Factors affecting pregnancy outcomes following the surgical removal of intrauterine adhesions and subsequent in vitro fertilization and embryo transfer

Abstract

This study aimed to investigate the clinical factors affecting pregnancy rates following the surgical removal of intrauterine adhesions (IUAs) and subsequent in vitro fertilization and embryo transfer (IVF-ET). We retrospectively evaluated case data from patients who had undergone hysteroscopic surgery to remove varying degrees of IUAs and who had subsequently received assisted reproductive treatments with IVF-ET (in all 140 cycles) at our hospital between January, 2011 and January, 2015. The patient data were divided into either the pregnancy or non-pregnancy groups based on the pregnancy outcomes, and a number of clinicopathological variables were compared these two groups, such as age, infertility (type and duration), the number of prior surgical treatments for and severity of IUAs, the baseline follicle-stimulating hormone/luteinizing hormone (FSH/LH) ratio and estradiol level, endometrial thickness on the day of human chorionic gonadotropin (hCG) administration, etc. We selected the variables with statistically significant differences to generate multivariate logistic regression and linear correlation analyses. We found that i) the mean endometrial thickness on the day of hCG administration was greater in the pregnancy group, and that the average gestational age was younger than that in the non-pregnancy group. The different age groups had significantly different pregnancy rates. The mean baseline FSH/LH ratio of the women in the pregnancy group was lower than that in the women in the non-pregnancy group. The number of embryos transferred in the pregnancy group was higher than that in the non-pregnancy group. However, the other variables exhibited similar values between these two groups. ii) Our multivariate logistic regression analyses revealed that age and endometrial thickness on the day of hCG administration had significant effects on the pregnancy outcome. The baseline FSH/LH ratio and the number of embryos transferred were similar between the groups. On the whole, age and endometrial thickness on the day of hCG administration are the most important predictors of pregnancy outcome in the patients undergoing IVF-ET following the surgical removal of IUAs. Importantly however, the identification of effective methods with which to improve the endometrial thickness and the ovarian response in patients with diminished ovarian reserves warrants further investigation in future research.

The link between intrauterine adhesions and impaired reproductive performance: a systematic review of the literature

“…The endometrium is substantially thinner in women with IUAs than in women without IUAs [ 51 , 55 ]. Among women with IUAs who underwent IVF, the endometrium was significantly thicker in women who conceived compared to women who did not [ 56 ].…”

Effectiveness of Hyaluronic Acid Gel and Intrauterine Devices in Prevention of Intrauterine Adhesions after Hysteroscopic Adhesiolysis in Infertile Women

“…An odds ratio below 1.00 indicates a protective effect of the treatment on recurrent adhesions. For the modelling of ongoing pregnancies, factors that were shown to be associated with the chance of pregnancy after hysteroscopic adhesiolysis were adjusted including EMT on day of embryo transfer, women's age, type of infertility, and pre-treatment AFS scores 3,6 .…”

“…Secondly, to date our study provides the largest sample size that investigates the combination of HA gel and IUD following hysteroscopic adhesiolysis. Moreover, to minimize the risk of selection bias in our retrospective study, we adjusted carefully for possible prognostic factors based on previous findings 3,6 . Thirdly, the post-treatment AFS scores in our study were assessed by consensus of the two surgeons who performed all the surgeries, which are difficult to achieve in multicenter studies.…”

“…Hysteroscopic adhesiolysis has become the standard treatment choice for IUAs management 4 . However, potential damage caused by this surgery may lead to an adhesion-prone condition of the endometrium, resulting in a high recurrent rate of IUAs from 3.1% -62.5% [5][6][7] . Subsequent adhesions may have detrimental effects on reproductive outcomes following hysteroscopic adhesiolysis.…”

Hormone Replacement Therapy With GnRH Agonist Pretreatment Improves Pregnancy Outcomes in Patients With Previous Intrauterine Adhesions: a Retrospective Study

“…Hysteroscopic surgery to remove IUAs followed by reproductive assistance technology has become the most effective treatment for good pregnancy outcomes [21]. It is well recognized that successful implantation relies on a properly developed blastocyst, a receptive endometrium, and synchrony of these factors.…”