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Reproductive Outcome After Hysteroscopic Septum Resection: A Retrospective Study

Year 2017, Volume: 14 Issue: 4, 172 - 175, 01.10.2017

Abstract

Aim: To determine the conception and term pregnancy rates following the hysteroscopic resection of the primary and secondary infertile women with a septate uterus.Material and Methods: In 36 patients admitted to our department, from September 2009 to March 2014, with primary and secondary infertility previous abortions, premature deliveries , uterine septum was detected via HSG. Primary and secondary infertility categories consisted of 16 and 20 patients, respectively. A retrospective study investigating reproductive outcomes following septum resection was conducted. Results were compared between pregnancies prior to and after the septum resection.Results: The mean duration of the operation was 27.5 ±7.0 mn. After septum resection, asherman syndrome was observed in 4 11.1% patients and 3 8.3% patients was required cervical cerclage. 25 patients have conceived 69.4% following the resection. Of these 25 cases, term pregnancy was achieved in 19 patients 52.8% . In primary and secondary infertility groups, the term pregnancy rate was found to be 53.3% and 54.2%, respectively. In secondary infertility group, the miscarriage rate for those who had experienced 2 or more previous miscarriages decreased from 61.9% to 4.8%. The term delivery rate also rose from 19% to 61.9%.Conclusion: Hysteroscopic septum resection promotes the fertility both primary and secondary infertility patients. Thus, patients with a history of recurrent pregnancy and infertility necessitates the investigation for the presence of the uterine septum. Hysteroscopic surgical approaches should be preferred in regard to the short duration of the operation and the hospital stay as well as the increased chance for the vaginal delivery in the next pregnancies following the operation.

References

  • Marcal L, Nothaft MA, Coelho F, Volpato R, Iyer R. Mullerian duct anomalies: MR imaging. Abdom Imag. 2011; 36 (6):756–64.
  • Giacomucci E, Bellavia E, Sandri F, Farina A, Scagliarni G. Term delivery rate after hysteroscopic metroplasty in patients with recurrent spontaneous abortion and T-shaped, arcuate and septate uterus. Gynecol Obstetr Investig. 2011; 71 (3):183–8.
  • Pai HD, Kundnani MT, Palshetkar NP, Pai RD, Saxena N. Reproductive performance after hysteroscopic metroplasty in women with primary infertility and septate uterus. J Gynecol Endosc Surg. 2009; 1 (1):17–20.
  • Grimbizis GF, Camus M, Tarlatzis BC, Bontis JN, Devroey P. Clinical implications of uterine malformations and hysteroscopic treatment results. Human Reprod Update. 2001; 7 (2):161–74.
  • Valle RF, Ekpo GE. Hysteroscopic metroplasty for the septate uterus: review and meta-analysis. J Minimal Invas Gynecol. 2013; 20 (1):22–42.
  • Paradisi R, Barzanti R, Natali F, Battaglia G, Venturoli S. Metroplasty in a large population of women with septate uterus. J Minimal Invas Gyenecol. 2011; 18 (4):449–54.
  • Selvaraj P, Selvaraj K. Reproductive outcome of septate uterus following hysteroscopic septum resection. J Hum Reprod Sci. 2010; 3 (3):143–5.
  • Bendifallah S, Faivre E, Legendre G, Deffieux X, Fernandez H. Metroplasty for AFS Class V and VI septate uterus in patients with infertility or miscarriage: reproductive outcomes study. J Minimal Invas Gynecol. 2013; 20 (2):178–84.
  • Agostini A, De Guibert F, Salari K, Crochet P, Bretelle F, Gamerre M. Adverse obstetric outcomes at term after hysteroscopic metroplasty. J Minimal Invas Gynecol. 2009; 16 (4):454–7.
  • Grimbizis GF, Gordts S, Di Spiezio. The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Hum Reprod. 2013; 28(8):2032.
  • Homer H, Li T, Cooke I. The septate uterus: a review of management and reproductive outcome. Fertil Steril. 2000; 73(1):1-14.
  • Ayas S, Gurbuz A, Tuna G, Sargın M. A, Alkan A, Eren S. Hysteroscopic resection of uterine septum improves reproductive performance in women with unexplained infertility. Turk J Med Sci. 2011; 41 (4): 595- 601
  • Fedele L, Bianchi S, Marchini M, Franchi D, Tozzi L, Dorta M. Ultrastructure aspects of endometrium in infertile women with septate uterus. Fertil Steril. 1996; 65 (4):750–752.
  • Pabuccu R, Gomel V. Reproductive outcome after hysteroscopic metroplasty in women with septate uterus and otherwise unexplained infertility. Fertil Steril. 2004; 81 (6):1675–8.
  • Saygili-Yilmaz E, Yildiz S, Erman-Akar M, Akyuz G, Yilmaz Z. Reproductive outcome of septate uterus after hysteroscopic metroplasty. Arch Gynecol Obstet. 2003; 268(4): 289-92.
  • Marcus S, Al-Shawaf T, Brinsden P. The obstetric outcome of in vitro fertilization and embryo transfer in women with congenital uterine malformation. Am J Obstet Gynecol. 1996; 175 (1): 85-9.
  • Corson S. Operative hysteroscopy for infertility. Clin Obstet Gynecol. 1992; 35(2): 229-41.
  • Lee DM, Osathanondh R, Yeh J. Localization of Bcl-2 in the human fetal mullerian tract. Fertil Steril. 1998; 70 (1): 135–40.
  • Taylor E, Gomel V. The uterus and fertility. Fertil Steril. 2008;89(1) :1-16

Histeroskopik Septum Rezeksiyonu Sonrası Gebelik Sonuçları: Retrospektif Bir Çalışma

Year 2017, Volume: 14 Issue: 4, 172 - 175, 01.10.2017

Abstract

Amaç: Primer infertilite ve düşük veya prematür doğum öyküsü olan sekonder infertilite tanısı ile başvuran ve uterin septum saptanan olgularda histeroskopik septum rezeksiyonu sonrası gebelik sonuçlarının ve hızlarının retrospektif olarak saptanması.Gereçler ve Yöntem: Eylül 2009- Mart 2014 tarihleri arasında Mustafa Kemal Üniversitesi Kadın Hastalıkları ve Doğum kliniğine başvuran, histerosalpingografi ile uterin septum tanısı koyduğumuz primer veya sekonder infertil hastalara histereskopik septum rezeksiyonu uygulandı. 16 hasta primer infertilite; 20 hasta ise düşük ve/veya prematür doğum öyküsü olan sekonder infertilite grubunda idi. Hastaların retrospektif olarak verileri tarandıktan sonra hastalar aranarak operasyon sonrası gebelik bilgilerine ulaşıldı.Bulgular: 20 vakada komplet septus, 16 vakada parsiyel septus izlendi. Ortalama operasyon süresi 27,5 ± 7,0 dk. İdi. 4 %11,1 vakada işlem sonrasında asherman sendromu gelişti. 3 %8,3 vakada işlem sonrası servikal yetmezlik tespit edildiğinden dolayı servikal serklaj uygulandı. Histeroskopik rezeksiyon sonrası 25 olguda %69,4 konsepsiyon sağlandı. Bu 25 olgunun 19’unda %52,8 gebelik terme kadar ulaştı. 2 olguda ise düşük meydana geldi. Primer ve sekonder infertil kabul edilen grupta term gebelik hızı sırasıyla %53,3 ve %52,4 olarak bulundu. Histereskopik septum rezeksiyonu sonrası sekonder infertil gruptaki habituel abortuslu hastaların spontan düşük hızı %61,9 ‘dan %4,8 ‘e düştü ve canlı doğum oranları %19 ‘dan % 61,9 ‘a yükseldi. Sonuç: Histeroskopik septum rezeksiyonu gerek primer, gerekse sekonder infertil olgularda fertiliteyi olumlu bir ölçüde artırmaktadır. Bu yüzden infertilite veya tekrarlayan gebelik kayıpları saptanan olgularda septum varlığı araştırılmalıdır. Bu tür olgularda operasyon süresinin ve hastanede kalış süresinin kısalığı, ayrıca daha sonraki gebeliklere vajinal doğum şansı tanıması açısından histeroskopik yaklaşım tercih edilmelidir.

References

  • Marcal L, Nothaft MA, Coelho F, Volpato R, Iyer R. Mullerian duct anomalies: MR imaging. Abdom Imag. 2011; 36 (6):756–64.
  • Giacomucci E, Bellavia E, Sandri F, Farina A, Scagliarni G. Term delivery rate after hysteroscopic metroplasty in patients with recurrent spontaneous abortion and T-shaped, arcuate and septate uterus. Gynecol Obstetr Investig. 2011; 71 (3):183–8.
  • Pai HD, Kundnani MT, Palshetkar NP, Pai RD, Saxena N. Reproductive performance after hysteroscopic metroplasty in women with primary infertility and septate uterus. J Gynecol Endosc Surg. 2009; 1 (1):17–20.
  • Grimbizis GF, Camus M, Tarlatzis BC, Bontis JN, Devroey P. Clinical implications of uterine malformations and hysteroscopic treatment results. Human Reprod Update. 2001; 7 (2):161–74.
  • Valle RF, Ekpo GE. Hysteroscopic metroplasty for the septate uterus: review and meta-analysis. J Minimal Invas Gynecol. 2013; 20 (1):22–42.
  • Paradisi R, Barzanti R, Natali F, Battaglia G, Venturoli S. Metroplasty in a large population of women with septate uterus. J Minimal Invas Gyenecol. 2011; 18 (4):449–54.
  • Selvaraj P, Selvaraj K. Reproductive outcome of septate uterus following hysteroscopic septum resection. J Hum Reprod Sci. 2010; 3 (3):143–5.
  • Bendifallah S, Faivre E, Legendre G, Deffieux X, Fernandez H. Metroplasty for AFS Class V and VI septate uterus in patients with infertility or miscarriage: reproductive outcomes study. J Minimal Invas Gynecol. 2013; 20 (2):178–84.
  • Agostini A, De Guibert F, Salari K, Crochet P, Bretelle F, Gamerre M. Adverse obstetric outcomes at term after hysteroscopic metroplasty. J Minimal Invas Gynecol. 2009; 16 (4):454–7.
  • Grimbizis GF, Gordts S, Di Spiezio. The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Hum Reprod. 2013; 28(8):2032.
  • Homer H, Li T, Cooke I. The septate uterus: a review of management and reproductive outcome. Fertil Steril. 2000; 73(1):1-14.
  • Ayas S, Gurbuz A, Tuna G, Sargın M. A, Alkan A, Eren S. Hysteroscopic resection of uterine septum improves reproductive performance in women with unexplained infertility. Turk J Med Sci. 2011; 41 (4): 595- 601
  • Fedele L, Bianchi S, Marchini M, Franchi D, Tozzi L, Dorta M. Ultrastructure aspects of endometrium in infertile women with septate uterus. Fertil Steril. 1996; 65 (4):750–752.
  • Pabuccu R, Gomel V. Reproductive outcome after hysteroscopic metroplasty in women with septate uterus and otherwise unexplained infertility. Fertil Steril. 2004; 81 (6):1675–8.
  • Saygili-Yilmaz E, Yildiz S, Erman-Akar M, Akyuz G, Yilmaz Z. Reproductive outcome of septate uterus after hysteroscopic metroplasty. Arch Gynecol Obstet. 2003; 268(4): 289-92.
  • Marcus S, Al-Shawaf T, Brinsden P. The obstetric outcome of in vitro fertilization and embryo transfer in women with congenital uterine malformation. Am J Obstet Gynecol. 1996; 175 (1): 85-9.
  • Corson S. Operative hysteroscopy for infertility. Clin Obstet Gynecol. 1992; 35(2): 229-41.
  • Lee DM, Osathanondh R, Yeh J. Localization of Bcl-2 in the human fetal mullerian tract. Fertil Steril. 1998; 70 (1): 135–40.
  • Taylor E, Gomel V. The uterus and fertility. Fertil Steril. 2008;89(1) :1-16
There are 19 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Oya Soylu Karapınar This is me

İlay Gözükara This is me

Ali Ulvi Hakverdi This is me

Dilek Benk Şilfeler This is me

Hanifi Şahin This is me

Kenan Dolapçıoğlu This is me

Publication Date October 1, 2017
Published in Issue Year 2017 Volume: 14 Issue: 4

Cite

Vancouver Karapınar OS, Gözükara İ, Hakverdi AU, Şilfeler DB, Şahin H, Dolapçıoğlu K. Histeroskopik Septum Rezeksiyonu Sonrası Gebelik Sonuçları: Retrospektif Bir Çalışma. JGON. 2017;14(4):172-5.