice (right). A dot-dash curve is drawn in the uterus with end points at the external os 3 and the opening 18 of the fallopian tube 5 into the uterus. It is desirable to bring the endoscope used for embryo implantation into contact with the lining of the uterus as little as possible. The curve shows a possible connection along which the endoscope could be guided with little or no mucosal contact.

In the embodiment of 4 the lock device 16 has a length which this Points 3, 18 bridged. For this purpose, the cervical sluice 16 is designed with a straight section 16A proximal to the operator and a section 16B bent distally in the direction of the mouth 18 . The sheath device 16 can be made of a polymer material similar to a tubular biliary stent.

To facilitate insertion into the uterus, there may be a smooth surface or surface coating inside and/or. Teflon material (PTFE) can be used to make it easier to guide the endoscope tube 13 and the endoscope head 14 . When the sluice device 16 is made of Teflon, there is particularly low static and sliding friction in the passage between the endoscope and the cervical sluice.

Overall, the proposed devices and methods allow an improved examination of the female reproductive system and a more promising artificial fertilization than with conventional catheter applications, which only allow positioning in the body of the uterus.

Reference List

1

uterus/womb

2

Vagina/Vagina

3

external cervix

4

internal cervix

5

fallopian tubes

6

ovary

7

ovarian ligament

8th

cervix

9

uterine body

10

implant position

11

contraption

12

endoscope device

13

endoscope tube

14

endoscope head

15

handling section

16

lock facility

16A

straight section

16B

curved section

17

passage

18

mouth of the fallopian tube

Claims (10)

Device (11) for inserting an embryo, in particular in a fallopian tube (5) of a woman, comprising: an endoscope device (12) with an endoscope tube (13) and an endoscope head (14) which is suitable through the vagina (2), the cervix (3, 4) and the uterus (8, 9) of a woman and at least partially into one Fallopian tubes (5) of the woman to be guided, an embryo being able to be brought to the endoscope head (14); and a lock device (16) which is suitable for being used in or on the cervical os (3, 4) and has a passage for the endoscope tube (17) and the endoscope head (14). device after claim 1 , wherein the lock device (16) is designed in the shape of a torus, in particular as an elastic ring. device after claim 1 or 2 , wherein the lock device (16) is formed from a flexible material in such a way that the endoscope head (14) and the endoscope tube (13) can be pushed through the passage (17). device after one Claims 1 - 3 , wherein the passage (17) has a length of between 2 and 5 cm, preferably between 2 and 10 cm. device after one Claims 1 - 4 , wherein the endoscope hose (13) and the endoscope head (14) have a maximum cross-sectional extent, in particular a diameter, between 1 and 5 mm. device after one Claims 1 - 5 , wherein the endoscope device (11) is suitable and/or provided for mirroring the bile ducts or airways of a human being. device after one Claims 1 - 6 , wherein the endoscope device (11) is a bronchoscope, in particular a bronchoscope of the type BF-MP 190F from the manufacturer Olympus at the time of the filing date. Sluice device (16) for use in a device (11) and the sluice device features according to one of Claims 1 - 7 which in particular: has a smooth inner and/or outer surface; has a length of between 3 and 10 cm to reduce contact of the endoscope device (11) with a uterine lining inside the uterus (8, 9); has an outer diameter between 2 and 15 mm, preferably between 3 and 7 mm; has a sleeve-shaped portion; is designed as a tube; has a straight (16A) and a bent section (16B), the bent section (16B) pointing in the direction of an orifice (18) of the fallopian tube (5) into the uterus (9) when the lock device (17) through the cervix (3, 4) is guided and inserted; is curved along its length so as to reduce endoscopic contact with a lining of the uterus within the uterus (9) when the sheath device (17) is passed through the cervical os (3, 4) and inserted; is at least partially made of a friction-reducing material, in particular Teflon. Use of an endoscope device (12) intended for viewing the biliary or respiratory tract of a human for inserting an embryo into a fallopian tube (5) of a woman. Method of implanting an embryo in a woman's body having a vagina (2), a uterus (8, 9) and a fallopian tube (5), in which a fertilized egg or embryo is transferred via the woman's vagina (2), cervix ( 3, 4) and the uterus (8, 9) is introduced into a fallopian tube (5) in the direction of a respective ovary (6), in particular with the steps: providing a fertilized ovum as an embryo; Inserting an endoscope device (12) via the vagina (3), cervix (3, 4) and uterus (8, 9) into a fallopian tube (5); and Introduction of the embryo via the endoscope device (12) into the fallopian tube (5).

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