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Liu C, Liao Z, Gong X, Chen Y. Does septum resection improve reproductive outcomes for women with a septate uterus? A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2024; 15:1361358. [PMID: 39104816 PMCID: PMC11298444 DOI: 10.3389/fendo.2024.1361358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 05/24/2024] [Indexed: 08/07/2024] Open
Abstract
Objective To investigate whether incising the septum facilitates reproductive outcomes for patients with a septate uterus compared to expectant management. Methods Research was retrieved from three electronic databases: PubMed, Embase, and the Cochrane Library, with no time or language restrictions. Two authors independently selected the articles and extracted data regarding study characteristics, quality, and results. A random-effects model was employed, and summary risk ratios (RR) with 95% confidence intervals (CI) were calculated. Results A total of 468 patients from two randomized controlled trials and one cohort study were included in the systematic review and meta-analysis. Pooled results showed that septum resection did not improve the live birth rate for patients with a septate uterus (RR = 0.84, 95% CI = 0.56 - 1.25, P = 0.39). Additionally, no significant differences were found between the septum resection and expectant management groups in terms of clinical pregnancy (RR = 1.08, 95% CI 0.81 - 1.44, P = 0.60), abortion (RR = 1.99, 95% CI 0.80 - 4.98, P = 0.14), and preterm delivery rates (RR = 0.99, 95% CI 0.42 - 2.31, P = 0.98). Conclusion Our data provide clear evidence that septum resection does not improve the reproductive outcomes of patients with a septate uterus. These findings might be useful for revising current clinical guidelines.
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Affiliation(s)
- Chang Liu
- Reproductive Medicine Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhiqi Liao
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xueqi Gong
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yinwei Chen
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Mert SA, Dilbaz B, Akpinar F, Diktas EG, Kinay T, Ensari T, Tekin OM. Evaluation of the Success of Hysteroscopic Uterine Septum Resection. Gynecol Minim Invasive Ther 2023; 12:230-235. [PMID: 38034112 PMCID: PMC10683958 DOI: 10.4103/gmit.gmit_131_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/10/2023] [Accepted: 04/24/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives The aim is to use three-dimensional transvaginal ultrasonography (3-D TVUS) to evaluate the success of hysteroscopic metroplasty for the uterine septum and to compare the pregnancy outcomes. Materials and Methods Thirty-eight patients with uterine septum who had hysteroscopic uterine septum resection were recruited. Preoperative 3-D TVUS measurements of the septal apex to the uterine fundus (s1), septal apex to internal os distance (s2), and intercornual distance (s3) were compared with the postoperative values. The pregnancies of the patients were followed up for a year postoperative period. Results Out of the 38 patients, thirty-five had partial uterine septum (class U2a), while 3 patients had complete uterine septum (class U2b). Eighteen (47.36%) of the patients who underwent uterine septum resection achieved pregnancy, and thirteen of these pregnancies were (72.2%) term pregnancies, and all term pregnancies resulted in a live birth. Natural conception was achieved in 77.7% (14 of 18) of the patients. Term pregnancy occurred in 68.7% (11 of 16) of the patients with a partial septum and in 66.6% (2 of 3) of the patients with a complete uterine septum. A comparison of the 3-D TVUS measurements of the uterus pre- and postoperatively showed a decrease in s1 and an increase in s2 (P < 0.05). The uterine cavity length of pregnant patients was found to be higher than nonpregnant patients (P < 0.05). Conclusion Reproductive results of hysteroscopic metroplasty were favorable in achieving live and term birth. three-dimensional TVUS can be preferred as a noninvasive effective method in objective evaluation of the success of the hysteroscopic surgery.
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Affiliation(s)
- Sule Atalay Mert
- Department of Reproductive Endocrinology, Etlik Zübeyde Hanim Women’s Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Berna Dilbaz
- Department of Reproductive Endocrinology, Etlik Zübeyde Hanim Women’s Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Funda Akpinar
- Gynecology and Obstetrics Clinic, Ankara Training and Research Hospital, Ankara, Turkey
| | - Elif Gulsah Diktas
- Department of Reproductive Endocrinology, Etlik Zübeyde Hanim Women’s Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Tugba Kinay
- Department of Reproductive Endocrinology, Etlik Zübeyde Hanim Women’s Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Tugba Ensari
- Gynecology and Obstetrics Clinic, Ankara City Hospital, Ankara, Turkey
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Chen J, Sun L, Qian H, Wu C, Jiang J, Guo X, Gao S. Hysteroscopic Fenestration with Precise Incision of the Cavity Septum: A Novel Minimally Invasive Surgery of Complete Septate Uterus with Double Cervix. J Minim Invasive Gynecol 2023; 30:716-724. [PMID: 37196886 DOI: 10.1016/j.jmig.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/02/2023] [Accepted: 05/11/2023] [Indexed: 05/19/2023]
Abstract
STUDY OBJECTIVE This study aimed to develop and describe a novel surgical procedure that involves hysteroscopic fenestration with precise incision of the complete uterine septum and double cervix preservation after magnetic resonance imaging (MRI) evaluation in patients and to evaluate its efficacy. DESIGN A prospective consecutive clinical study. SETTING A university teaching hospital. PATIENTS Twenty-four patients with complete septate uterus and double cervix. INTERVENTIONS Three-dimensional reconstruction of uterus was performed with pelvic MRI and three-dimensional SPACE sequence scanning. Hysteroscopic fenestration with precise incision of the cavity septum and double cervix preservation was performed in patients. Three months after operation, follow-up pelvic MRI and second-look hysteroscopy were performed conventionally. MEASUREMENTS AND MAIN RESULTS Operating time, blood loss, operative complications, MRI and hysteroscopic changes of uterus, symptoms improvement, and reproductive outcomes were assessed. The surgery was successfully completed without any intraoperative complications in all patients. Operating time was 21.71 ± 8.28 minutes (range, 10-40 minutes) and blood loss was 9.92 ± 7.14 mL (range, 5-30 mL). Postoperative MRI showed the uterine anteroposterior diameter (3.66 cm vs 3.92 cm; p <.05) was increased. Postoperative MRI and the second-look hysteroscopy showed the cavity shape and uterine volume were expanded to the normal. Symptoms of dysmenorrhea, abnormal uterine bleeding, and dyspareunia were ameliorated after the surgery in 70% of patients (7 of 10), 60% of patients (3 of 5), and 1 patient, respectively. The preoperative spontaneous abortion rate was 80% (4 of 5) and the postoperative spontaneous abortion rate was 11.11% (1 of 9). After the surgery, there were 2 ongoing pregnancies and 6 pregnancies ended in term births. Two live births were delivered by cesarean section and 4 by vaginal delivery without cervical incompetence during pregnancy. CONCLUSIONS Hysteroscopic fenestration with precise incision of the uterine septum and double cervix preservation is an effective surgical procedure.
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Affiliation(s)
- Jialing Chen
- Center of Diagnosis and Treatment for Cervical and Uterine Cavity Diseases (Drs. Chen, Wu, and Gao), Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Lin Sun
- Department of Gynecology (Dr. Sun), Lianshui County People's Hospital, Kangda College of Nanjing Medical University, Huai'an, China
| | - Huijun Qian
- Departments of Radiology (Dr. Qian), Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Congquan Wu
- Center of Diagnosis and Treatment for Cervical and Uterine Cavity Diseases (Drs. Chen, Wu, and Gao), Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Jiqin Jiang
- Department of Gynecology (Dr. Jiang), Shaoxing Central Hospital, Shaoxing, China
| | - Xiaolan Guo
- Department of Surgery, Obstetrics and Gynecology (Dr. Guo), Hospital of Fudan University, Shanghai, China
| | - Shujun Gao
- Center of Diagnosis and Treatment for Cervical and Uterine Cavity Diseases (Drs. Chen, Wu, and Gao), Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China; Shanghai Key Laboratory of Female Reproductive Endocrine-Related Disease (Dr. Gao), Fudan University, Shanghai, China..
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Al-Husban N, Odeh O, AlRamahi M, Qadri S, Al-Husban H. Fertility-enhancing hysteroscopic surgery; multi-center retrospective cohort study of reproductive outcome. BMC Womens Health 2023; 23:459. [PMID: 37644542 PMCID: PMC10464282 DOI: 10.1186/s12905-023-02562-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 07/21/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Hysteroscopic surgery and assisted reproduction technology are feasible ways to improve the reproductive outcome. Our aim was to study hysteroscopic septoplasty and myomectomy's effect on infertility and reproductive performance. METHODS Retrospective cohort of patients who had unexplained infertility and/or recurrent miscarriages and had myomectomy or septoplasty in the period September 2016-october 2021 with a total of 18 months' follow up. The main outcome measures were spontaneous pregnancy, term pregnancy and miscarriage. For analysis, we used Statistical Package for Social Sciences (SPSS) version 20. RESULTS One hundred and sixty-five patients were included. The mean age of patients was 39 years. 40 patients had septum resection and 125 patients had hysteroscopic myomectomy. A spontaneous pregnancy rate after surgery was achieved in 46 patients (27.9%). Out of the 64 patients who had failed IVF preoperatively, 32 patients (50%) had a successful IVF post-hysteroscopic surgery and there were more successful cases in the patients who had fibroid resection but this difference did not reach a statistical significance (P value 0.055). In the 79 pregnancies after surgery, preterm birth and miscarriage were seen in 10 patients (12.7%), similarly, respectively after septal or fibroid resection. Miscarriages were less post-operatively. Hysteroscopic myomectomy, compared with hysteroscopic metroplasty, was significantly associated with higher spontaneous pregnancy rate (63.0% Vs 37.0%, P value 0.018), more term pregnancies (87.5% vs. 12.5%, P value 0.001) and less miscarriage rate (40%vs 60%, P value 0.003). Pregnancy post-operatively in patients with primary infertility was more statistically significantly associated with hysteroscopic myomectomy than with hysteroscopic septoplasty (95.8% vs. 4.2%, p value 0.030). In patients who got pregnant postoperatively there was no statistically significant difference in the mode of delivery. CONCLUSION In carefully selected patients with unexplained infertility and recurrent miscarriage, hysteroscopic myomectomy, compared with hysteroscopic metroplasty, was significantly associated with higher spontaneous pregnancy, more term pregnancies and less miscarriage rates. More than metroplasty, hysteroscopic myomectomy led to higher spontaneous pregnancies in patients with primary infertility. TRIAL REGISTRATION NCT05560295.
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Affiliation(s)
- Naser Al-Husban
- School of Medicine, The University of Jordan, P O Box 2194, Amman, 11941, Jordan.
| | - Omar Odeh
- Jordan University hospital, Amman, Jordan
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Lamari I, Ziogas AC, Thanasas I, Kotronis KV, Xydias EM. Spontaneous Pregnancy After Surgical Repair of Subseptate Uterus: A Case Report and Review of the Available Literature. Cureus 2023; 15:e43399. [PMID: 37706127 PMCID: PMC10495772 DOI: 10.7759/cureus.43399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2023] [Indexed: 09/15/2023] Open
Abstract
Septate uterus is the most common congenital uterine malformation. It has been associated with poor reproductive outcomes, such as infertility and recurrent miscarriage, in the context of both assisted and non-assisted reproduction, though the exact underlying pathophysiological reasons remain unclear. Diagnosis is based on two-dimensional and three-dimensional ultrasound, magnetic resonance imaging, or laparoscopic/hysteroscopic findings. Hysteroscopic repair of the uterine septum has been shown to confer several benefits to reproductive outcomes, though this fact remains in question, due to inconsistent and or low-quality evidence in the medical literature. An individualized approach to the treatment of infertility patients with septate uteri is imperative, given the plethora of possible underlying factors that may complicate management. In this report, we present the case of a patient with a subseptate uterus and a history of infertility, who, following hysteroscopic metroplasty, managed to conceive and ultimately successfully deliver a healthy child.
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Affiliation(s)
- Ioanna Lamari
- Department of Internal Medicine, Gennimatas General Hospital, Athens, GRC
- Faculty of Medicine, University of Thessaly, School of Health Sciences, Larissa, GRC
| | - Apostolos C Ziogas
- Department of Obstetrics and Gynaecology, IASO Thessalias Hospital, Larissa, GRC
- Faculty of Medicine, University of Thessaly, School of Health Sciences, Larissa, GRC
| | - Ioannis Thanasas
- Department of Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
| | | | - Emmanouil M Xydias
- Faculty of Medicine, University of Thessaly, School of Health Sciences, Larissa, GRC
- Department of Obstetrics and Gynaecology, EmbryoClinic IVF, Thessaloniki, GRC
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Li H, Zhao Q, Yu Y, Li W. Clinical observation of different dosages of dexmedetomidine combined with a target-controlled infusion of propofol in hysteroscopic submucosal myomectomy. Front Surg 2023; 9:1025592. [PMID: 36684220 PMCID: PMC9852038 DOI: 10.3389/fsurg.2022.1025592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/21/2022] [Indexed: 01/07/2023] Open
Abstract
Objective This study aimed to explore the clinical effects of different dosages of dexmedetomidine (Dex) combined with a target-controlled infusion of propofol in hysteroscopic submucosal myomectomy. Methods Ninety patients who underwent hysteroscopic submucosal myomectomy between September 2021 and March 2022 were enrolled and randomly divided into three groups, with 30 patients in each group. Patients in Groups A, B, and C received injections of 0.25, 0.5, or 0.75 µg/kg of Dex, respectively, by intravenous pump over 10 min. After this time, a maintenance dosage of 0.5 µg/kg/h was administered by intravenous infusion until the end of the surgery. Anesthesia was induced using 1.5 mg/kg of propofol and 0.3 µg/kg of sufentanil that were introduced through a laryngeal mask. The plasma concentration of propofol was maintained at 3 µg/ml by target-controlled infusion until the end of the surgery. The mean arterial pressure (MAP), heart rate (HR), and electroencephalographic bispectral index (BIS) were observed when the patient entered the operating room (T0), after catheter indwelling for anesthesia (T1), at the time of cervical dilation (T2), at the time of hysteroscopic surgery (T3), and at the end of the surgery (T4) in all three groups. The total dosage of propofol for induction and maintenance, anesthesia awakening time, orientation recovery time, Visual Analog Scale (VAS) score of the post-awakening uterine contraction pain, and adverse reactions were recorded. Results The intraoperative reductions of MAP and HR in patients were significant in Group C when compared with those in Groups A and B (P < 0.05), and BIS was significantly lower in Group C at T2 and T3 when compared with the baseline measurement at T0 (P < 0.05). The dosage of propofol was significantly higher for Group A than for Groups B and C (P < 0.05). The anesthesia awakening time and orientation recovery time were significantly longer for patients in Group C when compared with patients in Groups A and B (P < 0.05). Within 5-30 min after awakening, the VAS scores in Groups B and C were significantly lower than those for Group A (P < 0.05). The incidence of adverse reactions in Group B was significantly less than that for Groups A and C (P < 0.05). Conclusion The continuous pumping of 0.5 µg/kg of Dex combined with a target-controlled infusion of propofol in hysteroscopic submucosal myomectomy resulted in positive anesthetic and analgesia effects and fewer adverse reactions. It therefore has high clinical significance.
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Fabregues F, Antonio García-Velasco J, Llácer J, Requena A, Ángel Checa M, Bellver J, José Espinós J. The role of thrombophilias in reproduction: A swot analysis. Eur J Obstet Gynecol Reprod Biol 2023; 280:12-21. [PMID: 36375360 DOI: 10.1016/j.ejogrb.2022.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/25/2022] [Indexed: 12/27/2022]
Abstract
Thrombophilia is a group of inherited or acquired coagulation disorders that have been associated with reproductive failure. However, there are still no clear recommendations on whether its inclusion in the initial study of the infertile couple or patients with recurrent implantation failure is necessary. In this discussion paper, based on a SWOT (strengths, weaknesses, opportunities, threats) analysis, the different aspects of the repercussions of thrombophilia screening and treatment in reproduction are evaluated. To avoid possible subjectivity in the analysis and results of this study, researchers followed Oxford criteria for the evaluation of evidence. The results from the evaluation of the reviewed bibliography seem to indicate that, pending new evidence, it would be advisable not to include thrombophilia screening in the initial baseline study of the infertile couple. There is no evidence to support a clear association between thrombophilia and implantation failure or infertility. Thrombophilia testing in this setting may increase cost, with minimal potential benefit and lead to inappropriate use of anticoagulants with possible deleterious adverse effects. Future well-designed studies are needed to assess the possible benefit of anticoagulant therapy in infertile thrombophilic patients with implantation failure.
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Affiliation(s)
- Francisco Fabregues
- Institut Clinic Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic, C/Villarroel 160, Barcelona 08036, Spain.
| | | | - Joaquín Llácer
- Ginefiv-GeneraLife, Calle José Silva 18, Madrid 28043, Spain
| | - Antonio Requena
- Ginefiv-GeneraLife, Calle José Silva 18, Madrid 28043, Spain
| | - Miguel Ángel Checa
- Hospital del Mar-Parc de Salut Mar, Paseo Maritimo 25-29, Barcelona 08005, Spain; Fundación Fertty, Ausiàs March 25, Barcelona 08010, Spain
| | - José Bellver
- Departamento de Pediatría, Obstetricia y Ginecología, Facultad de Medicina, Universidad de Valencia, Spain; Instituto Valenciano de Infertilidad (IVI-RMA) Valencia, Plaza de la Policía Local, 3, Valencia 46015, Spain; Fundación FIVI, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Juan José Espinós
- Fundación Fertty, Ausiàs March 25, Barcelona 08010, Spain; Universidad Autónoma de Barcelona. Campus de la UAB, Plaza Cívica, s/n, Bellaterra (Barcelona) 08193, Spain
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CEVHER AKDULUM MF, DEMİRDAĞ E, ARIK Sİ, ERDEM M, BOZKURT N, OKTEM M, GÜLER İ, ERDEM A. Does uterine septum resection improve IVF treatment success? JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1133577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: Uterine septum is the most common type of congenital uterine malformation. The septum has also been suggested as a potential cause of infertility. The role of the septum in infertility and whether the septum can be resected is debatable. We aimed to reveal the results of assisted reproductive techniques in patients with septate uterus according to whether or not resection is performed.
Material and Method: 7790 patients were scanned retrospectively. 110 patients with the uterine septum and unexplained infertility were included in the study. Patients who underwent uterine septum resection were recorded. The clinical pregnancies of patients were compared according to whether or not resection was performed. In addition, patients with complete septum were evaluated according to whether or not resection was performed, and their clinical pregnancies were evaluated.
Results: It was revealed that 79 of the patients with uterine septum underwent septum resection operation. It was determined that 31 patients were not treated. Clinical pregnancy rates were found to be statistically significantly higher in the expectant management group (p=0.02). In addition, comparing the clinical pregnancy rates of the resection and expectant management groups in patients with a complete septum, no significant difference was found between the groups (p=0.134).
Conclusion: In our study, the success of treatment with assisted reproductive techniques did not change after septum resection. Although uterine septum resection is a simple and safe method, it has disadvantages such as the development of adhesions and rupture in the uterus. There is insufficient evidence to perform septum resection in patients with uterine septum prior to infertility treatment.
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Affiliation(s)
| | | | | | - Mehmet ERDEM
- GAZI UNIVERSITY, SCHOOL OF MEDICINE, MEDICINE PR
| | | | - Mesut OKTEM
- GAZI UNIVERSITY, SCHOOL OF MEDICINE, MEDICINE PR
| | - İsmail GÜLER
- GAZI UNIVERSITY, SCHOOL OF MEDICINE, MEDICINE PR
| | - Ahmet ERDEM
- GAZI UNIVERSITY, SCHOOL OF MEDICINE, MEDICINE PR
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Sık BA, Ozdamar O, Ozolcay O, Sismanoglu A, Aba YA, Oral S, Koc M. Second look hysteroscopy following hysteroscopic septum resection improves reproductive outcomes in patients undergoing ICSI. J OBSTET GYNAECOL 2022; 42:2265-2271. [PMID: 35275047 DOI: 10.1080/01443615.2022.2038105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of this study was to compare the reproductive outcomes between infertile women who underwent hysteroscopic uterine septum resection and those who required a second look hysteroscopy due to residual septum prior to intracytoplasmic sperm injection (ICSI) cycles with selective single 'Grade A' embryo transfer (ET). All second look hysteroscopies were performed due to partial remnant septum in a control three dimensional transvaginal ultrasonography (3D TVUSG) after the first hysteroscopic resection. Miscarriage and biochemical pregnancy rates were not different between the groups while clinical pregnancy and live birth rates were significantly higher in Group 2 than in Group 1. Second look hysteroscopic metroplasty performed to restore remnant septum significantly improves live birth rate as well as clinical pregnancy rates while it appears not to alleviate abortion and biochemical pregnancy rates in women undergoing ICSI-ET.IMPACT STATEMENTWhat is already known on this subject? The effect of hysteroscopic septum resection on reproductive outcomes in IVF treatment in infertile patients with uterine septum is not clearly known.What do the results of this study add? With the selective single ET strategy, complete or partial hysteroscopic correction of the uterine septum before ICSI and subsequent resection of the residual septum with control hysteroscopy significantly increases the live birth rates in the infertile population.What are the implications of these findings for clinical practice and/or further research? In the group of infertile patients with uterine septum, second control hysteroscopy should be performed 1 month later for residual septum or adhesions after hysteroscopic septum resection performed once.
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Affiliation(s)
- Bulat Aytek Sık
- Department of Reproductive Endocrinology and Infertility, Sisli Kolan International Hospital, Istanbul, Turkey
| | - Ozkan Ozdamar
- Department of Reproductive Endocrinology and Infertility, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Ozan Ozolcay
- Department of Reproductive Endocrinology and Infertility, Istanbul IVF Centre, Istanbul, Turkey
| | - Alper Sismanoglu
- Department of Reproductive Endocrinology and Infertility, Sisli Kolan International Hospital, Istanbul, Turkey
| | - Yilda Arzu Aba
- Health Sciences Faculty, Bandirma Onyedi Eylul University, Balikesir, Turkey
| | - Serkan Oral
- Department of Reproductive Endocrinology and Infertility, Sisli Kolan International Hospital, Istanbul, Turkey
| | - Mehmet Koc
- Department of Reproductive Endocrinology and Infertility, Sisli Kolan International Hospital, Istanbul, Turkey
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Chen H, Sun P, Zhang N, Lv S, Cao Y, Yan L. Effects of Septum Resection for Secondary Infertility on Subsequent Reproductive Outcomes of in vitro Fertilization–Intracytoplasmic Sperm Injection. Front Med (Lausanne) 2022; 9:765827. [PMID: 35186988 PMCID: PMC8850346 DOI: 10.3389/fmed.2022.765827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo assess the effect of uterine septum resection on reproductive outcomes of in vitro fertilization (IVF) / intracytoplasmic sperm injection (ICSI) in patients with secondary infertility complicated with uterine septum.MethodsA retrospective cohort study included 269 patients. Surgical group included 169 patients with secondary infertility complicated with uterine septum, who underwent 252 embryo-transfer (ET) cycles following septum resection. Control group consisted of 100 patients with secondary infertility and uterine septum, who underwent 178 ET cycles. Cumulative pregnancy rate and cumulative live birth rate after one complete assisted reproductive technology (ART) cycle were the primary outcomes.ResultsThe results showed that the cumulative pregnancy rate was higher in the surgery group, and statistically significant difference was observed in the cumulative pregnancy rate between the two groups (71.0 vs. 59%, P = 0.044). In fresh ET cycle, no statistically significant difference between the two groups was evident (54.9 vs. 40.6%, P = 0.061). Statistical analysis of other results of the fresh ET cycle did not differ significantly between the two groups. In terms of frozen embryo transfer (FET) cycle outcomes, the clinical pregnancy rate and delivery rate in surgery group were 52.7 and 38.2%, respectively, which were significantly higher than those in the control group (38.2 and 22.5%, respectively) (P = 0.028 and P = 0.011).ConclusionThe reproductive outcomes of IVF/ICSI after septum resection in patients with secondary infertility were better than that in the untreated group, suggesting that uterine septum resection can be performed in patients with uterine septum combined with infertility to improve their reproductive outcomes.
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Affiliation(s)
- Huixiao Chen
- School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Gynecology and Obstetrics, Liaocheng People's Hospital, Liaocheng, China
| | - Ping Sun
- School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Na Zhang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Shangge Lv
- School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yongzhi Cao
- School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Yongzhi Cao
| | - Lei Yan
- School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Lei Yan
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Surgical treatment of uterine septum to improve reproductive outcomes - resect or not? Fertil Steril 2021; 116:298-305. [PMID: 34274115 DOI: 10.1016/j.fertnstert.2021.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/22/2022]
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Detti L, Peregrin-Alvarez I, Roman RA, Levi D'Ancona R, Gordon JC, Christiansen ME. A comparison of four systems for uterine septum diagnosis and indication for surgical correction. Minerva Obstet Gynecol 2021; 73:376-383. [PMID: 34008393 DOI: 10.23736/s2724-606x.21.04789-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Existing guidelines do not settle on a specific length to indicate surgical incision of subseptations because of differences in the four published diagnostic methods: AFS-10 mm classification, 1988/2003, ESHRE-ESGE classification, 2013, ASRM criteria, 2016- and 5.9-mm length cut-off, 2017. With this review and data analysis we sought to identify the classification method with the most accurate association with early pregnancy loss, as to identify a subseptation length cut-off to indicate surgical correction. EVIDENCE ACQUISITION We performed an exhaustive literature search of PubMed (MEDLINE), Embase, and Cochrane Library databases until April 20, 2020 (limited to articles published in English) of the terms "uterine septum," "arcuate uterus," "subseptation," "Müllerian anomalies," from 1980-2020. After identifying all the available classifications for uterine subseptations, we performed a secondary data analysis of our departmental database on uterine subseptations and compared the identified classification criteria. Measurement of the subseptation's length was obtained on 2-D and 3-D ultrasound in accordance with the different methods. The incidence of uterine subseptations according to each method's specifications was compared among the groups and the association with pregnancy loss was evaluated. EVIDENCE SYNTHESIS The database comprised 125 women with uterine subseptations and all four diagnostic systems identified septate uteri within it. The 5.9-mm cut-off diagnosed 89 septate, and 36 normal uteri and was the most inclusive while the ASRM cut-off was the most restrictive one, diagnosing 92/125 as arcuate uteri, only 8/125 as septate, and 25 in the gray zone. The AFS-10 mm criteria diagnosed 92/125 as arcuate, and 33 (26.4%) as septate uteri. Subseptations were inconsistently diagnosed by the ESHRE-ESGE classification, as some subseptations longer than 10 mm would be classified as normal uteri. Five/24 women had had one previous early loss and 19/24 had recurrent pregnancy loss. The 5.9-mm system was the most sensitive, while the ASRM was the least sensitive in predicting pregnancy loss (71.2% vs. 9.5% of septate uteri). CONCLUSIONS The proposed 5.9-mm cut-off was the most sensitive in diagnosing a septate uterus and in predicting an associated early pregnancy loss. Conversely, the AFS-10 mm and the ASRM were the most restrictive, potentially missing treatment for hazardous subseptations. This update highlights the major weaknesses in the current diagnosis of uterine subseptations and indication for surgical treatment. Standardization of clinical practice is essential for reproductive clinicians and efforts should be made to prevent even one further early pregnancy loss to uterine subseptations.
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Affiliation(s)
- Laura Detti
- Department of Subspecialty Care for Women's Health, Ob/Gyn Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA -
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Augusta University, Augusta, GA, USA -
| | - Irene Peregrin-Alvarez
- Department of Subspecialty Care for Women's Health, Ob/Gyn Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Augusta University, Augusta, GA, USA
| | - Robert A Roman
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Augusta University, Augusta, GA, USA
| | - Roberto Levi D'Ancona
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jennifer C Gordon
- Department of Obstetrics and Gynecology, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Mary E Christiansen
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA
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Chen HX, Lv SG, Zhang YN, Yu Q, Du J, Yan L, Chen ZJ. Effect of hysteroscopic septum resection on subsequent in vitro fertilization-intracytoplasmic sperm injection outcomes in cases of primary infertility. J Gynecol Obstet Hum Reprod 2021; 50:102149. [PMID: 33872814 DOI: 10.1016/j.jogoh.2021.102149] [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: 12/17/2020] [Revised: 04/07/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Women with septate uteri are at risk for subfertility, recurrent miscarriage, and preterm birth. It is not clear if hysteroscopic septum resection is beneficial to subsequent in vitro fertilization-intracytoplasmic sperm injection o (IVF/ICSI) outcomes in women with primary infertility. STUDY DESIGN We analyzed all 278 women with uterine septum and primary infertility between January 2011 and January 2019. In this retrospective cohort study, the patients were divided into a surgery group and an expectant (non-surgery) group. RESULTS Among them, 87 had a complete and 191 a partial septate uterus. The IVF-ET characteristics of the two groups showed no significant differences in the patients' age, body mass index, or basal follicle-stimulating hormone, luteinizing hormone, and estradiol levels (P>0.05). The miscarriage rate in those who underwent hysteroscopic septum resection, however, was significantly reduced (5.1% vs. 12.9%, P = 0.035). In contrast, the live birth rate between the two groups revealed no significant difference (51.4% vs. 43.6%, P = 0.1771), nor did the obstetric and neonatal outcomes (P>0.05). CONCLUSIONS Hysteroscopic septum resection can be recommended prior to IVF/ICSI.
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Affiliation(s)
- Hui-Xiao Chen
- School of medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China; Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, Jinan, Shandong, 250012, China; Department of Gynecology and Obstetrics, Liaocheng People's Hospital, Shandong Province, 252000, China
| | - Shang-Ge Lv
- School of medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China; Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, Jinan, Shandong, 250012, China
| | - Ya-Nan Zhang
- Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, Jinan, Shandong, 250012, China
| | - Qian Yu
- Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, Jinan, Shandong, 250012, China
| | - Jing Du
- Department of Gynecology and Obstetrics, Liaocheng People's Hospital, Shandong Province, 252000, China
| | - Lei Yan
- School of medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China; Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, Jinan, Shandong, 250012, China.
| | - Zi-Jiang Chen
- School of medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China; Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, Jinan, Shandong, 250012, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, 250012, China
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Coelho Neto MA, Ludwin A, Petraglia F, Martins WP. Definition, prevalence, clinical relevance and treatment of T-shaped uterus: systematic review. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:366-377. [PMID: 32898287 DOI: 10.1002/uog.23108] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/26/2020] [Accepted: 08/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To summarize in a systematic review the current evidence regarding definitions, diagnosis, prevalence, etiology, clinical relevance and impact of surgical treatment for T-shaped uterus not related to diethylstilbestrol (DES) exposure, and to highlight areas on which future research should focus. METHODS A search of PubMed, Scopus and EMBASE was performed on 9 April 2020 using the search terms 't-shaped OR t-shape OR infantile OR (lateral indentation) OR (diethylstilbestrol OR DES) AND (uterus OR uterine OR uteri) AND (anomaly OR anomalies OR malformation OR malformations)'. Additionally, the reference lists of the included studies were searched manually for other relevant publications. All studies presenting data on T-shaped uterus not associated with DES exposure and including at least 10 women were considered eligible. Studies regarding DES-related T-shaped uterus were excluded because DES has not been used since 1971. There were no restrictions on language, date of publication or status of publication. RESULTS Of 2504 records identified by the electronic search, 20 studies were included in the systematic review. The majority of studies were of poor quality. In 11 of 16 studies reporting on the diagnosis of T-shaped uterus, the diagnostic method used was three-dimensional ultrasound. There is no consensus on the definition of T-shaped uterus, but the most cited criteria (4/16 studies) were of the European Society of Human Reproduction and Embryology and the European Society for Gynaecological Endoscopy (ESHRE/ESGE; 2013). The prevalence of T-shaped uterus varied from 0.2% to 10% in the four included studies reporting such data. With respect to etiology (except for DES), T-shaped uterus was considered a primary condition in three studies and secondary to adhesions in five and adenomyosis in one. T-shaped uterus was related to worse reproductive outcome based on subfertility (nine studies), miscarriage (seven studies), preterm delivery (two studies), ectopic pregnancy (one study) and repeat implantation failure (seven studies). Of the 12 studies that reported on the effects of surgical treatment of T-shaped uterus by hysteroscopic metroplasty, some mentioned an improvement in pregnancy rate (rates ranging from 49.6% to 88%; eight studies), live-birth rate (rates ranging from 35.1% to 76%; seven studies) and term-delivery rate (four studies) and a reduction in miscarriage (rates ranging from 7% to 49.6%; five studies) and ectopic pregnancy (one study). However, the evidence is of very low quality with serious/critical risk of bias toward overestimating the intervention effect. Some authors reported no complications related to the procedure, while others mentioned persistence of the dysmorphism (rates ranging from 1.4% to 11%; three studies), bleeding (1.3%; one study), infection (2.6%; one study) and adhesions (11.1% and 16.8%; two studies). CONCLUSIONS The prevalence, etiology and clinical relevance, with respect to reproductive outcome, of T-shaped uterus remain unclear and there is no consensus on the definition and diagnostic method for this condition. Expectant management should be considered the most appropriate choice for everyday practice until randomized controlled trials show a benefit of intervention. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M A Coelho Neto
- Department of Obstetrics and Gynecology, Faculty of Medicine of Ribeirão Preto, University of São Paulo (DGO-FRMP-USP), Ribeirão Preto, Brazil
- SEMEAR Fertilidade, Reproductive Medicine, Ribeirão Preto, Brazil
| | - A Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
- Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland
| | - F Petraglia
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - W P Martins
- SEMEAR Fertilidade, Reproductive Medicine, Ribeirão Preto, Brazil
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Espinós JJ, Fabregues F, Fontes J, García-Velasco JA, Llácer J, Requena A, Checa MÁ, Bellver J. Impact of chronic endometritis in infertility: a SWOT analysis. Reprod Biomed Online 2021; 42:939-951. [PMID: 33736994 DOI: 10.1016/j.rbmo.2021.02.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/01/2021] [Accepted: 02/05/2021] [Indexed: 12/12/2022]
Abstract
Chronic endometritis is a pathology often associated with reproductive failure, but there are still no clear recommendations on whether its inclusion in the initial study of infertile couples is necessary. In this discussion paper, based on a SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis, the different aspects of the repercussions of chronic endometritis in fertility are evaluated. To avoid possible subjectivity in the analysis and results of this study, the researchers followed the Oxford criteria for the evaluation of evidence. The results from the evaluation of the reviewed literature seem to indicate that, pending new evidence, it would be advisable not to include chronic endometritis in the initial baseline study before assisted reproduction in order not to delay other assisted reproduction treatments. However, it would be advisable in cases of repetitive implantation failure and pregnancy loss after having undergone IVF with viable embryos and before continuing with costly reproductive processes, since results could be improved. The development of randomized studies assessing the impact of antibiotic treatment as a possible therapeutic option in infertile women with chronic endometritis, as well as the possible impact on endometrial microbiota and receptivity/implantation, would allow for the establishment of more precise clinical guidelines in this regard.
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Affiliation(s)
- Juan J Espinós
- Fertty, Barcelona, Spain, Universidad Autónoma de Barcelona, Bellaterra Barcelona, Spain.
| | - Francisco Fabregues
- Institut Clinic Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic Barcelona, Spain
| | - Juan Fontes
- Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | | | | | | | - José Bellver
- Departamento de Pediatría, Obstetricia y Ginecología, Facultad de Medicina, Universidad de Valencia, Spain, Instituto Valenciano de Infertilidad (IVI-RMA) Valencia, Valencia, Spain
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Jansa V, Laganà AS, Ferrari F, Ghezzi F, Burnik Papler T, Vrtacnik Bokal E, Ban Frangež H. Uterine rupture in pregnancy after hysteroscopic septum resection: a 20-year retrospective analysis. MINIM INVASIV THER 2020; 31:448-455. [PMID: 33331203 DOI: 10.1080/13645706.2020.1837884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In this study, we reviewed the cases of uterine rupture in our setting, identified which of them had previously undergone hysteroscopic septum resection (HSR), and evaluated the main clinical characteristics for each case. MATERIAL AND METHODS We retrospectively analyzed (ClinicalTrial ID: NCT04449640) the delivery outcomes from the National Perinatal Information System of the National Institute of Public Health of the Republic of Slovenia of the last 20 years (1 January 1999 - 31 December 2019) and cross-linked the patients with surgical data from our electronic database. We collected baseline characteristics, surgical details and obstetrical outcomes. We excluded women who had undergone previous myomectomy or cesarean section (CS) and described the clinical course of each case since no statistical analysis was performed. RESULTS We found four patients who had uterine rupture in pregnancy after HSR. Median time to pregnancy was 17 months (range 1-60), all the women underwent CS and fetal-maternal outcomes were acceptable in half of the cases. Symptoms were nonspecific and included pain, fetal distress and vaginal bleeding. CONCLUSION Uterine rupture in pregnancy after a previous HSR is a very rare, but life-threatening event. Prompt diagnosis can ensure successful management and avoid adverse maternal-fetal outcomes.
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Affiliation(s)
- Vid Jansa
- Department of Human Reproduction, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Federico Ferrari
- Department of Obstetrics and Gynecology, Spedali Civili of Brescia, Brescia, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Tanja Burnik Papler
- Department of Human Reproduction, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Eda Vrtacnik Bokal
- Department of Human Reproduction, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Helena Ban Frangež
- Department of Human Reproduction, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Abstract
Recurrent pregnancy loss is a distressing pregnancy disorder experienced by ~2.5% of women trying to conceive. Recurrent pregnancy loss is defined as the failure of two or more clinically recognized pregnancies before 20-24 weeks of gestation and includes embryonic and fetal losses. The diagnosis of an early pregnancy loss is relatively straightforward, although progress in predicting and preventing recurrent pregnancy loss has been hampered by a lack of standardized definitions, the uncertainties surrounding the pathogenesis and the highly variable clinical presentation. The prognosis for couples with recurrent pregnancy loss is generally good, although the likelihood of a successful pregnancy depends on maternal age and the number of previous losses. Recurrent pregnancy loss can be caused by chromosomal errors, anatomical uterine defects, autoimmune disorders and endometrial dysfunction. Available treatments target the putative risk factors of pregnancy loss, although the effectiveness of many medical interventions is controversial. Regardless of the underlying aetiology, couples require accurate information on their chances of having a baby and appropriate support should be offered to reduce the psychological burden associated with multiple miscarriages. Future research must investigate the pathogenesis of recurrent pregnancy loss and evaluate novel diagnostic tests and treatments in adequately powered clinical trials.
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Miklavcic J, Laganà AS, Premru Srsen T, Korosec S, Ban Frangež H. Effect of hysteroscopic septum resection on preterm delivery rate in singleton pregnancies. MINIM INVASIV THER 2020; 30:377-383. [PMID: 32196404 DOI: 10.1080/13645706.2020.1743721] [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] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Uterine septum is the most common uterine anomaly and is often found during the work-up in primary infertile women. In this study, we aimed to evaluate the potential effect of hysteroscopic septum resection (HSR) on preterm delivery (PTD) in primary infertile women who had singleton pregnancies. MATERIAL AND METHODS We analyzed 420 singleton pregnancies after primary infertility treatment and compared the PTD rates in women who underwent previous HSR (cases) and women who did not undergo previous operative hysteroscopy or cervical dilation (controls), regardless of the modality of conception (spontaneous or by in vitro fertilization). RESULTS We did not find significant differences between cases and controls for the incidence of overall PTD rate (p = .237), PTD before 32 gestational weeks (p = .848), and between 32 and 37 gestational weeks (p = .324), premature rupture of membranes (p = .419), and neonatal birth weight (p = .129). Overall, the risk of spontaneous PTD <37 gestational weeks after HSR was not found to be significantly higher compared to controls (RR 1.29, 0.61-2.73 95% CI; p = .561). CONCLUSION According to our results, previous HSR could be not considered a risk factor for PTD in singleton pregnancies, regardless of the modality of conception (spontaneous or by in vitro fertilization).
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Affiliation(s)
- Jana Miklavcic
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Tanja Premru Srsen
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Perinatology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Sara Korosec
- Department of Human reproduction, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Helena Ban Frangež
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Human reproduction, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Huang D, Zhang L, Chen J, Zhang S. The cervical function and pregnancy outcomes after hysteroscopic resection of the complete uterine septum, duplicate cervix and vaginal septum. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2019. [DOI: 10.1016/j.lers.2019.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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