IVF outcomes after hysteroscopic metroplasty in patients with T- shaped uterus

Uyar, Esra; Usal, Deniz; Selam, Belgin; Cıncık, Mehmet; Bağış, Tayfun

doi:10.1186/s40738-019-0063-y

Cited by 16 publications

(36 citation statements)

References 28 publications

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“…Since there are concerns that T‐shaped uterus may be associated with poor reproductive outcome, some authors are proposing hysteroscopic metroplasty as potential treatment for T‐shaped uterus in patients with a history of impaired reproductive outcome. Recently, a cascade of surgical reports on metroplasty of T‐shaped uterus has been published 2,123,125–130,135–137,139 (Table S2). All the studies mentioned improvement of reproductive outcome in patients with T‐shaped uterus after metroplasty: eight studies reported an increase in pregnancy rate 123,125–128,135,137,139 , seven studies reported increase in live‐birth rate 2,123,125,127,129,130,135 , five studies reported reduction in miscarriage rate 2,127–129,137 , four studies reported increased term‐delivery rate 128,135–137 and one study reported reduction in ectopic‐pregnancy rate 128 (Table 3).…”

Section: Resultsmentioning

confidence: 99%

“…Recently, a cascade of surgical reports on metroplasty of T‐shaped uterus has been published 2,123,125–130,135–137,139 (Table S2). All the studies mentioned improvement of reproductive outcome in patients with T‐shaped uterus after metroplasty: eight studies reported an increase in pregnancy rate 123,125–128,135,137,139 , seven studies reported increase in live‐birth rate 2,123,125,127,129,130,135 , five studies reported reduction in miscarriage rate 2,127–129,137 , four studies reported increased term‐delivery rate 128,135–137 and one study reported reduction in ectopic‐pregnancy rate 128 (Table 3). After metroplasty, pregnancy rate varied between 49.6% and 88% 123,126,128,135,137,139 , clinical pregnancy rate was between 43.2% and 83.3% 123,125,127 , miscarriage rate between 7% and 49.6% 123,125,127,128,137 and live‐birth rate varied between 35.1% and 76% 2,123,125,127,129,130,135 .…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies included patients with T‐shaped uterus and a history of previous miscarriage 123–127,136,139 , with the prevalence varying between 22% and 50%. One study included only patients with a history of miscarriage 136 .…”

Section: Resultsmentioning

confidence: 99%

“…One study included only patients with a history of miscarriage 136 . Only two studies 123,124 had a control group of patients with a normal uterus for comparison, one of which showed that the history of miscarriage was five times more common in patients with a T‐shaped uterus compared to those with a normal uterus 124 and the other that it was similar between the two groups 123 .…”

Section: Resultsmentioning

confidence: 99%

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Definition, prevalence, clinical relevance and treatment of T‐shaped uterus: systematic review

Neto

Ludwin

Martins³

2021

Ultrasound in Obstet & Gyne

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Objectives To summarize in a systematic review the current evidence regarding definitions, diagnosis, prevalence, etiology, clinical relevance and impact of surgical treatment for T‐shaped uterus not related to diethylstilbestrol (DES) exposure, and to highlight areas on which future research should focus. Methods A search of PubMed, Scopus and EMBASE was performed on 9 April 2020 using the search terms ‘t‐shaped OR t‐shape OR infantile OR (lateral indentation) OR (diethylstilbestrol OR DES) AND (uterus OR uterine OR uteri) AND (anomaly OR anomalies OR malformation OR malformations)’. Additionally, the reference lists of the included studies were searched manually for other relevant publications. All studies presenting data on T‐shaped uterus not associated with DES exposure and including at least 10 women were considered eligible. Studies regarding DES‐related T‐shaped uterus were excluded because DES has not been used since 1971. There were no restrictions on language, date of publication or status of publication. Results Of 2504 records identified by the electronic search, 20 studies were included in the systematic review. The majority of studies were of poor quality. In 11 of 16 studies reporting on the diagnosis of T‐shaped uterus, the diagnostic method used was three‐dimensional ultrasound. There is no consensus on the definition of T‐shaped uterus, but the most cited criteria (4/16 studies) were of the European Society of Human Reproduction and Embryology and the European Society for Gynaecological Endoscopy (ESHRE/ESGE; 2013). The prevalence of T‐shaped uterus varied from 0.2% to 10% in the four included studies reporting such data. With respect to etiology (except for DES), T‐shaped uterus was considered a primary condition in three studies and secondary to adhesions in five and adenomyosis in one. T‐shaped uterus was related to worse reproductive outcome based on subfertility (nine studies), miscarriage (seven studies), preterm delivery (two studies), ectopic pregnancy (one study) and repeat implantation failure (seven studies). Of the 12 studies that reported on the effects of surgical treatment of T‐shaped uterus by hysteroscopic metroplasty, some mentioned an improvement in pregnancy rate (rates ranging from 49.6% to 88%; eight studies), live‐birth rate (rates ranging from 35.1% to 76%; seven studies) and term‐delivery rate (four studies) and a reduction in miscarriage (rates ranging from 7% to 49.6%; five studies) and ectopic pregnancy (one study). However, the evidence is of very low quality with serious/critical risk of bias toward overestimating the intervention effect. Some authors reported no complications related to the procedure, while others mentioned persistence of the dysmorphism (rates ranging from 1.4% to 11%; three studies), bleeding (1.3%; one study), infection (2.6%; one study) and adhesions (11.1% and 16.8%; two studies). Conclusions The prevalence, etiology and clinical relevance, with respect to reproductive outcome, of T‐shaped uterus remain unclear and there is no conse...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Definition, prevalence, clinical relevance and treatment of T‐shaped uterus: systematic review

Neto

Ludwin

Martins³

2021

Ultrasound in Obstet & Gyne

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“…antecedentes de resultados reprodutivos ruins: infertilidade(13,26,27), abortamento(20,21,(26)(27)(28), aborto de repetição(20,21,(26)(27)(28), parto pré-termo(29,30), falha de implantação(20,21,27- 29,31) e gravidez ectópica(29). Não há dados referentes a desfechos reprodutivos do útero em "T" na população geral; não se sabe, portanto, quantas mulheres conseguem alcançar gravidez bem-sucedida apesar de ter útero em "T", pois elas não chegam aos serviços de medicina reprodutiva.…”

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Útero em forma de \"T\": definição, critérios diagnósticos, prevalência, implicações clínicas e tratamento

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Alencar²

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Objetivos: Avaliar se existe medida confiável e precisa para distinguir o útero em "T" do útero normal/arqueado e sumarizar a evidência disponível em relação a definições, diagnóstico, prevalência, implicações clínicas e impacto do tratamento cirúrgico para o útero em "T" não relacionado ao dietilestilbestrol (DES). Métodos: Estudo prospectivo observacional para avaliar confiabilidade/concordância com elementos de acurácia diagnóstica em uma amostra de 100 blocos de ultrassonografia tridimensional (US-3D) de úteros apresentando endentação lateral da cavidade, tendo como padrão de referência a impressão subjetiva de 15 especialistas. As medidas foram realizadas de forma independente por dois especialistas para avaliar o coeficiente de correlação de concordância (CCC), a precisão diagnóstica pela a área sob a curva (AUROC), e o melhor ponto de corte pelo índice de Youden. Para resumir a evidência disponível em relação ao útero em "T", realizou-se uma revisão sistematizada buscando estudos no PubMed, Scopus e EMBASE em mar-2020. Estudos sobre útero em "T" não relacionado ao DES incluindo 10 ou mais mulheres foram elegíveis. Resultados: No estudo de reprodutibilidade e precisão diagnóstica, foram incluídos 100 participantes (pelo padrão de referência, 20 foram julgados em "T" e 80 normais/arqueados). A concordância entre especialistas foi de 82% (kappa=0,43). As três medidas identificadas com precisão diagnóstica e seus respectivos pontos de corte foram: ângulo de endentação lateral (AUROC=0,95) ≤130°, profundidade da endentação lateral (AUROC=0,92) ≥7 mm, e ângulo "T" (AUROC=0,87) ≤40°. O ângulo "T" foi a medida com melhor reprodutibilidade interobservador (CCC=0,87). Sugere-se considerar útero em "T" na presença dos três critérios (valor preditivo positivo=0.93). Na revisão sistematizada, 2504 referências foram identificadas, e 20 estudos foram incluídos. Há apenas estudos de baixa qualidade. O diagnóstico do útero em "T" foi, comumente, realizado por US-3D, e o critério mais citado foi o da European Society of Human Reproduction and Embryology and the European Society for Gynecological Endoscopy (ESHRE-ESGE). A prevalência do útero em "T" variou de 0,2-10%. Sua etiologia foi relacionada à adenomiose, sinéquias e como sendo uma condição primária. Resultados reprodutivos ruins foram relacionados ao útero em "T" (infertilidade, aborto, parto pré-termo, gravidez ectópica e falha de implantação). Os benefícios do tratamento cirúrgico por metroplastia histeroscópica foram analisados em 12 estudos, que mencionaram melhora nas taxas de gravidez, nascidos vivos, parto a termo, redução de abortamento e gravidez ectópica (evidência de muito baixa qualidade). Conclusões: A concordância entre especialistas para o diagnóstico do útero em "T" foi moderada. Três medidas tiveram boa acurácia diagnóstica e confiabilidade razoável a moderada. Até o momento, prevalência, importância clínica e impacto da cirurgia nos resultados reprodutivos de mulheres com útero em "T" são desconhecidos. Alguns estudos relatam melhora nos resultados r...

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