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Yinglan Z, Li X, Su H. Benefits of antibiotics and the optimal time interval between biopsy and the next embryo transfer in patients with chronic endometritis. Medicine (Baltimore) 2023; 102:e34650. [PMID: 37713900 PMCID: PMC10508538 DOI: 10.1097/md.0000000000034650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/18/2023] [Indexed: 09/17/2023] Open
Abstract
This study evaluated the effects of antibiotics on the implantation rate (IR) as well as the optimal time interval from endometrial biopsy to subsequent embryo transfer (ET) to explore proper chronic endometritis (CE) management. We retrospectively analyzed the clinical data of patients who had failed 1 or 2 ET cycles and underwent hysteroscopy. CE was diagnosed when 3 or more cluster of differentiation138 - positive plasma cells were found per high-power field. We divided the patients into 3 groups: those with CE who received antibiotics (group 1), those with CE who did not receive antibiotics (group 2), and those without CE (group 3). We found that IR was significantly higher in Group 1 than in Group 2. Furthermore, while the IR in Groups 1 and 3 was significantly higher when the time interval was < 6 months than when the time interval was > 6 months, there were no significant differences in the IR when the time interval was < 2 months or ≥ 2 months but < 6 months. Postbiopsy oral antibiotic therapy significantly improved IR in patients with CE, whereas increasing the time interval from biopsy to ET reduced IR. This study may help to find a higher potential for success in the medical management of patients with CE.
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Affiliation(s)
- Zhang Yinglan
- Department of Reproductive Medical Center of Affiliated Beijing Chaoyang Hospital of Capital Medical University, Chaoyang District, Beijing, China
| | - Xue Li
- Department of Pathology of Affiliated Beijing Chaoyang Hospital of Capital Medical University, Chaoyang District, Beijing, China
| | - Hui Su
- Department of Reproductive Medical Center of Affiliated Beijing Chaoyang Hospital of Capital Medical University, Chaoyang District, Beijing, China
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Wang B, Meng N, Zhang W, Kong P, Liu Z, Liu W, Sun H, Zhang W, Ren C, Guan Y. Optimal waiting period for frozen embryo transfer after hysteroscopic polypectomy: A propensity score matching analysis. Front Endocrinol (Lausanne) 2022; 13:986809. [PMID: 36246905 PMCID: PMC9561364 DOI: 10.3389/fendo.2022.986809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/06/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate the optimal waiting period for frozen-thawed embryo transfer (FET) after hysteroscopic polypectomy (HSC-P). DESIGN Retrospective cohort. SETTING University-affiliated hospital. PATIENTS All patients included in this research underwent hysteroscopy before the first FET cycle after whole embryo freezing. A total of 206 patients had undergone HSC-P, and 3681 patients without endometrial polyps were defined as the controls. INTERVENTIONS HSC-P. MAIN OUTCOME MEASURES The HSC-P group was divided into three subgroups based on the time interval between HSC-P and the start of an FET cycle. Subgroup 1 consisted of patients who underwent FET after their next menses, subgroup 2 after two menstrual cycles, and subgroup 3 after three or more menstrual cycles. Demographics, baseline in vitro fertilization (IVF) characteristics, and pregnancy outcomes, especially perinatal outcomes after FET were compared among the groups. RESULTS There were 137 patients in subgroup 1, 40 in subgroup 2, and 29 in subgroup 3. There were no differences in the baseline characteristics of the three groups. IVF-related data and FET-related data, such as endometrial thickness and ET no. Of embryoes, were similar among the three subgroups. The three subgroups showed no significant differences in implantation rate, biochemical pregnancy rate, abortion rate, clinical pregnancy rate or live birth rate. Besides, There was no significant difference in perinatal outcomes including very preterm delivery, preterm delivery, low birth weight, macrosomia, small for gestational age, large for gestational age, birth weight(g), birth-height(cm)and Apgar Scores. CONCLUSIONS Compared with FET after their next menses, FET after two or more menstrual cycles after HSC-P does not necessarily produce superior outcomes.
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Affiliation(s)
- Bijun Wang
- Department of Obstetrics and Gynecology, The Reproductive Medicine Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Nan Meng
- Department of Obstetrics and Gynecology, The Reproductive Medicine Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenjuan Zhang
- Department of Obstetrics and Gynecology, The Reproductive Medicine Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Pingping Kong
- Department of Obstetrics and Gynecology, The Reproductive Medicine Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhaozhao Liu
- Department of Obstetrics and Gynecology, The Reproductive Medicine Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenxia Liu
- Department of Obstetrics and Gynecology, The Reproductive Medicine Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Huaqing Sun
- Department of Obstetrics and Gynecology, The Reproductive Medicine Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wen Zhang
- Department of Obstetrics and Gynecology, The Reproductive Medicine Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chenchen Ren
- Gynecology and Obstetrics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou Key Laboratory of Cervical Disease, National Clinical Research Center for Obstetrics and Gynecology, Henan Branch, Zhengzhou, China
- *Correspondence: Yichun Guan, ; Chenchen Ren,
| | - Yichun Guan
- Department of Obstetrics and Gynecology, The Reproductive Medicine Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Yichun Guan, ; Chenchen Ren,
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The effects of hysteroscopic morcellation of endometrial polyps on frozen embryo transfer outcomes. Eur J Obstet Gynecol Reprod Biol 2021; 267:241-244. [PMID: 34837853 DOI: 10.1016/j.ejogrb.2021.11.420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/11/2021] [Accepted: 11/13/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE(S) To determine if hysteroscopic removal of endometrial polyps, specifically via morcellation of polyps, affects implantation rate (IR), clinical pregnancy rate (CPR), spontaneous abortion (SAB) rate, and live birth rate (LBR) in first frozen embryo transfer (FET) cycles. STUDY DESIGN Retrospective chart review, with data abstracted from the charts of all first autologous oocyte frozen embryo transfer (FET) cases (n = 135) at a single fertility center from January 2018 through June 2020. Subjects were grouped into (A) hysteroscopic polypectomy prior to first FET (n = 25) or (B) no hysteroscopic polypectomy prior to first FET (n = 110). The primary outcome was live birth rate (LBR). Secondary outcomes were implantation rate (IR), clinical pregnancy rate (CPR), and spontaneous abortion (SAB) rate. RESULTS We found no difference between the groups in terms of the primary outcome (LBR) or the secondary outcomes IR, CPR, and SAB rate. CONCLUSION(S) The data analyzed here suggest that hysteroscopic morcellation of endometrial polyps has no adverse effect on IR, SAB rate, CPR, or LBR among first FET cases after this type of polypectomy.
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DE Angelis MC, DI Spiezio Sardo A, Carugno J, Manzi A, Sorrentino F, Nappi L. Fertility outcomes after hysteroscopic removal of intrauterine leiomyomas and polyps. Minerva Obstet Gynecol 2021; 74:3-11. [PMID: 33876900 DOI: 10.23736/s2724-606x.21.04739-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Thanks to the progress of science, it is now understood that a successful implantation not only depends on the quality of the embryo, but also on having a receptive endometrium. During the years, several authors have reviewed the important role of the uterine factor, ranging from the congenital anomalies, such as uterine septa and subsepta, and acquired conditions such as endometrial polyps and submucous myomas. Currently, hysteroscopy has proved to be a powerful and accurate tool for visualizing the uterine cavity and treating intrauterine pathologies. EVIDENCE ACQUISITION This review of the literature aims to report the current available data on the effects of the two most common endouterine pathologies (i.e. endometrial polyps and submucous myomas) and the impact of hysteroscopic removal on fertility outcomes. EVIDENCE SYNTHESIS To date, the low number of randomized controlled trials available does not yet make it possible to give a definitive answer on what are the reproductive outcomes following treatment of endometrial polyps and leiomyomas. Nevertheless, existing evidence points to a benefit of removal of this two pathologies in infertile women, mostly when they have a history of recurrent pregnancy loss. CONCLUSIONS Further studies are needed to demonstrate that surgical treatments of endometrial polyps and myomas could improve not only the morphology but also the function of the uterine cavity before undergoing any assisted fertility treatment.
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Affiliation(s)
| | | | - Jose Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, University of Miami, Miami, FL, USA
| | - Alfonso Manzi
- Department of Neurologic, Reproductive, and Odontostomatologic Sciences, Federico II University, Naples, Italy
| | - Felice Sorrentino
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
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Stamenov GS, Vitale SG, Della Corte L, Vilos GA, Parvanov DA, Nikolova DN, Ganeva RR, Haimovich S. Hysteroscopy and female infertility: a fresh look to a busy corner. HUM FERTIL 2020; 25:430-446. [PMID: 33261529 DOI: 10.1080/14647273.2020.1851399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Hysteroscopy has evolved from the traditional art of examining the uterine cavity for diagnostic purposes to an invaluable modality to concomitantly diagnose and (see and) treat a multitude of intrauterine pathologies, especially in the field and clinics specialising in female reproduction. This article reviews the literature on the most common cervical, endometrial, uterine and tubal pathologies such as chronic endometritis, endometrial polyps, adenomyosis, endometriosis, endometrial atrophy, adhesions, endometrial hyperplasia, cancer, and uterine malformations. The aim is to determine the efficiency of hysteroscopy compared with other available techniques as a diagnostic and treatment tool and its association with the success of in vitro fertilisation procedures. Although hysteroscopy requires an experienced operator for optimal results and is still an invasive procedure, it has the unique advantage of combining great diagnostic and treatment opportunities before and after ART procedures. In conclusion, hysteroscopy should be recommended as a first-line procedure in all cases with female infertility, and a special effort should be made for its implementation in the development of new high-tech procedures for identification and treatment infertility-associated conditions.
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Affiliation(s)
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - George Angelos Vilos
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Western University, London, Canada
| | | | | | | | - Sergio Haimovich
- Hillel Yaffe Medical Center/Technion - Israel Technology Institute, Hadera, Israel
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Tu YA, Yang PK, Chen SU, Yang JH. Optimal time interval between hysteroscopic polypectomy and frozen-thawed blastocyst transfer: A retrospective study. PLoS One 2020; 15:e0240882. [PMID: 33079974 PMCID: PMC7575078 DOI: 10.1371/journal.pone.0240882] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/05/2020] [Indexed: 11/19/2022] Open
Abstract
The optimal timing of frozen-thawed blastocyst transfer following hysteroscopic polypectomy is an important and unanswered clinical question. In this study, we conducted a retrospective survey of cases from an infertility center at an academic hospital. We reviewed the charts of all patients who received in-vitro fertilization and frozen-thawed blastocyst transfers (FBT) at the center from January 2009 to November 2019. One hundred and two patients with prior diagnosis of endometrial polyp that were treated with hysteroscopic polypectomy before received their first FBT at the center were identified as cases. Patients without prior diagnosis of endometrial polyp, and who received their first FBT at the center were defined as controls. Controls were enrolled at a 1-to-1 ratio to the cases. The cases and controls did not show differences in baseline characteristics, endometrial thickness, or the number of good blastocysts transferred. The clinical pregnancy rates and live birth rates were similar. Regarding the optimal interval between polypectomy and FBT, a cut-off of 120 days was identified from the ROC curve. A stratified analysis showed that when FBT was performed within an interval of 120 days after polypectomy, there were higher biochemical pregnancy rates (73.2%, 45.2%; OR 3.3; P = .007) and clinical pregnancy rates (64.8%, 41.9%; OR 2.54; P = .032), when compared with intervals greater than 120 days. There were no significant differences in implantation and live birth rates. In conclusion, pregnancy rates following FBT in patients who had received prior endometrial polypectomy were comparable to pregnancy rates after FBT in patients without endometrial polyp. Subgroup analysis showed that an interval greater than 120 days between hysteroscopic polypectomy and FBT was associated with decreased pregnancy rates. Patients who wish to receive embryo transfer after polypectomy should wait no longer than 120 days.
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Affiliation(s)
- Yi-An Tu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Kai Yang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shee-Uan Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jehn-Hsiahn Yang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- * E-mail:
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Aharon D, Sekhon L, Lee JA, Ascher-Walsh C, Copperman AB. Optimal Interval of Time from Operative Hysteroscopy to Embryo Transfer in an In Vitro Fertilization Cycle. J Minim Invasive Gynecol 2019; 26:1083-1087.e1. [DOI: 10.1016/j.jmig.2018.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 10/25/2018] [Accepted: 10/25/2018] [Indexed: 10/28/2022]
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Zhang H, He X, Tian W, Song X, Zhang H. Hysteroscopic Resection of Endometrial Polyps and Assisted Reproductive Technology Pregnancy Outcomes Compared with No Treatment: A Systematic Review. J Minim Invasive Gynecol 2018; 26:618-627. [PMID: 30557636 DOI: 10.1016/j.jmig.2018.10.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 10/06/2018] [Accepted: 10/29/2018] [Indexed: 11/26/2022]
Abstract
Endometrial polyps are frequently encountered in the uterine cavity of infertile women. There is much debate regarding the treatment of endometrial polyps in patients who are undergoing assisted reproductive technology (ART). A systematic review was performed by searching PubMed, Embase, and the Cochrane Library for retrospective or prospective studies that compared the effect of hysteroscopic resection of polyps with no treatment on pregnancy outcomes of patients who underwent ART. The primary outcomes were clinical pregnancy, live birth, miscarriage, and implantation rates after ART. Eight studies with a total of 2267 patients were included. The results showed that hysteroscopic resection of endometrial polyps (mean size <2 cm) was associated with an increased rate of clinical pregnancy in patients who underwent intrauterine insemination. No clear benefit was observed for clinical pregnancy, live birth, miscarriage, or implantation rates in patients who underwent in vitro fertilization/intracytoplasmic sperm injection cycles. In conclusion, the effect of hysteroscopic polypectomy on pregnancy outcomes of patients who have undergone ART remains unclear. More prospective, randomized controlled trials are warranted to determine appropriate treatment.
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Affiliation(s)
- Huixia Zhang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, People's Republic of China (all authors)
| | - Xueqing He
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, People's Republic of China (all authors)
| | - Wenyan Tian
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, People's Republic of China (all authors)
| | - Xueru Song
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, People's Republic of China (all authors)
| | - Huiying Zhang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, People's Republic of China (all authors)..
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Asuzu IM, Olaofe OO. Histological Pattern of Endometrial Biopsies in Women with Abnormal Uterine Bleeding in a Hospital in North Central Nigeria. Int J Reprod Med 2018; 2018:2765927. [PMID: 30515385 PMCID: PMC6236767 DOI: 10.1155/2018/2765927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 09/30/2018] [Indexed: 11/26/2022] Open
Abstract
The study is a retrospective cross-sectional study carried out in the Department of Pathology of Premier Hospital, Abuja, on specimens received over a one-year period. Four hundred and eighty-six samples of endometrial biopsies and curettings from women presenting with abnormal uterine bleeding sent to the histopathology laboratory were analyzed. The most common biopsies were those of product of conception which accounted for 304 cases (62.6%). Most of the cases of endometrial hyperplasia were typical. Endometritis and chorioamnionitis were the inflammatory conditions seen. Twenty-three women had molar pregnancies. The most common cause of abnormal uterine bleeding in this population is retained products of conception. There may be need to retrain some of the staff involved in the management of pregnancy related complications. There is need to further evaluate pregnancy related complications to ascertain the causes and circumstances responsible for them so as to appropriately direct interventional protocols.
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Affiliation(s)
- Ifeyinwa Mary Asuzu
- Department of Pathology and Forensic Medicine, University of Abuja, Abuja 902101, Nigeria
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The effect of frozen-thawed embryo transfer performed concurrently with hysteroscopy on the reproductive outcomes during assisted reproductive treatments. Sci Rep 2017; 7:11852. [PMID: 28928434 PMCID: PMC5605495 DOI: 10.1038/s41598-017-12068-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 08/31/2017] [Indexed: 11/08/2022] Open
Abstract
The uterine environment is vital to the successful conception; recently, hysteroscopy was used to remove uterine anomalies in patients undergoing assisted reproductive treatments in combination with a “freeze-all” strategy. However, the rapid recurrence of uterine anomalies impose a negative impact on pregnancy. A possible way to avoid this issue is to implement frozen-thawed embryo transfer (FET) as soon as possible. Thus, we sought to investigate the impact of performing FET concurrently with hysteroscopy in the same mense on the pregnancy outcome. Patients enrolled were divided into two groups: group 1 (n = 272, FET in this mense) and group 2 (n = 251, FET in the next mense). There were no differences in the clinical pregnancy rate (55.15% vs. 53.78%), implantation rate (39.32% vs. 37.2%), spontaneous miscarriage rate (10% vs. 8.89%), or live birth rate (45.96% vs. 45.02%) when comparing the two groups. Binary logistic regression indicated maternal age was negatively associated with the live birth rate, while FET following hysteroscopy in the same mense had no adverse effects on the live birth rate. Our data indicate performing FET concurrently with hysteroscopy in the same menstrual cycle does not impair the pregnancy outcomes, but additional studies with larger populations are needed to confirm these results.
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Does the time interval between hysteroscopic polypectomy and start of in vitro fertilization affect outcomes? Fertil Steril 2016; 105:539-44.e1. [DOI: 10.1016/j.fertnstert.2015.10.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 10/18/2015] [Accepted: 10/27/2015] [Indexed: 11/23/2022]
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Surgical Management of Endometrial Polyps in Infertile Women: A Comprehensive Review. Surg Res Pract 2015; 2015:914390. [PMID: 26301260 PMCID: PMC4537769 DOI: 10.1155/2015/914390] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 07/26/2015] [Indexed: 11/18/2022] Open
Abstract
Endometrial polyps are benign localized lesions of the endometrium, which are commonly seen in women of reproductive age. Observational studies have suggested a detrimental effect of endometrial polyps on fertility. The natural course of endometrial polyps remains unclear. Expectant management of small and asymptomatic polyps is reasonable in many cases. However, surgical resection of endometrial polyps is recommended in infertile patients prior to treatment in order to increase natural conception or assisted reproductive pregnancy rates. There is mixed evidence regarding the resection of newly diagnosed endometrial polyps during ovarian stimulation to improve the outcomes of fresh in vitro fertilization cycles. Hysteroscopy polypectomy remains the gold standard for surgical treatment. Evidence regarding the cost and efficacy of different methods for hysteroscopic resection of endometrial polyps in the office and outpatient surgical settings has begun to emerge.
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