PROSPECTIVE EVALUATION OF MEDIUM-TERM OUTCOMES OF PATIENTS UNDERGOING HYSTEROSCOPIC UTERINE SEPTUM RESECTION

Abstract

Objectives: To retrospectively and prospectively investigate the pregnancy outcomes after hysteroscopy (H/S) for septum resection in patients detected to have a uterine septum after presenting with a history of recurrent pregnancy loss (RPL), diagnosis of secondary infertility or primary infertility. Methods: This study included 62 patients with infertility or a history of RPL who underwent hysteroscopic uterine septum resection. Patients who had uterine anomalies other than a uterine septum, such as submucous myoma, endometrial polyp were excluded. Those discharged home with a live infant after a uterine septum operation were compared based on certain variables, those who succeeded and those who failed were categorized into group 1 and group 2, respectively. The two groups were compared with regard to the total number of deliveries before and after the operation, total number of abortions, preterm and term deliveries, delivery methods, control hysterosalpingographies (HSG) and whether they were reoperated. Results: In our study, 25 (40%) patients were primary infertile, 37 (60%) had secondary infertility or a history of RPL. Hysteroscopic septum resection was performed under general anesthesia in 61 and spinal anesthesia in 1 of these patients. Of the patients who were postoperatively discharged home with a live infant, 8 (26.7%) were determined to be primary infertile and 22 (73.3%) to have secondary infertility or a history of RPL. The rate of discharge with a live infant was determined as 76.9% among patients who conceived. The success rate of Group 1 patients, who were secondary infertile or had history of RPL, was significantly higher compared to patients who were primary infertile. Conclusions: Hysteroscopic uterine septum resection is a method with an easy application and high effectiveness. The success of the operation is particularly higher in patients who have a history of RPL or are secondary infertile compared with patients who are primary infertile.

Keywords

• Infertility
• recurrent pregnancy loss
• uterine septum
• hysteroscopy

References

1. 1. Schorge, O.J., Schaffer, I.J., Halvorson, M.L., Williams Gynecology, 2010. ISBN: 978-0-07-147257.
2. 2. Boyar, H.I., “Female infertility and endocrinological diseases”, Dicle Med J., 40, 700-703, 2013.
3. 3. Speroff, L., Fritz, M., Female infertility, Chapter 27, Clinical Gynecologic Endocrinology and Infertility, Eighth Edition, Lippincott Williams & Wilkins, 2010.
4. 4. Li, Y.H., Marren, A., “Recurrent pregnancy loss: A summary of international evidence-based guidelines and practice”, Australian Journal of General Practice, 47, 432-436, 2018.
5. 5. Royal College of Obstetricians and Gynaecologists. The Investigation and Treatment of Couples with Recurrent First Trimester and Second Trimester Miscarriage. London: RCOG, 2011.
6. 6. Practice Committee of the American Society for Reproductive Medicine. Evaluation and treatment of recurrent pregnancy loss: A committee opinion, Fertil Steril., 98, 1103–1111, 2012. Doi: 10.1016/j.fertnstert.2012.06.048.
7. 7. Tonguc, E.A. , Var, T., Batioglu, S., “Hysteroscopic metroplasty in patients with a uterine septum and otherwise unexplained infertility”, International Journal of Gynecology and Obstetrics, 113, 128–130, 2011.
8. 8. Valle, R.F., Ekpo, G.E., “Hysteroscopic metroplasty for the septate uterus: review and meta-analysis”, J Min Invas Gynecol., 20, 22–42, 2013.

9. 9. Paradisi, R., Barzanti, R., Natali, F., et al. “Metroplasty in a large population of women with septate uterus”, J Minimal Invas Gyenecol., 18, 449–54, 2011.
10. 10. Agostini, A., De Guibert, F., Salari, K., et al, “Adverse obstetric outcomes at term after hysteroscopic metroplasty”, J Minimal Invas Gynecol., 16, 454–7, 2009.
11. 11. Sendag, F., Mermer, T., Yucebilgin, S., et al., “Reproductive Outcomes After Hysteroscopic Metroplasty for Uterine Septum”, Clin Exp Obstet Gynecol., 37, 287-289, 2010.
12. 12. Dalal, R.J., Pai, H.D., Palshetkar, N.P., et al., “Hysteroscopic Metroplasty in Women With Primary Infertility and Septate Uterus: Reproductive Performance After Surgery”, J Reprod Med., 57, 13-16, 2012.
13. 13. Gundabattula, S.R., Joseph, E., Marakani, L.R., et al., “Reproductive outcomes after resection of intrauterine septum”, Journal of Obstetrics and Gynaecology, 34, 235–237, 2014.
14. 14. Yu, X., Yuhan, L., Dongmei, S., et al, “The Incidence of Post-Operative Adhesion Following Transection of Uterine Septum: A Cohort Study Comparing Three Different Adjuvant Therapies”, Eur J Obstet Gynecol Reprod Biol., 201, 61-64, 2016.
15. 15. Practice Committee of the American Society for Reproductive Medicine.Uterine septum: a guideline, Fertility and Sterility, 106, 530-540, 2016.