Study Objective To propose the density of endometrial glandular openings (DEGO) as a simple and reliable new variable in predicting live birth after hysteroscopic adhesiolysis (HA). Design Retrospective cohort study. Setting University hospital. Patients or Participants 469 patients with intra-uterine adhesions who underwent hysteroscopic adhesiolysis followed by second look hysteroscopy with images recorded. 12 were lost to follow-up or excluded by criteria. The remaining 457 were included in the study and followed up over a period of 2 years. 231 patients had live-births,82 patients had recurrent spontaneous abortion without live-birth and 144 patients remained infertile at the end of the study. Interventions None Measurements and Main Results N/A. Main Outcome Measure(s): The second look hysteroscopic images were evaluated by an automatic counting system to calculate the density of endometrial glandular openings (DEGO). The American Fertility Society (AFS) scores were also calculated for each patient. Logistic regression analysis was performed to develop a prediction model for each of these scores to predict live-birth-rate following hysteroscopic adhesiolysis. The performance of each of these prediction models was compared by calculating the area under the curve (AUC). Result(s): The logistic regression analysis revealed that both DEGO and AFS scores were closely correlated with live-birth rates in patients with intra-uterine adhesions (p=0). The AUCs of AFS scores pre-operatively and post-operatively (evaluated during the final second-look hysteroscopy) were 0.7611 and 0.7691 respectively; The AUC for DEGO post-operatively (evaluated during the final second-look hysteroscopy) was 0.8628. When compared with pre- or post-operative AFS score, the post-operative DEGO had an optimal prediction performance (p=0.0002, p Conclusion Post-operative DEGO has superior performance to AFS score in predicting the live-birth rate following hysteroscopic adhesiolysis for patients with intrauterine adhesions.
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