Hysteroscopic septum resection in patients with recurrent abortions or infertility

Abstract

Fifty-seven patients who underwent hysteroscopic septum resection between January 1991 and December 1996 were studied; nine patients presented with recurrent abortions, 46 with infertility (26 primary and 20 secondary), one with dysmenorrhoea and one with an asymptomatic complete septum. Their reproductive history included 78 pregnancies: 69 (88.4%) abortions, two (2.6%) ectopics, two (2.6%) preterm deliveries and five (6.4%) term deliveries. In patients with infertility, the incidence of unexplained infertility was 19.6% and the incidence of endometriosis was 26.1%. After hysteroscopic septum resection, 42 patients were interested in pregnancy. All patients with recurrent abortions conceived spontaneously. Twenty-one (63.6%) infertile patients achieved a pregnancy, 13 (61.9%) of them after treatment with various assisted reproduction techniques. The reproductive outcome after septum resection yielded 44 pregnancies, including three sets of twins and one set of triplets reduced to twins: 11 (25%) abortions, one (2.3%) ectopic pregnancy, two (4.5%) preterm deliveries (both twins), 28 (63.7%) term deliveries and two (4.5%) as-yet ongoing pregnancies. It seems that the hysteroscopic treatment of uterine septum has a beneficial effect on pregnancy outcome. A septate uterus does not seem to be an infertility factor. The achievement of pregnancy is normal in patients with recurrent abortions, while the chances of conception in patients with infertility seem to be similar to those for the general infertile population.

Hysteroscopic septum resection in patients with recurrent abortions and infertility

“…Hysteroscopic metroplasty in this group is applied mainly as a prophylactic procedure to prevent spontaneous abortions and complications during labour [3].…”

Reproductive Outcome After Hysteroscopic Septum Excision In Infertile Women

“…Çalışmamızda sekonder infertil grupta septum eksizyonu öncesi düşük, preterm doğum ve canlı doğum oranları, sırasıyla, %64 (20/31), %35 (11/31) ve %3 (1/31) iken septum eksizyonu sonrasında sırasıyla, %22 (7/31), %9 (3/31) ve %45 (14/31) olarak bulunmuştur. Histeroskopik septum eksizyonu sonrası fertilite oranlarını bildiren pek çok çalışmada işlem sonrası yardımcı üreme teknikleri kullanılmıştır (13,14). Çalışmamızdaki gebelik oranları değerlendirilirken bu çalışmanın ana sonlanım öl-çütlerinin sadece spontan klinik gebelik ve sonucunda oluşan canlı doğum oranları olduğu hesaba katılmalı-dır.…”

Influence of Hysteroscopic Metroplasty on Reproductive Outcome in Patients with Infertility and Recurrent Pregnancy Loss

“…A good surgical correction by metroplasty provides an anatomically normal uterine cavity, but does not unfailingly result in a favourable reproductive outcome since uterine vascularization is probably involved in the uterine function. The theory which is nowadays widely accepted states that septum consists of fibroelastic tissue with inadequate vascularization and a changed ratio between blood vessels of the endometrium and myometrium, presenting negative effects on decidualisation and placentation [14].…”

“…Hysteroscopic metroplasty has all the benefits of a good operative treatment: decreesed intra-and post-operative morbidity, shorttime intervention, fewer analgesic requirements, a shorter hospital stay, a shorter interval to conception and the possibility of a vaginal delivery. Most research findings have revealed that the majority of uterine malformations (> 55%) are presented with septate and arcuate uterus (type s5 and 6 according to AFS classification), which can be effectively treated by means of operative hysteroscopy [14,15]. Partial reconstruction of the uterine cavity by hysteroscopy is possible in some cases of partial bicornuate uterus (type 4b).…”