Reproductive Outcome after Hysteroscopic Metroplasty in Patients with Infertility and Recurrent Pregnancy Loss
DOI:
https://doi.org/10.3889/oamjms.2014.018Keywords:
hysteroscopy, reproduction, infertility, pregnancy, hysteroscopic metroplasty.Abstract
Introduction: Reproductive outcome can be negatively affected in patients with congenital uterine anomalies (CUA), increasing the number of unsuccessful pregnancies and obstetric complications. Compared with the population with normally formed uterus, patients with CUA have higher abortion rate, higher fetal loss rate and decreased live birth rate. Hysteroscopic metroplasty (HM) is a standard, safe and minimally invasive method for the treatment of correctible types of congenital uterine anomalies.
Aim: The aim of the study was to analyze the reproductive outcome in group of patients with infertility and recurrent pregnancy loss and present CUA, before and after hysteroscopic metroplasty.
Material and Methods: We analyzed 67 patients to whom 78 interventions hysteroscopic metroplasty were performed at the University Clinic of Obstetrics and Gynecology in Skopje during a two year period, between 01.01.2010 and 31.12.2011. Their reproductive outcome was monitored during a two-year period and the same group served as a control group, taking into account their previous reproductive history. Statistical analysis was performed using Chi-square test and p < 0.05 was considered to be statistically significant.
Results: Most common CUA were types 5b and 6 represented by 88 %. In a follow up period of two years, 33 of the patients become pregnant. There was a statistically significant decrease of abortion rate from 92% to 21.2%, as well as an increase in the term delivery rate from 0% to 69.7%.
Conclusion: Treatment with hysteroscopic metroplasty is significantly improving the reproductive outcome in patients with CUA and previous fetal loss.Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Chan YY, Jayaprakasan K, Zamora J, et al. The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systematic review. Hum Reprod Update. 2011; 17(6): 761–771. DOI: https://doi.org/10.1093/humupd/dmr028
Lin P, Bhatnagar K, Nettleton S, Nakajima S. Female genital anomalies affecting reproduction. Fertil Steril. 2002;78 (5):899-915. DOI: https://doi.org/10.1016/S0015-0282(02)03368-X
Propst AM, Hill JA 3rd. Anatomic factors associated with recurrent pregnancy loss. Semin Reprod Med. 2000;18(4):341-50. DOI: https://doi.org/10.1055/s-2000-13723
Fedele L, Bianchi S. Hysteroscopic metroplasty for septate uterus. Obstet Gynecol Clin North Am. 1995; 22:473-489. DOI: https://doi.org/10.1016/S0889-8545(21)00198-4
Raga F, Bauset C, Remohi J, Bonilla-Musoles F, Simon C, Pellicer A. Reproductive impact of congenital Mullerian anomalies. Hum Reprod. 1997;12 (10):2277-2281. DOI: https://doi.org/10.1093/humrep/12.10.2277
Speroff L, Glass RH, Kase NG. Development of the mullerian system. In: Mitchell C, eds. Clinical gynecologic endocrinology and infertility. 6th ed Baltimore, Md: Williams & Wilkins, Lippincott, 1998: 124.
Harger JH, Archer DF, Marchese SG, et al. Etiology of recurrent pregnancy losses and outcome of subsequent pregnancies. Obstet Gynecol. 1983;62:574-581.
The American Fertility Society classifications of adnexal adhesions, distal tubal obstruction, tubal occlusion secondary to tubal ligation, tubal pregnancies, mullerian anomalies and intrauterine adhesions. Fertil Steril. 1988;49:944-55. DOI: https://doi.org/10.1016/S0015-0282(16)59942-7
Saravelos SH, Cocksedge KA, Li TC. Prevalence and diagnosis of congenital uterine anomalies in women with reproductive failure: a critical appraisal. Hum Reprod Update. 2008;14(5):415-29. DOI: https://doi.org/10.1093/humupd/dmn018
Shokeir TA, Shalan HM, El-Shafei MM. Combined diagnostic approach of laparoscopy and hysteroscopy in the evaluation of female infertility: results of 612 patients. J Obstet Gynaecol Res. 2004;30(1):9-14. DOI: https://doi.org/10.1111/j.1341-8076.2004.00147.x
Hourvitz A, Ledee N, Gervaise A, Fernandez H, Frydman R, Olivennes F. Should diagnostic hysteroscopy be a routine procedure during diagnostic laparoscopy in women with normal hysterosalpingography? Reprod Biomed Online. 2002;4(3):256-60. DOI: https://doi.org/10.1016/S1472-6483(10)61815-9
Daly DC, Maier D, Soto-Albors C. Hysteroscopic metroplasty: six years experience. Obstet Gynecol. 1989;73:201-5.
Grimbizis G, Camus M, Tarlatzis BC, Bontis JN, Devroey P. Clinical implications of uterine malformations and hysteroscopic treatment results. Hum Reprod Update. 2001;7(2):161-74. DOI: https://doi.org/10.1093/humupd/7.2.161
Grimbizis G, Camus M, Clasen K, Tournaye H, De Munck L, Devroey P. Hysteroscopic septum resection in patients with recurrent abortions or infertility. Hum Reprod. 1998;13: 1188-1193. DOI: https://doi.org/10.1093/humrep/13.5.1188
Jacobsen LJ, De Cherney A. Results of conventional and hysteroscopic surgery. Hum Reprod. 1997;12: 1376-1381. DOI: https://doi.org/10.1093/oxfordjournals.humrep.a019589
Pellicer A. Shall we operate Mullerian defects? An introduction to the debate. Hum Reprod. 1997;12:1371-1372. DOI: https://doi.org/10.1093/humrep/12.7.1371
Jones WH. Mullerian anomalies. Hum Reprod. 1998;13:789-791. DOI: https://doi.org/10.1093/humrep/13.4.789
Homer HA, Li T, Cooke ID. The septate uterus: a review of management and reproductive outcome. Fertil Steril. 2000;73:1-14. DOI: https://doi.org/10.1016/S0015-0282(99)00480-X
Wilcox AJ, Weinberg CR, O'Connor JF, et al: Incidence of early loss of pregnancy. N Engl J Med. 1988; 319:189. DOI: https://doi.org/10.1056/NEJM198807283190401
Mills JL, Simpson JL, Driscoll SG, et al: Incidence of spontaneous abortion among normal women and insulin-dependent diabetic women whose pregnancies were identified within 21 days of conception. N Engl J Med. 1988; 319:1617. DOI: https://doi.org/10.1056/NEJM198812223192501
Simpson JL, Mills JL, Holmes LB, et al: Low fetal loss rates after ultrasound-proved viability in early pregnancy. JAMA. 1987; 258:2555. DOI: https://doi.org/10.1001/jama.1987.03400180089033
Wilson RD, Kendrick V, Wittmann BK, et al: Risk of spontaneous abortion in ultrasonically normal pregnancies. Lancet. 1984; 2:920. DOI: https://doi.org/10.1016/S0140-6736(84)90670-6
Gilmore DH, McNay MB: Spontaneous fetal loss rate in early pregnancy. Lancet. 1985; 1:107. DOI: https://doi.org/10.1016/S0140-6736(85)91997-X
Hoesli IM, Walter-Gobel I, Tercanli S, et al: Spontaneous fetal loss rates in a non-selected population. Am J Med Genet. 2001;100:106. DOI: https://doi.org/10.1002/1096-8628(20010422)100:2<106::AID-AJMG1238>3.0.CO;2-L
Ford HB, Schust DJ. Reccurent pregnancy loss: etiology, diagnosis and therapy. Rev Obstet Gynecol. 2009;2(2):76-83.
Regan L. A prospective study on spontaneous abortion. In Beard RW, Sharp F (eds): Early Pregnancy Loss: Mechanisms and Treatment, London: Springer-Verlag, 1988:22. DOI: https://doi.org/10.1007/978-1-4471-1658-5_4
Knudsen UB, Hansen V, Juul S, Secher NJ. Prognosis of a new pregnancy following previous spontaneus abortions. Eur J Obstet Gynecol Reprod Biol. 1991;39:31-36. DOI: https://doi.org/10.1016/0028-2243(91)90138-B
Acien P. Reproductive performance of women with uterine malformations. Hum Reprod. 1993;8:122-126. DOI: https://doi.org/10.1093/oxfordjournals.humrep.a137860
Buttram CV. Mullerian anomalies and their management. Fertil Steril. 1983;40:159-163. DOI: https://doi.org/10.1016/S0015-0282(16)47230-4
Heinonen KP, Saarikoski S, Postynen P. Reproductive performance of women with uterine anomalies. Acta Obstet Gynecol Scand. 1982;61:157-162. DOI: https://doi.org/10.3109/00016348209156548
Saygili E, Yildiz S, Erman-AkarM, et al. Reproductive outcome of septate uterus after hysteroscopic metroplasty. Arch Gynecolog Obstet. 2003;268:289-292. DOI: https://doi.org/10.1007/s00404-002-0378-4
Fedele L, Bianchi S, Frontino G. Septums and synechiae:approaches to surgical correction. Clin Obstet Gynecol. 2006;49:767-788. DOI: https://doi.org/10.1097/01.grf.0000211948.36465.a6
Sendag F, Mermer T, Yucebilgin S, et al. Reproductive outcomes after hysteroscopic metroplasty for uterine septum. Clin Exp Obstet Gynecol. 2010;37(4):287-9.
Nouri K, Ott J, Huber JC, Fischer EM, et al. Reproductive outcome after hysteroscopic septoplasty in patients with septate uterus – a retrospective cohort study and systematic review of the literature. Reprod Biol Endocrinol. 2010;8:52. DOI: https://doi.org/10.1186/1477-7827-8-52
Roy KK, Singla S, Baruah J, et al. Reproductive outcome following hysteroscopic septal resection in patients with infertility and recurrent abortions. Arch Gynecol Obstet. 2011;283:273-279. DOI: https://doi.org/10.1007/s00404-009-1336-1
Downloads
Published
How to Cite
Issue
Section
License
http://creativecommons.org/licenses/by-nc/4.0