Hysteroscopic Metroplasty In Women Research Articles

352 Hysteroscopic metroplasty for septate uterus: A retrospective bicentric study involving 519 women

Introduction and aims: Women with a septate uterus have an increased risk of infertility and impair outcomes. Hysteroscopic metroplasty is a well-described procedure. The need for metroplasty is however controversial. A recent study concluded that metroplasty didn’t improve reproductive outcomes and lead to less chance of ongoing pregnancy than expectant management. Aim of this study is then to evaluate reproductive outcomes and risks of hysteroscopic metroplasty in women of reproductive age. Methods: We performed a retrospective bicentric study in the gynaecologic unit of two teaching hospitals with expertise in hysteroscopy.

Reproductive outcomes of office hysteroscopic metroplasty in women with unexplained infertility with dysmorphic uterus.

Objective:The correlation between dysmorphic uterus and infertility still remains enigmatic. We evaluated the reproductive outcomes of metroplasty via office hysteroscopy in unexplained infertile women with dysmorphic uteri.Materials and Methods:In this retrospective cohort study, metroplasty via office hysteroscopy using a bipolar system was performed to 272 women with unexplained infertility with dysmorphic uteri from January 2013 to January 2016. Of all the patients, 162 had primary infertility, and 110 had secondary infertility.Results:In the primary infertility group, the clinical pregnancy rate was 45.68% (74/162) and the live birth rate was 38.9% (63/162), and in the secondary infertility group, the clinical pregnancy rate was 55.45% (61/110) and the live birth rate was 49% (54/110) after metroplasty. In the secondary infertility group, the miscarriage rate and especially the ectopic pregnancy rate declined dramatically [from 84.5% (93/110) to 9.8% (6/61) and from 15.5% (17/110) to 1.6% (1/61), respectively] (p<0.01).Conclusion:Reproductive outcome can be impaired by Müllerian anomalies, hence, infertile women with dysmorphic uteri should undergo hysteroscopy to improve reproductive outcomes. Our study demonstrated that office hysteroscopic metroplasty of a dysmorphic uterus might improve fertility, particularly in patients with unexplained infertility with dysmorphic uteri, which was an ignored factor previously. Office hysteroscopy is an alternative option in terms of non-invasive procedure.

Hysteroscopic Metroplasty in Women With Unexplained Primary Infertility: A Prospective Cohort Study.

Hysteroscopic Metroplasty in Women With Unexplained Primary Infertility: A Prospective Cohort Study.

The techniques and outcomes of hysteroscopic metroplasty

To evaluate the reproductive outcomes and surgical techniques of the hysteroscopic metroplasty in women with septate uterus and recurrent abortions or primary unexplained infertility. Septate uterus is the most frequent congenital uterine anomaly caused by inadequate resorption of the Müllerian ducts. Hysteroscopic metroplasty has replaced the traditional laparotomy approach because of its positive and satisfactory outcomes in pregnancy and live-birth rates, and also many different postoperative benefits. The aim of metroplasty is to restore a normal anatomy of the uterine cavity as a prerequisite for a positive implantation and subsequent good obstetrical outcomes. This treatment clearly demonstrates its effectiveness both in recurrent abortion and in primary unexplained infertility. The hysteroscopic metroplasty with its simplicity, safety, and improved reproductive outcomes has liberalized the approach to treatment. Today, hysteroscopic metroplasty is a common practice to treat septate uterus with salutary effects both in infertile patients and in patients with recurrent pregnancy loss or premature labor, especially if in-vitro fertilization is being contemplated. Decisions on when to treat uterine septa are discussed in particular because of lack of prospective, randomized controlled trials.

Hysteroscopic Resection of Uterine Septum and Reproductive Outcome in Women with Unexplained Infertility

Background/Aims: To investigate the reproductive outcome after hysteroscopic resection of uterine septum in women with septate uterus and otherwise idiopathic primary infertility. Methods: Sixty-eight patients with septate uterus and idiopathic primary infertility were included in this prospective observational study. All patients underwent hysteroscopic metroplasty with scissors under general anesthesia. Main outcome measures were clinical pregnancy rate, live birth and abortion rate at 12 months’ follow-up and at mean follow-up time. Results: At 12 months’ follow-up, the clinical pregnancy rate, the live birth rate and the abortion rate were 44% (30/68), 36.8% (25/68) and 16.6% (5/30), respectively. At total follow-up time, the overall pregnancy rate, the live birth rate and the abortion rate were 53.8% (35/65), 41.5% and 14.2% (7/35), respectively, while the stillbirth rate was 2.8% (1/35). Conclusion: Hysteroscopic metroplasty in women with septate uterus and unexplained infertility could improve clinical pregnancy rate and live birth rate in patients with otherwise unexplained infertility. If such a patient is looking for a spontaneous pregnancy, this is more likely to occur during the first 15 months following the procedure.

Metroplasty in a Large Population of Women with Septate Uterus

Study Objective To determine the reproductive outcome after hysteroscopic metroplasty in women with septate uterus. Design Retrospective comparative single-center study (Canadian Task Force classification II-3). Setting University-affiliated hospital. Patients Two hundred forty-six patients with septate uterus undergoing hysteroscopic metroplasty between January 1998 and December 2007. The diagnosis was based on hysteroscopy and 3-dimensional ultrasonography. In the most cases laparoscopy was also available. The subjects were divided into 2 age-matched groups. Group 1 consisted of 108 women with unexplained infertility, and group 2 consisted of 138 women suffering from recurrent abortion. Interventions Patients underwent hysteroscopic metroplasty by use of resectoscopy with an equatorial semicircular loop cutting at 0 degree with monopolar energy. All septa were completely removed without complications of bleeding, infection, risk of perforation, visceral injury, or uterine dehiscence during pregnancy. Measurement and Main Results The 2 groups were compared in terms of reproductive performance in mean ± SD follow-up of 37 ± 18 months. In group 1, 61 (56.5%) patients achieved pregnancy. Seventy-one pregnancies ensued, including 1 twin gestation. Fourteen of the 71 pregnancies (19.7%) ended in miscarriage. In group 2, 90 (65.3%) patients achieved pregnancy. One hundred twenty-nine pregnancies ensued, including 2 twin gestations. Forty-four of the 129 pregnancies (34.1%) ended in miscarriage. The 2 groups have no significant differences in terms of reproductive outcome after surgery, except for the number of abortions, which was higher in group 2 (p <.05). Conclusion This study confirms that hysteroscopic metroplasty is a simple, safe, and rapid surgical procedure with no complications for achieving normal uterine architecture, which is peculiar to a good reproductive outcome. The use of an equatorial semicircular loop may give satisfactory and similar results to those obtained with Collin’s loop.

Hysteroscopic resection of uterine septum improves reproductive performance in women with unexplained infertility

To evaluate the reproductive outcome after hysteroscopic metroplasty in women with a septate uterus, with particular focus on patients suffering from unexplained infertility. Materials and methods: Hysteroscopic septum resection was performed on 181 patients with uterine septa, including 98 patients with infertility and 83 patients with secondary infertility. Patients were placed into 1 of 3 groups: those with unexplained infertility, those who had experienced 1 miscarriage, and those who had experienced 2 or more miscarriages. All were analyzed retrospectively in terms of their reproductive outcome. Results: After undergoing the hysteroscopic septum resection, 43 out of 98 primary infertility patients became pregnant (43.8%). This figure was lower than the pregnancy rates for patients who had experienced 1 miscarriage or 2 or more miscarriages, 70.2% and 82.6%, respectively (P < 0.05). In spontaneous pregnancies, the miscarriage rate for those who had experienced 1 previous miscarriage decreased from 88.1% (37/42) to 13.6% (3/22, P < 0.001); for those who had experienced 2 or more previous miscarriages, it decreased from 96.5% (168/174) to 17.1% (7/41, P < 0.001). The term delivery rate and live birth rate also rose significantly in all of the groups (P < 0.05). The rate of cesarean sections was 28 out of 107 births, or 26.1%. Conclusion: The reproductive prognosis for patients with unexplained infertility can be improved significantly by performing hysteroscopic metroplasty. Vaginal delivery is a safe way of giving birth for these patients.

Reproductive Performance in Hysteroscopic Metroplasty

Background: This study was to ascertain reproductive better outcome in hysteroscopic metroplasty, the literature to support thatremoval of septum improves pregnancy rates in women with bad obstetric history. However, its role in patients with otherwiseunexplained infertility is still not clear due to paucity of enough evidence.Objective: To assess reproductive performance in women with septate uterus and otherwise unexplained infertility after hysteroscopicmetroplasty.Materials and methods: Eight women with septate uterus and otherwise unexplained primary infertility were included in the study. Allthese women underwent hysteroscopic septal resection. Reproductive performance of these women within one year of surgery wasstudied and analyzed.Result: Forty women (45.83%) conceived within one year of surgery. Only six women (12%) had spontaneous abortions and only five(15%) had preterm delivery.Conclusion: Hysteroscopic metroplasty in women with septate uterus significantly improves the reproductive performance. Septateuterus is not a primary factor of infertility. Hysteroscopic metroplasty restores normal uterine cavity with a good uterine vascularizationto have better reproductive outcome.

Critical appraisal regarding the effect on reproductive outcome of hysteroscopic metroplasty in patients with recurrent miscarriage

Dear Editor, We read with interest the online issue of Archives of Gynecology and Obstetrics of December 2009, Roy et al. [1] present a retrospective study on the effect of hysteroscopic septal resection for women with a history of recurrent miscarriages, preterm deliveries and infertility. The authors conclude that hysteroscopic metroplasty is a safe and effective procedure to improve obstetric outcome in these women. Unfortunately the interpretation of the results of this study has been subjected to a methodological pitfall. This study, amongst many others evaluating the efficacy of hysteroscopic metroplasty, compares reproductive outcome in women before and after surgery, using these women as their own controls. This is not a fair comparison since the very reason for performing the surgery has been the poor reproductive outcome in the index pregnancy. These women could have miscarried by chance and still have a good chance of conceiving and having a live birth without any treatment. Making these before–after comparison will always favor the intervention [2, 3]. Therefore, we cannot agree with the conclusions of Roy et al. [1]. The only way to evaluate the efficacy of hysteroscopic metroplasty in women with recurrent miscarriage is to perform a randomized controlled trial. We disagree with the comments of Roy et al. that performing such a trial would not be possible due to ethical reasons. In our opinion, it is unethical to perform treatment without the knowledge of the effectiveness of this treatment. We have recently launched the TRUST trial (The Randomized Uterine Septum Transsection trial: NTR1676) that randomizes women with recurrent miscarriage between hysteroscopic metroplasty and expectant management. The results of this trial will answer the question, whether hysteroscopic metroplasty is a safe and effective method for improving reproductive outcome. Roy et al. are warmly invited to participate in our study.

Reproductive performance after hysteroscopic metroplasty in women with primary infertility and septate uterus

Background:There is enough evidence in the literature to support that removal of septum improves pregnancy rates in women with bad obstetric history. However, its role in patients with otherwise unexplained infertility is still not clear due to paucity of enough evidence.Objective:To assess reproductive performance in women with septate uterus and otherwise unexplained infertility after hysteroscopic metroplasty.Materials and Methods:72 women with septate uterus and otherwise unexplained primary infertility were included in the study. All these women underwent hysteroscopic septal resection. Reproductive performance of these women within one year of surgery was studied and analysed.Result:33 women (45.83%) conceived within one year of surgery. Only 4 women (12%) had spontaneous abortions and only 5 (15%) had preterm delivery.Conclusion:Hysteroscopic metroplasty in women with septate uterus significantly improves the reproductive performance.

Fertility Rate and Reproductive Outcome after Hysteroscopic Metroplasty in Women with Septate Uterus

Fertility Rate and Reproductive Outcome after Hysteroscopic Metroplasty in Women with Septate Uterus

Reproductive Outcome after Hysteroscopic Metroplasty in Women with Primary Infertility

Reproductive Outcome after Hysteroscopic Metroplasty in Women with Primary Infertility

Reproductive outcome after hysteroscopic metroplasty in women with primary infertility

Reproductive outcome after hysteroscopic metroplasty in women with primary infertility

288: Reproductive Outcome after Hysteroscopic Metroplasty in Women with Septate Uterus

To analyze obstetric results of hysteroscopic metroplasty in women with primary or secondary infertility and recurrent early or late pregnancy loss. Retrospective analysis of 302 cases of uterine septum. Tertiary level reference hospital. Three hundred two women (ages 17-46 years) with septate uterus. Hysteroscopic metroplasty with transection of uterine septum. Of the patients with primary or secondary infertility term pregnancies occurred in addition to preterm deliveries, spontaneous or missed abortions. Of the patients with primary infertility 16 term pregnancies occurred while 36 secondary infertile patients had live births. Hysteroscopic metroplasty improves obstetric outcome in women with early and late abortion in addition to those with secondary infertility. However it seems to be less effective in patients with primary infertility since several risk factors like tubal damage or male infertility coexist.

Reproductive outcome after hysteroscopic metroplasty in women with septate uterus and otherwise unexplained infertility

Objective To evaluate the reproductive outcome of hysteroscopic metroplasty performed in women with septate uterus and otherwise unexplained primary infertility. Design Prospective, observational study. Setting Tertiary center for reproductive medicine. Patient(s) Sixty-one patients with uterine septa and otherwise unexplained primary infertility. Intervention(s) Hysteroscopic division of the uterine septum. Main outcome measure(s) Reproductive outcome after hysteroscopic metroplasty. Result(s) Of 61 women, 25 (41%) conceived within 8–14 (mean 11.2) months after hysteroscopic metroplasty. Of these, 18 (29.5% of the total group) had live births (13 carried to term and 5 had preterm deliveries), and 7 (11.5% of the total group) had spontaneous abortions. Cervical cerclage was performed in 9 women; only 1 (11.1%) of these patients and 4 (44.4%) of the 9 who did not have a cerclage had preterm deliveries. Twelve of the 18 women (66.6%) who had live births were delivered by cesarean section. Conclusion(s) Women with uterine septum and otherwise unexplained infertility might benefit from hysteroscopic metroplasty.

Danazol versus a gonadotropin-releasing hormone agonist as preoperative preparation for hysteroscopic metroplasty

To compare the efficacy of danazol and a GnRH agonist as preoperative preparation for hysteroscopic metroplasty in women with septate uterus. Prospective randomized clinical study. Tertiary care center. Thirty patients with septate uterus. The patients were randomized to treatment with danazol 600 mg/d for 2 to 4 weeks (n = 15) or with leuprolide acetate depot 3.75 mg for 2 months (n = 15) as preoperative therapy for hysteroscopic metroplasty. At the intervention the hysteroscopist evaluated difficulty in dilation of the cervical canal, presence of endometrial fragments, bleeding, difficulty in maneuvering the resectoscope, and operating time. Both the treatments were well tolerated. Metroplasty was simpler overall in the danazol group and also faster in introducing the resectoscope through the cervical canal and maneuvering it in the uterine cavity were both easier. Bleeding was modest in both groups and the anatomic outcome of the operation was similar. Short preoperative preparation with danazol results in favorable operating conditions at limited costs with minimal side effects.

Beneficial effect of hysteroscopic metroplasty on the reproductive outcome in a 'T-shaped' uterus.

Eight women (aged 27-43) with reproductive dysfunction who were diagnosed by hysterosalpingogram and hysteroscopy as having a 'T-shaped' uterus were operated on using fiberoptic hysteroscopic guidance; the uterine side walls were incised until a normal uterine cavity was achieved. The women's gynecologic and obstetric records were compared before and after the operation. In all the 8 women the operation was without complications and resulted in a satisfactory uterine cavity. Before the operative procedure, the women had had 10 spontaneous abortions and 1 ectopic pregnancy. The postoperative performance available for 7 of the 8 women showed 4 term pregnancies in 3 women, 1 ectopic pregnancy, and no abortions. Our study suggests that hysteroscopic metroplasty in women with a T-shaped uterus improves the reproductive outcome, mainly in women with repeated abortions. We conclude that women with a T-shaped uterus who want to improve their reproductive function should be encouraged to undergo hysteroscopic metroplasty.