Reproductive Outcomes Following Hysteroscopic Repair of Uterine Lesions

Document Type : Original Article (s)

Authors

1 Associate Professor, Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Resident, Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Professor, Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Small intrauterine lesions such as septum, adhesion, polyp, and Submucuos myomas may have a great role in causing implantation failure, poor reproductive performance and abnormal uterine bleeding (AUB). We studied the effectiveness of therapeutic intervention through operative hysteroscopy in improvement of pregnancy outcome and in women with pregnancy and fertility problems.Methods: This prospective cohort study was performed between 2003-2009 on 65 patients’ refered to Alzahra and Sina hospital, Iran, with primary or secondary infertility or recurrent abortion and structural uterine lesions reported in sonography or hysterosalpangography. After hysteroscopic metroplasty, myomectomy, adhesiolysis and polypectomy under laparascopic guide, we evaluated reproductive outcome in these patient during one year after surgry.Findings: pregnancy rate after metroplasty was 58%. Among patients with recurrent abortion 6 patients (75%) complete their pregnancy successfully. Abnormal uterine bleeding was improved in 62% of patients. Reproductive outcome was poor after Myomectomy and Adhesiolysis.Conclusion: Our study shows improvement in conceptional outcome and abnormal utrein bleeding after hysteroscopic surgery of these anomalies.Keywords: Hysteroscopy, Metroplasty, Myomectomy, Adhesiolysis, Infertility. 

Keywords

References

  1. Valle RF. Development of hysteroscopy: from a dream to a reality, and its linkage to the present and future. J Minim Invasive Gynecol 2007; 14(4): 407-18.
  2. Cunningham FG, Williams JW. Reproductive tract anomaly. In: Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong KY, Editors. William's Obstetrics. 23rd ed. New York: Mc Graw Hill; 2010. p. 890-911.
  3. Berek JS, Novak E. Berek and Novak's gynecology. 14th ed. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 688-734.
  4. Rock JA, Jones HW. Te Linde's operative gynecology. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2008. p. 319-35.
  5. Homer HA, Li TC, Cooke ID. The septate uterus: a review of management and reproductive outcome. Fertility and Sterility 2000; 73(1): 1-14.
  6. Cicinelli E, Matteo M, Causio F, Schonauer LM, Pinto V, Galantino P. Tolerability of the mini-pan-endoscopic approach (transvaginal hydro-laparoscopy and minihysteroscopy) versus hysterosalpingography in an outpatient infertility investigation. Fertil Steril 2001; 76(5): 1048-51.
  7. Ventolini G, Zhang M, Gruber J. Hysteroscopy in the evaluation of patients with recurrent pregnancy loss: a cohort study in a primary care population. Surg Endosc 2004; 18(12): 1782-4.
  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.
  9. Valli E, Vaquero E, Lazzarin N, Caserta D, Marconi D, Zupi E. Hysteroscopic metroplasty improves gestational outcome in women with recurrent spontaneous abortion. J Am Assoc Gynecol Laparosc 2004; 11(2): 240-4.
  10. Fedele L, Bianchi S. Hysteroscopic metroplasty for septate uterus. Obstet Gynecol Clin North Am 1995; 22(3): 473-89.
  11. Porcu G, Cravello L, D'Ercole C, Cohen D, Roger V, De Montgolfier R, et al. Hysteroscopic metroplasty for septate uterus and repetitive abortions: reproductive outcome. Eur J Obstet Gynecol Reprod Biol 2000; 88(1): 81-4.
  12. Saygili-Yilmaz ES, Erman-Akar M, Yilmaz Z. A retrospective study on the reproductive outcome of the septate uterus corrected by hysteroscopic metroplasty. Int J Gynaecol Obstet 2002; 78(1): 59-60.
  13. Rama Raju GA, Shashi Kumari G, Krishna KM, Prakash GJ, Madan K. Assessment of uterine cavity by hysteroscopy in assisted reproduction programme and its influence on pregnancy outcome. Arch Gynecol Obstet 2006; 274(3): 160-4.
  14. Yu D, Li TC, Xia E, Huang X, Liu Y, Peng X. Factors affecting reproductive outcome of hysteroscopic adhesiolysis for Asherman's syndrome. Fertil Steril 2008; 89(3): 715-22.
  15. Camanni M, Bonino L, Delpiano EM, Ferrero B, Migliaretti G, Deltetto F. Hysteroscopic management of large symptomatic submucous uterine myomas. J Minim Invasive Gynecol 2010; 17(1): 59-65.
  16. Somigliana E, Vercellini P, Daguati R, Pasin R, De Giorgi O, Crosignani PG. Fibroids and female reproduction: a critical analysis of the evidence. Hum Reprod Update 2007; 13(5): 465-76.
  17. Lasmar RB, Dias R, Barrozo PR, Oliveira MA, Coutinho Eda S, Da Rosa DB. Prevalence of hysteroscopic findings and histologic diagnoses in patients with abnormal uterine bleeding. Fertil Steril 2007; 89(6): 1803-7.
  18. Lasma RB, Bassil R, Dias R, De Oliveria P. Submucuos fibroids: pre-surgical classification to evaluat the viability of hysteroscopic surgical managment. Rev Bras Ginecol Obstet 2004; 26(4): 305-9.
  19. Salma U, Xu D, Sheikh SA. Diagnosis and treatment of intrauterin adhession. World Journal of Medical Sciences 2011; 6(2): 46-53.
  20. Chi-feng Y, Chyi-long L, Chin-jung W, Yung-Kuei S, Arici A. Succesful pregnancies in women with diffuse uterine liomyomatosis after hysteroscopic management. Fertil Steril 2007; 88(6): 1667-73.
  21. Shokeir T, El-Shafei M, Yousef H, Allam AF, Sadek E. Submucous myomas and their implications in the pregnancy rates of patients with otherwise unexplained primary infertility undergoing hysteroscopic myomectomy: a randomized matched control study. Fertil Steril 2010; 94(2): 724-9.
Journal of Isfahan Medical School
Volume 29, Issue 146 - Serial Number 146
May and June 2011
Pages 875-881

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History

  • Receive Date: 11 June 2011
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

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