Subseptate Uterus Research Articles

Not every subseptate uterus requires surgical correction to reduce poor reproductive outcome

Objective To evaluate whether hysteroscopic septoplasty should be performed in all women diagnosed with subseptate uterus. Methods In a prospective study, 138 patients diagnosed with subseptate uterus at the First Affiliated Hospital of Guangxi Medical University, Nanning, China, were enrolled between January 1, 2006, and March 1, 2011, and reproductive outcomes were compared among women who did and those who did not undergo hysteroscopic resection. Women were divided in 2 groups: group A comprised women with a history of recurrent spontaneous abortion (RSA), and was subdivided into control (A1) and surgery (A2) groups; group B comprised women with no history of poor reproductive outcomes, and was subdivided into control (B1) and surgery (B2) groups. Results The rates of pregnancy and term delivery were higher in group A2 than in group A1 ( P < 0.05). The incidence of RSA and preterm delivery was higher in group A1 than in group A2 ( P < 0.05). There was no difference in pregnancy rate, incidence of RSA, or preterm or term delivery between group B1 and group B2. Conclusion Hysteroscopic septoplasty significantly improved pregnancy outcomes in women with a history of RSA, but did not influence reproductive outcomes in women with no history of poor pregnancy outcomes.

Reproductive outcomes in women with congenital uterine anomalies: a systematic review

Congenital uterine anomalies are common but their effect on reproductive outcome is unclear. We conducted a systematic review to evaluate the association between different types of congenital uterine anomaly and various reproductive outcomes. Searches were performed using MEDLINE, EMBASE, the Cochrane Library and Web of Science. The Newcastle-Ottawa Quality Assessment Scale was used for quality assessment. Uterine defects were grouped into arcuate uteri, canalization defects (septate and subseptate uteri) and unification defects (unicornuate, bicornuate and didelphys uteri). Pooled risk ratios (RR) with 95% confidence intervals (CI) were computed using random effects models. We identified nine studies comprising 3805 women. Meta-analysis showed that arcuate uteri were associated with increased rates of second-trimester miscarriage (RR, 2.39; 95% CI, 1.33-4.27, P = 0.003) and fetal malpresentation at delivery (RR, 2.53; 95% CI, 1.54-4.18; P < 0.001). Canalization defects were associated with reduced clinical pregnancy rates (RR, 0.86; 95% CI, 0.77-0.96; P = 0.009) and increased rates of first-trimester miscarriage (RR, 2.89; 95% CI; 2.02-4.14; P < 0.001), preterm birth (RR, 2.14; 95% CI, 1.48-3.11; P < 0.001) and fetal malpresentation (RR, 6.24; 95% CI, 4.05-9.62; P < 0.001). Unification defects were associated with increased rates of preterm birth (RR, 2.97; 95% CI, 2.08-4.23; P < 0.001) and fetal malpresentation (RR, 3.87; 95% CI, 2.42-6.18; P < 0.001). Canalization defects reduce fertility and increase rates of miscarriage and preterm delivery. None of the unification defects reduces fertility but some are associated with miscarriage and preterm delivery. Arcuate uteri are specifically associated with second-trimester miscarriage. All uterine anomalies increase the chance of fetal malpresentation at delivery.

Útero septo completo con duplicidad cervical y septo vaginal. Abordaje histeroscópico

Uterine malformations are estimated to occur in 3-4%, of which 35% correspond to septate uterus. Consequently, this anomaly is the most common uterine malformation, with a prevalence of 1-2% in the general population. Uterine septum is caused by incomplete absorption of the junction of the two Müllerian ducts, which can lead to a complete or a partial septum. Complete septum reaches the internal os, dividing the uterus completely in two cavities. Partial septum, or subseptate uterus, divides the uterus partially and does not reach the internal os. Complete septum is classified as class Va and incomplete septum as class Vb. Septate uterus with double cervix and vaginal septum is not included in Buttram and Gibbons’ classification or in that of the American Society of Fertility. We describe the hysteroscopic management of three cases with the same diagnosis. The technique described by Vercellini et al was used. We also provide a review of this rare uterine malformation, which has rarely been reported in the literature.

Post-abortion hysteroscopy: a method for early diagnosis of congenital and acquired intrauterine causes of abortions

Objective Recurrent pregnancy loss is often defined as three or more consecutive pregnancy losses but there are no strict criteria for initiation of investigations after a miscarriage. We compared the frequency of uterine anomalies diagnosed by hysteroscopy following one, two and three or more miscarriages. Study design In our study 151 patients underwent diagnostic hysteroscopy following a missed or an incomplete abortion. Uterine septum, subseptum, arcuate uterus, and uterine hypoplasia are classified as congenital uterine anomalies and polyps, synechia, and submucous myomas are classified as acquired uterine abnormalities. Results 151 Patients were enrolled in the study. The pregnancy numbers of the patients varied between 1 and 12. Sixty nine (46%) of the patients had one miscarriage, 42 (28%) had two miscarriages and 40 (26%) had three or more miscarriages. Diagnostic hysteroscopy revealed normal uterine cavity in 61.1% of the patients, congenital uterine anomalies in 20.4% and acquired uterine pathologies in 18.5%. Among the congenital anomalies, 14 (9.3%) were uterine septum, 10 (6.6%) were subseptate uterus, 4 (2.6%) were arcuate uterus and 3 (1.9%) were uterine hypoplasia. Among acquired abnormalities 14 (9.3%) were uterine synechia, 12 (7.9%) were endometrial polyps, and 2 (1.3%) were submucous myoma. Among patients who had one miscarriage 64.1% had a normal uterine cavity, 18.2% had congenital abnormalities and 17.7% had acquired uterine pathologies. Of patients with two miscarriages, 52% had a normal uterine cavity, 21.9% had congenital anomalies and 26.1% had acquired uterine pathology. In the three or more miscarriage group, 58.4% had normal uterine cavity, 25.3% had congenital anomalies, and 16.3% had acquired uterine pathology. We did not find any statistically significant difference between the number of miscarriages and pathologic diagnostic hysteroscopy findings. Conclusions Post-abortion office hysteroscopy is a simple and efficient tool in the early diagnosis of congenital and acquired uterine pathologies. Diagnostic hysteroscopy can be performed after the first miscarriage in order to determine congenital and acquired uterine pathologies, with regard to the patient's age and anxiety level.

Evaluation of sFas in serum and follicular fluid during ovarian stimulation for assisted reproduction

To measure the level of sFas in serum and follicular fluid (FF) from infertile women undergoing exogenous gonadotropin stimulation as a part of IVF/ICSI cycles and to study its correlation with oocyte maturation, fertilization, and embryo quality. Serum and FF samples were obtained from 55 patients at the time of transvaginal oocyte retrieval after ovulation induction for assisted reproduction. sFas levels in the serum and FF were measured in duplicate by a solid phase enzyme-linked immunosorbent assay (ELISA). E2 levels were measured by an enzyme immunoassay. There was no statistically significant correlation between age and sFas levels in serum ( p =0.84, r =−0.35) or follicular fluid ( p =0.75, r =−0.36). It was observed that the levels of sFas in serum and FF vary with different patients’ diagnosis. There was a statistically significant increase in sFas levels in both serum ( p =0.023, r =0.08) and FF ( p =0.014, r =0.01) in patients with uterine causes of infertility (subseptate uterus and previous myomectomy) compared with those having other causes of infertility. sFas were detected in low concentration in serum and FF in patients with male factor and idiopathic causes of infertility ( Fig. 1 ). A positive correlation was found between the sFas levels in the serum and those in the FF ( p =0.01, r =0.91) ( Fig. 2 ). However, no correlation was found between the levels of sFas and the levels of estradiol in the serum ( p =0.427, r =−0.03). There was a significant correlation between the number of fertilized oocytes and the level of sFas in the serum ( p =0.013, r =−0.42) ( Fig. 3 ). There was no correlation between the number of fertilized oocytes and the level of sFas in FF ( p =0.168, r =−0.40). However, a significant correlation between the levels of sFas in the serum of pregnant ( n =11) and non-pregnant women ( n =44) was observed ( p =0.045, r =0.90) ( Fig. 4 ). A lower level of sFas in serum was associated with a higher pregnancy rates. This may be attributed to the presence of good fertilized oocytes. The above phenomena may suggest that low levels of sFas in serum may be associated with improved implantation of fertilized oocytes or may prevent damage to the embryo. Lower levels of sFas seem to support embryo implantation.

A new uterine suture technique to control PPH in congenitally malformed uterus during caesarean section

SummaryThe objective of this prospective study was to evaluate the efficacy of simultaneous devascularisation and compression suture for the control of PPH in a congenitally malformed uterus during caesarean section while classic management failed. The technique adopted for devascularisation was ligation of uterine arteries bilaterally below the hysterotomy wound and for the compression of the uterine musculature, suture passing through and through the anterior and posterior wall above the hysterotomy wound closed to either side, tied anteriorly. The majority (75%) of the women were primigravida and mostly presented with malpresentation of the fetus. Mothers were in the age group of 19–24 years. Out of eight cases, four (50%) cases had a bicornuate uterus, two cases had unicornuate and two had a sub-septate uterus. This procedure was effective in 87.5% (7/8) of cases. In follow-up, normal puerperium, menstruation and pregnancy were observed. This procedure is a simple, effective and safe technique to control PPH in congenitally malformed uterus in the field of conservative surgical approaches.

Small uterine septum is an important risk variable for preterm birth

Objective(s) To evaluate whether a uterus with a small septum (arcuate uterus or class VI according to the American Fertility Society (AFS) classification) behaves similarly to a uterus with a larger septum (septate or subseptate uterus or AFS class V). Study design Observational study included 826 singleton deliveries to 730 women with a history of hysteroscopic resection of the uterine septum. Data on deliveries were obtained from the National Perinatal Registry of Slovenia (NPIS). Multiple gestations were excluded. We analysed and compared perinatal outcomes before and after hysteroscopic resection in two groups of women: in women with a small uterine septum (Group A) and in those with a larger uterine septum (Group B). Data on the septum length were obtained during hysteroscopic resection by comparing the length of the 1.4-cm long yellow tip of the electric knife to the length of the resected septum. A small uterine septum was defined as having a length of 1.3–1.5 cm. Results The preterm birth rate in Group A ( n = 420) was 33.9% before and 7.2% after hysteroscopic resection ( P < 0.001); the preterm birth rate in Group B ( n = 406) was 36.5% before and 8.0% after hysteroscopic resection ( P < 0.001). The very preterm birth rate in Group A was 12.5% before and 3.1% after hysteroscopic resection ( P < 0.001); the very preterm birth rate in Group B was 15.0% before and 2.9% after hysteroscopic resection ( P < 0.001). After surgery, we registered a decreased need for neonatal intensive care, as well as a significant decrease in stillbirth and neonatal death rates in both groups of patients. Conclusion(s) Similarly to a large uterine septum, a small uterine septum or arcuate uterus is an important hysteroscopically preventable risk variable for preterm birth.

A comparative study of glycodelin concentrations in uterine flushings in women with subseptate uteri, history of unexplained recurrent miscarriage and healthy controls

Objective To compare the concentration of glycodelin in uterine flushing at the implantation window obtained from women with subseptate uteri, women with a history of recurrent first trimester miscarriage and fertile controls. Study design Glycodelin concentration was assessed using Enzyme Linked Immunohistochemistry (ELISA) at The Early Pregnancy & Gynaecology Assessment Unit, King's College Hospital, London, England. Eight women with a subseptate uterus, 20 women with a history of unexplained recurrent first trimester miscarriage and 16 fertile controls had uterine cavity flushing, for glycodelin concentration, done 7 days after the luteinising hormone surge. Results Glycodelin concentrations in uterine flushing obtained from women with subseptate uteri ( n =8) (median 32.9 ng/ml, range 17.1–52.4 ng/ml) and recurrent miscarriage ( n =20) (median 26.8 ng/ml, range 9.7–78.5 ng/ml) were significantly lower than in the control group ( n = 16) (median 67.7 ng/ml, range 59.0–77.6 ng/ml) ( χ 2 = 19.565, p < 0.001). Conclusion Peri-implantation levels of glycodelin are lower in women at high risk of early pregnancy failure.

3445: Applications studies of the real-time three-dimensional ultrasound

Objectives: Application of the real-time three-dimensional ultrasound gives surface and diaphanous mode imaging of the gynecology and obstetrics and abdominal cavitary organs diseases, evaluates/critics the value of clinical application of the gynecology and obstetrics and abdominal cavitary organs diseases during diagnosis. Methods: Application of Medison SA-8000LIVE, the real-time three-dimensional ultrasound imaging gives 140 patients ultrasonic examinations. Results: The surface mode imaging of the real-time three-dimensional ultrasound directly displays the surface condition of the fetus in the amniotic fluid, it entirely displays the shape of gallbladder in every dimension and direction, urinary bladder cavitary organs disease; the diaphanous mode imaging can directly and lively display the 3D image of the fetus skeletal system, loop in the uterus and subseptate uterus. Conclusions: The real-time three-dimensional has the advantages of shorter operating time, less mock image. The images are three-dimensional and vivid, which can help us to diagnose disease in every position and direction. The joint applications of processing function after image is favourable to obtain good quality of three-dimensional image. So it has a good prospect of the clinical application.

3259: Transvaginal 3D sonohysterographic diagnosis of congenital uterine malformation

To evaluate the diagnostic value of transvaginal three-dimensional ultrasonic hysterography on congenital uterine malformation. We examined 35 women with suspected uterine malformation after intrauterine injection via transvaginal ultrasound. Then we compared the ultrasonic results with hysterography and laparoscopy. Six cases were diagnosed as complete septateuterus, 19 cases as subseptate uterus and 10 cases as bicornuate. Accuracy of three-dimensional ultrasonic hysterography was 100%. Transvaginal three-dimensional ultrasonic hysterography is a simple and convenient method with high accuracy, and can be regarded as a feasible way to diagnose congenital uterine malformation.

Is hysterosalpingography able to diagnose all uterine malformations correctly?: A retrospective study

Background: Müllerian duct anomalies are an uncommon but often a treatable cause of infertility. Material and methods: From January 2002 until November 2003, a total of 705 hysterosalpingographies were realised of which 658 were analysed retrospectively in order to determine the importance of uterine malformations in infertile and sterile patients. In ten cases, the results of hysterosalpingography were compared with hysteroscopy and laparoscopy. Results: The frequency of uterine malformations in infertile and sterile women was 10%. In this population, arcuate uterus (57.6%) was the most common malformation, followed by subseptate uterus (18.2%), uterus bicornis unicollis (10.6%), uterus bicornis bicollis (3.0%), septate uterus (6.1%), unicornuate uterus (3.0%) and unicornuate uterus with double vagina (1.5%). Discussion: Our bibliographic research confirmed that arcuate uterus is the most frequent congenital malformation, but in gestations it does not show a significantly reduced live birth rate. Nevertheless, the septate uterus presents an important decrease of live birth rate that can be improved significantly by doing hysteroscopic metroplasty. As this is a completely different surgical intervention compared to bicornuate uterus, a correct diagnosis is very important. Differentiation of these two malformations is quite difficult by hysterosalpingographic exploration, wherefore an additional exploration by means of endovaginal or three-dimensional ultrasound is recommended.

Embryo implantation in women with Müllerian anomalies: role of tubal embryo transfer

Background and Significance: It has previously been observed that embryo implantation following assisted reproductive techniques is decreased among women with Müllerian anomalies, especially those with anomalies secondary to antenatal diethylstilbesterol (DES) exposure. Whereas it has been proposed that this is secondary to diminished endometrial receptivity, it is also possible that trans-cervical embryo transfer (ET) in the anomalous uterus is associated with reduced transfer efficiency. We hypothesized that the latter effect could be mitigated with the use of tubal embryo transfer (TET); to date no study has examined this possibility. Objective: To compare implantation and pregnancy rates following TET with those previously reported following trans-cervical ET in women with anomalous uteri. Materials and Methods: Between 1995 and 2003, 12 TET procedures were performed in 7 women with Müllerian anomalies. Anomalies included: T-shaped uterus/DES exposed (n=3), T-shaped sub-septate uterus (n=3), and uterus didelphys (n=1). Septae were incised hysteroscopically before fertility treatment. All patients had bilaterally patent fallopian tubes. Tubal ET (mean 4.2 ± 1.0 embryos) was performed via laparoscopy 48 hours after standard IVF in 3 cycles in 2 patients (ages 35 and 39), whereas in 9 cycles in 5 patients, TET was performed in conjunction with egg donation (8 fresh and 1 frozen-thawed). Results: Of the 7 study patients, 5 (71%) had a previous history of 15 failed cycles with trans-cervical ET. The 12 TET procedures resulted in 11 clinical pregnancies (92%; 95% CI: 63, 99%). There were 7 deliveries/ongoing pregnancies (58%; 95% CI: 27%, 85%). The per embryo implantation rate was 33%. The miscarriage rate was 27%. There were no ectopic pregnancies. Historical controls are depicted in Table 1. Table 1Implantation and pregnancy rates following trans-cervical ET in women with Müllerian anomalies.StudyNAnomalyImplantation rateClinical preg rate/ETOngoing preg rate/ETLavergne et al., 199638Septate, Unicornuate, Bicornuate5.8%ap<0.05 (vs. internal control group with normal uteri).13.6%ap<0.05 (vs. internal control group with normal uteri).8.7%Heinonen et al., 200017Unicornuate, Didelphic, Septate8.8%18.0%8.2%Attia et al., 200137Septate, Bicornuate, Didelphic, DES exposed—8.3%ap<0.05 (vs. internal control group with normal uteri).8.3%ap<0.05 (vs. internal control group with normal uteri).Karande et al., 199046DES exposed7.4%ap<0.05 (vs. internal control group with normal uteri).15.3%8.3%ap<0.05 (vs. internal control group with normal uteri).Noyes et al., 199650DES exposed13.6%32.0%28.0%Pal et al., 199717DES exposed2.3%ap<0.05 (vs. internal control group with normal uteri).12.5%ap<0.05 (vs. internal control group with normal uteri).8.0%ap<0.05 (vs. internal control group with normal uteri).a p<0.05 (vs. internal control group with normal uteri). Open table in a new tab Conclusions: We observed high implantation and ongoing pregnancy rates in women with Müllerian anomalies, suggesting that: 1) endometrial receptivity in anomalous uteri is preserved, and 2) transfer efficiency is reduced but may be restored with the use of TET.

Hysteroscopic septal resection, the treatment of choice in patients with subseptate uterus: postoperative pregnancy rates

ABSTRACTObjective Hysteroscopic septal resection for subseptate uterus is a modern alternative to the classic procedures of Tompkins and Jones. We therefore investigated whether this new operation, which is less stressful for the patient, and can usually be carried out on an outpatient basis, can produce results similar to those of the classic laparotomy methods in patients receiving treatment for infertility.Design Questionnaires were sent to 14 women who had undergone hysteroscopic surgery for infertility and known subseptate uterus at the University Department of Gynaecology in Frankfurt‐am‐Main.Results Nine patients responded, six of whom had become pregnant after hysteroscopic resection of the septum. This corresponds to the results achieved with laparotomy methods.Conclusion These results, like those of the few other studies on the topic in the literature, show that hysteroscopic septal resection in infertile patients offers a low‐stress, fast and outpatient alternative to the elaborate classic techniques of Tompkins and Jones.

Reproductive outcomes in women with congenital uterine anomalies detected by three-dimensional ultrasound screening

OBJECTIVE: To determine reproductive outcomes in women with congenital uterine anomalies detected incidentally by three-dimensional ultrasound. METHODS: We studied 1089 women with no history of infertility or recurrent miscarriage who were seen for a transvaginal ultrasound scan. They were screened for uterine abnormalities using three-dimensional ultrasound. We determined prevalence of miscarriage and preterm labor in women with normal and abnormal uterine morphology. RESULTS: We found that 983 women had a normally shaped uterine cavity, 72 an arcuate, 29 a subseptate, and five a bicornuate uterus. Women with a subseptate uterus had a significantly higher proportion of first-trimester loss ( Z = 4.68, P < .01) compared with women with a normal uterus. Women with an arcuate uterus had a significantly greater proportion of second-trimester loss ( Z = 5.76, P < .01) and preterm labor ( Z = 4.1, P < .01). There were no other significant differences in pregnancy outcomes between women with normal and abnormal uterine morphology. CONCLUSION: This study shows the potential value of three-dimensional ultrasound and confirmed that women with congenital uterine anomalies were more likely to have adverse pregnancy outcomes than women with a normal uterus.

3D ultrasound study of uterine anomalies in women with history of recurrent miscarriage

Purpose: Congenital uterine anomalies are associated with adverse reproductive outcomes. In this study, we have examined the significant differences in the severity of uterine malformation in women with history of recurrent miscarriage and those in whom uterine anomaly was diagnosed incidentally.Methods: A total of 503 consecutive women with a history of recurrent miscarriage and 3228 low risk women attending for an ultrasound scan for indications other than infertility or recurrent pregnancy loss were screened for the presence of congenital uterine anomaly using 3D ultrasound. The anomalies were classified according to the American Fertility Society classification. The length of uterine septa, depth of fundal indentation (arcuate uterus) and length of uterine cavity were all measured. The degree of distortion was expressed as a ratio of septum length (or fundal indentation) and the length of the uterine cavity (distortion ratio = septum length/septum length + residual cavity length).Results: Eighty‐one arcuate and 26 subseptate uteri were detected in the group of women with history of recurrent miscarriage, whilst 72 arcuate and 29 subseptate uteri were diagnosed incidentally. There was no significant difference in the septum length (P &gt; 0.01) or fundal indentation (P &gt; 0.01) between the two groups. The uterine distortion ratio in women with a history of recurrent miscarriage was significantly greater compared to women with a normal reproductive history in both arcuate (t = − 3.258, P &lt; 0.01) and subseptate (t = − 1.126, P &lt; 0.01) uteri.Conclusions: The uterine cavity was more distorted in women with history of recurrent miscarriage compared to low risk women. This finding may partly explain the differences in the past reproductive performance between these two groups of women.

Cervical cerclage after hysteroscopic metroplasty

Purpose: The objective of the study is to evaluate the role of cervical cerclage after hysteroscopic metroplasty.Methods: Forty‐six women, previously treated by hysteroscopic metroplasty for subseptate uteri, were prospectively recruited for this observational study. A total of 34 patients conceived 46 pregnancies. Miscarriages, ectopic pregnancies, and live births rate were 34, 7, 59%, respectively. Elective or ultrasound indicated cervical cerclage was proposed to these latter 27 patients. After discussing an informed consent form patients were asked to choose the elective cerclage or the ultrasound indicated cerclage. Cervical length was checked every 3 weeks, from 12 weeks of gestation. Indications for cervical cerclage were: cervical funneling or shortening &lt;25 mm. In symptomatic patients, or when cerclage was indicated, a cervicovaginal swab was performed, and, if necessary, antibiotic therapy was started. The Shirodkar technique was adopted for cerclage.Results: Eleven of 27 patients underwent cervical cerclage: seven on ultrasound indication, four electively. Mean gestational age at the time of indicated cervical cerclage was 20 ± 2 weeks. Three patients, in the US‐indicated group, had a pathologic cervicovaginal swab. All no cervical cerclage delivered at term (39 ± 2 weeks). Mean gestational age at delivery in patients who underwent indicated cervical cerclage was significantly lower (P &lt; 0.05) than in patients with no sonographic indication (37 ± 2 vs. 39 ± 1 weeks).Conclusions: Ultrasound cervical assessment is a useful tool to select patients for therapeutical cerclage. According to our data cervical cerclage should be performed only in cases of cervical changes diagnosed by transvaginal sonography.

F26Reproductive outcomes in women with arcuate and subseptate uteri

BackgroundThe effect of congenital uterine anomalies on reproductive performance is uncertain. The aim of this study to correlate uterine morphology with past reproductive outcomes in a large group of women with no history of infertility or recurrent pregnancy loss.MethodIn a period of three years 1028 women were recruited into the study. A detailed history of past pregnancies was obtained first, followed by transvaginal three‐dimensional ultrasound examination. The uterus was classified as being normal, arcuate or subseptate after the examination of uterine morphology in the coronal reformatted section. Uterine anomalies were classified according to the American Fertility Society classification and the degree of uterine cavity distortion was measured.Results884 women had a normal uterus, 72 arcuate and 29 subseptate uteri. In the past they had total of 1944 pregnancies. The risk of miscarriage was significantly increased in both women with arcuate (OR = 1.9; 95% CI 1.1–3.5) and subseptate uteri (OR = 5.8; 95% CI 3.4–10.1) compared to those with normal uterine morphology. There was no correlation between the depth of uterine septum and the risk of miscarriage.ConclusionMiscarriage is significantly more frequent in women with arcuate and subseptate uterus. Further research is needed to assess potential benefits of surgical treatment in these cases.

F07Hysterosonosalpingography – a new concept of diagnostic procedures in gynaecology

BackgroundThe aim of this study is to find the effectiveness of hysterosonosalpingography in the diagnosis of the endometrial pathology and in the study of tubal patency.MethodWe have studied 550 cases backwards. The women enrolled came from four departments of our Hospital: Menopause (n = 206), Reproductive Medicine (n = 195), General Gynaecology (n = 125) and Senology − Women on Tamoxifen (n = 24). We have analysed epidemiological data, Transvaginal Sonography and hysterosonosalpingography findings, as well as the conventional Hysterosalpingography, Laparoscopic, Hysteroscopic and histological data. We have looked for the concordance rate between the hysterosonosalpingography and the other diagnostic procedures.Results Main findings: Round hyporeflective broad‐based structures representing polyps or submucosal myomas, thin endometrium, floating thin or rigid strips, subseptate uterus, unobstructed tubes, uni or bilateral tubal occlusions. High concordance rate (from 85% to 95%) was verified between the hysterosonosalpingography and the classic diagnostic proceedings.ConclusionHysterosonosalpingography is a good and valuable complement of Transvaginal Sonography in the endometrial study. It makes possible appropriate preoperative triage to hysteroscopy. It may be also a first class exam of screening infertility. The success of this technique led us to include it at the diagnostic protocols in our Hospital.

Comparison of Sonohysterography with Magnetic Resonance Imaging (MRI) for the Evaluation of Müllerian Anomalies

Objective: To evaluate the role of sonohysterography for diagnosing congenital Müllerian anomalies. Design: Prospective double-blind comparison of sonohysterography and pelvic MRI in patients suspected of having a congenital Müllerian anomaly. Materials and Methods: Sonohysterography and pelvic MRI were performed in 13 patients with suspected Müllerian anomalies. The sonohysterogram and MRI were interpreted by a single investigator (DRS and KD, respectively) who was blinded to the results of the other test and the patient’s history. Results: The sonohysterogram demonstrated 100% sensitivity and specificity with the pelvic MRI used as the gold standard. The only discrepancy was a report of subseptate uterus by pelvic MRI that was diagnosed as an arcuate uterus by sonohysterography. Uterine abnormalities were: 8 septate, 2 normal, 1 arcuate, 1 didelphic and 1 unicornuate. Sonohysterography permitted the measurement of the height and width of a uterine septum and the relationship of the uterine septum to the cervix. Ultrasound gave additional information regarding the proximity of the ovaries to the vaginal probe in patients planning an IVF procedure. Conclusion: Sonohysterography provides an accurate alternative to pelvic MRI in the screening of uterine anomalies. Differentiation of the classes of malformation depends on the external contour of the uterus which can be visualized with either pelvic MRI or sonohysterography, but not x-ray hysterosalpingography. The use of sonohysterography may lessen the need for a diagnostic laparoscopy and assist in planning a therapeutic procedure. This work was supported by the Mayo Foundation.

Assisted reproduction in women with uterine anomalies

A retrospective analysis was performed to evaluate the reproductive performance of 17 women with uterine anomalies who underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) and embryo transfer (ET). Eight women had a unicornuate uterus, and two a didelphic uterus. Seven women with a subseptate uterus underwent metroplasty before assisted reproduction. Ten (58.8%) out of 17 women achieved 11 (18.0%) pregnancies out of 61 embryo transfers in 55 stimulated cycles. The implantation rate per embryo was 8/83 (9.6%) for women with a unicornuate uterus, one of 17 (5.9%) for those with didelphic uterus and four of 48 (8.3%) for those with subseptate uterus. Pregnancy rates per embryo transfer were 19.4, 11.1 and 19.0%, respectively. Three out of 11 pregnancies were ectopic, three were miscarriages and five were full-term deliveries, two sets of twins. Delivery rate per embryo transfer was 5.0% in patients with unicornuate or didephic uterus and 14.3% in women who had a subseptate uterus operated prior to assisted reproduction. Women with uterine anomalies treated by IVF or ICSI had low implantation rates. Pregnancy in a subseptate uterus which has been previously operated had a trend to end more frequently in delivery than that in a unicornuate uterus or in a didelphic uterus.