Transcervical pathway systems and methods are described. The system may include a delivery sheath having a first longitudinal opening and a second longitudinal opening. A visualization system, such as a hysteroscope, is deliverable through the first longitudinal opening of the delivery sheath. An implant delivery system is deliverable through the second longitudinal opening of the sheath. The implant delivery system may include a guide and an implant delivery system moveably (e.g. slideably) engaged with the guide.