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Jiang N, Xie Y, Qu W, Lei L, Gao S, Zhang H, Wang Q, Chen L, Sui L. Cervical Septum Incision Adversely Impacts Clinical Outcomes in Women With Complete Uterine Septum and Duplicated Cervix. J Minim Invasive Gynecol 2024; 31:756-760. [PMID: 38740131 DOI: 10.1016/j.jmig.2024.05.012] [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: 07/11/2023] [Revised: 05/02/2024] [Accepted: 05/05/2024] [Indexed: 05/16/2024]
Abstract
STUDY OBJECTIVE To investigate the reproductive outcomes of women with complete septate uterus and duplicated cervix who either did or did not receive cervical septum incision during hysteroscopic transcervical incision of the uterine septum. DESIGN Retrospective study approved by the hospital ethics committee. SETTING Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China. PATIENTS Women with complete septate uterus and duplicated cervix who underwent hysteroscopic transcervical incision of the uterine septum in Obstetrics and Gynecology Hospital of Fudan University between January 2008 and December 2020 (n = 105). INTERVENTIONS Hysteroscopic incision of the septum. MEASUREMENTS AND MAIN RESULTS Included patients were grouped according to whether or not cervical septum incision was performed. Reproductive outcomes including gravidity, abortion rate, preterm birth rate, full-term birth rate, premature rupture of membranes, and cervical incompetence were assessed. In the no incision group, the abortion rate (7.4%) was significantly lower than that of the incision group (27.6%, p = .01); the preterm birth rate (4.6%) was significantly lower than that of the incision group (36.8%); and the full-term birth rate (95.5%) exceeded that of the incision group (63.2%, p <.01). Incidence of premature rupture of membranes and cervical incompetence during pregnancy was higher in the incision group (15.8% and 10.5%, p <.01 and p = .03). CONCLUSION Significantly improved reproductive outcomes were observed among patients with complete septate uterus and duplicated cervix whose cervical septum was preserved during the hysteroscopic transcervical incision of the uterine septum procedure.
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Affiliation(s)
- Ninghong Jiang
- Medical Center for Diagnosis and Treatment of Uterine Cavity and Tubal Diseases, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (all authors)
| | - Yu Xie
- Medical Center for Diagnosis and Treatment of Uterine Cavity and Tubal Diseases, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (all authors)
| | - Wenjie Qu
- Medical Center for Diagnosis and Treatment of Uterine Cavity and Tubal Diseases, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (all authors)
| | - Lei Lei
- Medical Center for Diagnosis and Treatment of Uterine Cavity and Tubal Diseases, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (all authors)
| | - Shujun Gao
- Medical Center for Diagnosis and Treatment of Uterine Cavity and Tubal Diseases, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (all authors)
| | - Hongwei Zhang
- Medical Center for Diagnosis and Treatment of Uterine Cavity and Tubal Diseases, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (all authors)
| | - Qing Wang
- Medical Center for Diagnosis and Treatment of Uterine Cavity and Tubal Diseases, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (all authors)
| | - Limei Chen
- Medical Center for Diagnosis and Treatment of Uterine Cavity and Tubal Diseases, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (all authors)
| | - Long Sui
- Medical Center for Diagnosis and Treatment of Uterine Cavity and Tubal Diseases, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (all authors)..
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Chang Y, Shen M, Wang S, Guo Z, Duan H. Reproductive outcomes and risk factors of women with septate uterus after hysteroscopic metroplasty. Front Endocrinol (Lausanne) 2023; 14:1063774. [PMID: 37361532 PMCID: PMC10285310 DOI: 10.3389/fendo.2023.1063774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Background Hysteroscopic metroplasty of the uterine septum has been the standard treatment strategy to improve reproductive outcomes, but there are still controversies about the appropriateness of metroplasty. In addition, there have been few studies of the factors related to reproductive outcomes of women after surgery. The study aimed to evaluate the reproductive outcomes and the associated risk factors that influence reproductive outcomes after hysteroscopic metroplasty of women with septate uterus and the desire to conceive. Methods This study was an observational study. Cases were screened by searching electronic patient files, and demographic factors were collected. We conducted telephone follow-ups to collect the postoperative reproductive outcomes. The primary outcome of this study was live birth, and secondary outcomes were ongoing pregnancy, clinical pregnancy, early miscarriage, and preterm birth. Demographic variables included patients' age, body mass index (BMI), the type of septum, infertility and miscarriage history, and complications including intrauterine adhesions, endometrial polyps, endometriosis, and adenomyosis were collected to perform univariate and multivariate analyses to predict the risk factors of reproductive outcomes after surgery treatment. Results In total, 348 women were evaluated and followed up. There were 95 cases (27.3%, 95/348) with combined infertility, 195 cases (56.0%, 195/348) with miscarriage history, and cases combined with intrauterine adhesions, endometrial polyps, endometriosis, and adenomyosis were 107 (30.7%, 107/348), 53 (15.2%, 53/348), 28 (8.0%, 28/348), and 5 (1.4%), respectively. Following surgery, the live birth rate and clinical pregnancy rate were significantly higher than prior to surgery (84.6% vs 3.7%, p= 0.000; and 78.2% vs 69.5%, p= 0.01, respectively), early miscarriage rate and preterm delivery rate were significantly lower (8.8% vs 80.6%, p= 0.000; and 7.0% vs 66.7%, p=0.000, respectively). After adjusting for body mass index, miscarriage history, and complications, multivariable logistic regression analysis revealed age ≥ 35 years and primary infertility as independent factors that affected postoperative clinical pregnancy (OR 4.025, 95% CI 2.063-7.851, p= 0.000; and OR 3.603, 95% CI 1.903-6.820, p= 0.000; respectively) and ongoing pregnancy (OR 3.420, 95% CI 1.812-6.455, p= 0.000; and OR 2.586, 95% CI 1.419-4.712, p= 0.002; respectively). Conclusions Hysteroscopic metroplasty could lead to improved reproductive outcomes of women with septate uterus. Both age and primary infertility were independent factors for postoperative reproductive outcomes. Trial registration Chi ECRCT20210343.
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Affiliation(s)
- Yanan Chang
- Department of Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Minghong Shen
- Department of Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
- Department of Gynecology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Sha Wang
- Department of Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Zhengchen Guo
- Department of Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Hua Duan
- Department of Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
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Jiang Y, Wang L, Wang B, Shen H, Wu J, He J, Liu A, Wang Y, Zhang X, Ma B. Reproductive outcomes of natural pregnancy after hysteroscopic septum resection in patients with a septate uterus: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2023; 5:100762. [PMID: 36220552 DOI: 10.1016/j.ajogmf.2022.100762] [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: 06/08/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to analyze the reproductive outcomes of natural pregnancy after hysteroscopic septum resection in patients with recurrent miscarriage, primary infertility, or secondary infertility. DATA SOURCES The PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, VIP Database, and Chinese Biomedical Literature Database (CBM) databases were electronically searched. The search time frame was from inception up to July 2021. The English search terms were (arcuate* and uter*), (sept* and uter*), (subseptate* and uter*), metroplast*, septoplast*, and resect*. STUDY ELIGIBILITY CRITERIA Selection criteria included randomized controlled trials, cohort studies, and case series that explored reproductive outcomes after hysteroscopic septum resection in patients with recurrent miscarriage, primary infertility, or secondary infertility with or without a control group. METHODS The primary outcomes were the live birth rate and eventual postoperative live birth rate after hysteroscopic septum resection. The secondary outcomes were the clinical pregnancy rate, preterm birth rate, and miscarriage rate. Study-level proportions of outcomes were transformed using the Freeman-Tukey double-arcsine transformation to calculate pooled values for the postoperative rates; the counted data were analyzed using relative risk as the effect analysis statistic, and each effect size was provided with its 95% confidence interval. Heterogeneity between the results of the included studies was analyzed using the I2 test. RESULTS Overall, 5 cohort studies and 22 case series involving 1506 patients were included. In patients with a septate uterus and recurrent miscarriage, hysteroscopic septum resection was associated with an increased live birth rate (relative risk, 1.77; 95% confidence interval, 1.26-2.49; P=.001; I2=0%), resulting in a postoperative live birth rate of 66% (95% confidence interval, 59-72), and septum resection was associated with a reduced preterm birth rate (relative risk, 0.15; 95% confidence interval, 0.04-0.53; P=.003; I2=0%) and miscarriage rate (relative risk, 0.36; 95% confidence interval, 0.20-0.66; P=.0009; I2=0%). In patients with a septate uterus and primary infertility, hysteroscopic septum resection was associated with an increased live birth rate (relative risk, 4.12; 95% confidence interval, 1.19-14.29; P=.03; I2=0%) and clinical pregnancy rate (relative risk, 2.28; 95% confidence interval, 1.04-4.98; P=.04; I2=0%). The postoperative live birth rate was 37% (95% confidence interval, 30-44), and the miscarriage rate of patients with primary infertility was reduced (relative risk, 0.19; 95% confidence interval, 0.06-0.56; P=.003). The efficacy of hysteroscopic septum resection in patients with secondary infertility was unclear. However, their postoperative live birth rate was found to be 41% (95% confidence interval, 2-88). CONCLUSION Hysteroscopic septum resection is associated with an increased live birth rate and a reduced miscarriage rate in patients with recurrent miscarriage or primary infertility, indicating that septum resection may improve the reproductive outcomes of these patients. The effectiveness of septum resection was unclear for patients with secondary infertility. These findings are limited by the quality of the included studies, warranting further randomized controlled trials, including only patients with recurrent miscarriage or primary infertility.
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Affiliation(s)
- Yanbiao Jiang
- First Clinical Medical College, Lanzhou University, Lanzhou, China (XX Jiang, Dr B Wang and Shen, XX Wu, XX He, Dr Liu, and Zhang)
| | - Liyan Wang
- The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, China (Dr L Wang, Y Wang, and Zhang); Key Laboratory for Reproductive Medicine and Embryo of Gansu Province, Lanzhou, China (Dr L Wang, Y Wang, and Zhang)
| | - Bin Wang
- First Clinical Medical College, Lanzhou University, Lanzhou, China (XX Jiang, Dr B Wang and Shen, XX Wu, XX He, Dr Liu, and Zhang)
| | - Haofei Shen
- First Clinical Medical College, Lanzhou University, Lanzhou, China (XX Jiang, Dr B Wang and Shen, XX Wu, XX He, Dr Liu, and Zhang)
| | - Jingyuan Wu
- First Clinical Medical College, Lanzhou University, Lanzhou, China (XX Jiang, Dr B Wang and Shen, XX Wu, XX He, Dr Liu, and Zhang)
| | - Juanjuan He
- First Clinical Medical College, Lanzhou University, Lanzhou, China (XX Jiang, Dr B Wang and Shen, XX Wu, XX He, Dr Liu, and Zhang)
| | - Ahui Liu
- First Clinical Medical College, Lanzhou University, Lanzhou, China (XX Jiang, Dr B Wang and Shen, XX Wu, XX He, Dr Liu, and Zhang)
| | - Yiqing Wang
- The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, China (Dr L Wang, Y Wang, and Zhang); Key Laboratory for Reproductive Medicine and Embryo of Gansu Province, Lanzhou, China (Dr L Wang, Y Wang, and Zhang)
| | - Xuehong Zhang
- The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, China (Dr L Wang, Y Wang, and Zhang); Key Laboratory for Reproductive Medicine and Embryo of Gansu Province, Lanzhou, China (Dr L Wang, Y Wang, and Zhang).
| | - Bin Ma
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China (Dr B Ma)
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Zhang B, Wu S, Zhao X, Zhu X, Xu D. Diagnosis of septate uterus. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2022; 47:1479-1486. [PMID: 36481625 PMCID: PMC10930624 DOI: 10.11817/j.issn.1672-7347.2022.220507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Indexed: 12/13/2022]
Abstract
The septate uterus is the most common structural uterine anomalies and it is associated with the poor reproductive outcome. It is believed to be the result of the failure in resorption of the tissue connecting the 2 paramesonephric ducts prior to the 20th embryonic week. The true prevalence of uterine septum is difficult to ascertain, as many uterine septal defects are asymptomatic. The septate uterus is usually diagnosed during an infertility evaluation and affects reproductive health by impairing fertility and increasing adverse pregnancy outcomes. The variations in uterine and cervical/vaginal anomalies collectively referred to as Müllerian anomalies. No consistent gold standard for the diagnosis of Müllerian anomalies exists. The preferred diagnostic method for Müllerian anomalies is two-dimensional ultrasound, other methods such as three-dimensional ultrasound, magnetic resonance imaging, hysterosalpingo contrast sonography, hysterosalpingography, hysteroscopy, and laparoscopy are also used to improve accuracy.
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Affiliation(s)
- Baiyun Zhang
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013.
- Department of Ultrasonography, Hunan Guangxiu Hospital, Changsha 410205, China.
| | - Si Wu
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013.
| | - Xingping Zhao
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013
| | - Xiuting Zhu
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013.
| | - Dabao Xu
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013.
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Sallée C, Margueritte F, Marquet P, Piver P, Aubard Y, Lavoué V, Dion L, Gauthier T. Uterine Factor Infertility, a Systematic Review. J Clin Med 2022; 11:jcm11164907. [PMID: 36013146 PMCID: PMC9410422 DOI: 10.3390/jcm11164907] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022] Open
Abstract
Uterine factor infertility (UFI) is defined as a condition resulting from either a complete lack of a uterus or a non-functioning uterus due to many causes. The exact prevalence of UFI is currently unknown, while treatments to achieve pregnancy are very limited. To evaluate the prevalence of this condition within its different causes, we carried out a worldwide systematic review on UFI. We performed research on the prevalence of UFI and its various causes throughout the world, according to the PRISMA criteria. A total of 188 studies were included in qualitative synthesis. UFI accounted for 2.1 to 16.7% of the causes of female infertility. We tried to evaluate the proportion of the different causes of UFI: uterine agenesia, hysterectomies, uterine malformations, uterine irradiation, adenomyosis, synechiae and Asherman syndrome, uterine myomas and uterine polyps. However, the data available in countries and studies were highly heterogenous. This present systematic review underlines the lack of a consensual definition of UFI. A national register of patients with UFI based on a consensual definition of Absolute Uterine Factor Infertility and Non-Absolute Uterine Factor Infertility would be helpful for women, whose desire for pregnancy has reached a dead end.
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Affiliation(s)
- Camille Sallée
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, 87000 Limoges, France
- Correspondence: ; Tel.: +33-555-055-555
| | - François Margueritte
- Department of Gynecology and Obstetrics, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, 78103 Poissy, France
| | - Pierre Marquet
- Department of Pharmacology and Toxicology, Centre Hospitalier Universitaire de Limoges, 87042 Limoges, France
| | - Pascal Piver
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, 87000 Limoges, France
| | - Yves Aubard
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, 87000 Limoges, France
| | - Vincent Lavoué
- Department of Obstetrics and Gynecology, Hopital Universitaire de Rennes, 35000 Rennes, France
| | - Ludivine Dion
- Department of Obstetrics and Gynecology, Hopital Universitaire de Rennes, 35000 Rennes, France
| | - Tristan Gauthier
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, 87000 Limoges, France
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Yousif A, Moustafa ASZ, Abuzeid OM, Corrado JM, Abdullah A, Abuzeid MI. Limitations of imaging screening tests in the detection of incomplete uterine septum or arcuate uterine anomaly. Int J Gynaecol Obstet 2022; 159:544-549. [PMID: 35315517 DOI: 10.1002/ijgo.14180] [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: 11/13/2021] [Revised: 01/12/2022] [Accepted: 03/14/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To determine the detection rates of hysterosalpingogram (HSG), transvaginal 2D ultrasound (TV 2D US), transvaginal 3D ultrasound (TV 3D US) in diagnosing of incomplete uterine septum (IUS) and significant arcuate uterine anomaly (AUA). METHODS This retrospective cohort study included patients with infertility or recurrent pregnancy loss (516) that were found to have IUS (317) or significant AUA (199) on diagnostic hysteroscopy (DHS). We compared the detection rate of the various radiological tests in all patients with documented IUS or AUA on DHS. RESULTS The diagnosis of IUS and AUA was made in 49.7% on HSG, 54.2% on TV 2D US and 69.5% on TV 3D US. When both HSG and TV 2D US or HSG and TV3D US were used, the diagnosis was correct in 67.7% and 82.6% of patients, respectively. CONCLUSION Although HSG, TV 2D US, TV 3D US are useful in the screening for IUS/AUA, none of these imaging tests alone or in combination are accurate enough to rule out the diagnosis of such congenital uterine anomalies. In patients with a history of infertility or RPL and negative radiologic tests, DHS is the only reliable method to rule out IUS or significant AUA.
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Affiliation(s)
- Abdelrahman Yousif
- Department of Obstetrics and Gynecology, Hurley Medical Center, Michigan State University, College of Human Medicine, Flint, Michigan, USA
| | - Ahmed S Z Moustafa
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Omar M Abuzeid
- Division of Maternal Fetal-Medicine, Department of Obstetrics and Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, New York, New York, USA
| | | | - Ahmed Abdullah
- Women's Heath, Department of Obstetrics and Gynecology, McLaren Medical Center, Flint, Michigan, USA
| | - Mostafa I Abuzeid
- IVF Michigan Rochester Hills & Flint, PC, Rochester Hills, Michigan, USA.,Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Hurley Medical Center/Michigan State University, College of Human Medicine, Flint, Michigan, USA
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