Novel Retrograde Transfundal Hysteroscopic Reconstruction in a Case of Congenital Cervical Stenosis with Absent External Os

Cervical stenosis with an absent external os is a rare condition that poses significant challenges in diagnosis and management, often leading to primary amenorrhea, cyclic pelvic pain, and infertility. We report the case of a 27-year-old nulligravida presenting with primary amenorrhea and infertility due to congenital cervical stenosis with complete absence of the external os. Magnetic resonance imaging revealed cervical stenosis associated with hematometra and bilateral polycystic ovaries. The patient underwent retrograde hysteroscopy through a transfundal approach under laparoscopic guidance. The hysteroscope was introduced through the uterine fundus, intrauterine synechiae were divided, and the cervico-vaginal continuity was re-established using a trans-illumination technique. Progressive cervical dilatation was achieved, resulting in the creation of a functional 5–6 mm cervical canal. The procedure was completed without complications. Two months postoperatively, the patient experienced her first menstrual period at the age of 27 years, followed by the establishment of regular menstrual cycles and resolution of dysmenorrhea. Subsequently, conception was achieved after ovulation induction therapy, and a viable intrauterine pregnancy was confirmed at 7 weeks with detectable fetal cardiac activity. This case highlights the potential of retrograde transfundal hysteroscopy as a novel, minimally invasive technique for managing severe cervical stenosis, effectively restoring menstrual function and fertility while minimizing surgical morbidity.