Logistic regression analyses of factors affecting fertility of intrauterine adhesions patients

Abstract

Background: Intrauterine adhesion (IUA) prevalence is difficult to measure, but appears to have increased over the last few decades. The reproductive outcomes following hysteroscopic adhesiolysis (HA) for moderate-severe IUAs were unsatisfactory, and few studies have analyzed the clinical characteristics pre-, intra-and post-HA to determine the main risk factors for infertility in patients with IUAs. Methods: This retrospective observational study included 406 patients, desiring fertility, who had undergone HA between January 1st, 2016 to May 31st, 2017, and had moderate-to-severe IUA [5-12 on the American Fertility Society (AFS) classification scale]. Logistic regression was performed to analyze the data of the clinical characteristics associated with IUA.Results: A total of 406 IUA patients were initially collected. Twenty-six [26] were lost during followup or excluded by other criteria; 380 were included in the study with a follow-up period ranging from 2 to 3 years. There were 215 patients (56.6%) that became pregnant, of whom 18 spontaneously miscarried, 5 birthed prematurely (31-36 gestational weeks), 182 delivered at term, and 10 were pregnant at the end of the study. A bivariate and binary logistic regression analysis showed that an age of >30 years, cohesive IUA, lack of increased menstrual volume, and more than 2 times undergoing HA procedure were the risk factors for infertility in IUA patients (P<0.05).Conclusions: Age, severity of IUA, increased menstrual volume, and HA procedures were the dominant factors affecting reproductive outcomes and may be regarded as potential predictors for evaluating IUA prognosis.

Pregnancy Patterns Impact Live Birth Rate for Patients With Intrauterine Adhesions After Hysteroscopic Adhesiolysis: A Retrospective Cohort Study

“…The hysteroscope went through the cervical canal to the intrauterine cavity, and the adhesions were separated gradually from the central part to the lateral wall. As locating the bilateral fallopian tube ostia is crucial to clarifying the anatomy of the uterine cavity ( Zhao et al, 2020a ), a blunt spreading dissection technique ( Zhang et al, 2015 ) combined with transabdominal ultrasound monitoring was used to increase the visibility of the surgical site. When the intrauterine anatomy was clarified, the IUAs were treated with the cold scissors plowing technique ( Zhao et al, 2020b ) to reconstruct the normal uterine cavity with clearly visible bilateral fallopian tube ostia.…”

Decision Tree Model Predicts Live Birth after Surgery for Moderate-to-Severe Intrauterine Adhesions

“…Previous studies have shown that AFS score is closely related to treatment outcome [30][31][32]. In the decision tree, the AFS score before the operation and in the second look is not the main factor to affect live birth.…”

Uterine Cavity Parameters Evaluated by Hysteroscopy can Predict the Live Birth Rate For Intrauterine Adhesion Patients

“…The extent of IUA has been considered as an important factor relating to the reproductive outcome, and it has already been included in most classification systems. HA appears to be indicated when the extent of the adhesion is moderate to severe or when access to tubal ostia is blocked (5). The smaller proportion of the affected area was associated with the better the prognosis of HA.…”

“…With the widespread use of hysteroscopy in IUA patients, the reported incidence and diagnosis of IUA have increased significantly, with an average of 2.2 and 36.8%, respectively (1,2), among women of childbearing age. The main risk factors related to IUA are pregnancyrelated, and more than 90% of IUA are closely associated with curettage (3)(4)(5). The main clinical symptoms of IUA include menstrual abnormalities, recurrent miscarriages, and secondary infertility/subfertility.…”