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

Abstract

We aim to establish an objective and accurate prediction model by evaluating the uterine cavity and correlate these key factors with the live birth rate after hysteroscopic adhesiolysis (HA). A total of 457 intrauterine adhesions (IUA) patients were retrospectively enrolled in this study. The participants underwent HA and second-look hysteroscopy at the Third Xiangya Hospital of Central South University. Pregnancy outcomes, including spontaneous live births and no live births (miscarriages and infertility), were followed. Clinical parameters, containing the number of visible uterine horns and tubal ostia, the length of the uterine cavity, among others, were measured and analyzed to determine the dominant variables in an attempt to establish the live birth rate, prediction models. Women in the no live birth group were older than that in the live birth group (P = 0.0002, OR = 0.895, 95% CI: 0.844–0.949) and were more likely to be 2 gravidity (P = 0.0136, OR = 2.558, 95% CI: 1.213–5.394). Uterine cavity length in pre-HA hysteroscopy was longer in the live birth group (P = 0.0018, OR = 1.735, 95% CI: 1.227–2.453), and adhesion scores in pre-HA hysteroscopy were more frequently above 6 (P = 0.0252, OR = 0.286, 95% CI: 0.096–0.856) in the no live birth group. During the second-look, hysteroscopy, visible bilateral fallopian tube ostia were more frequently observed in the live birth group (P = 0.0339, OR = 11.76, 95% CI: 1.207–114.611), and adhesion scores were 4–6 (P < 0.0001, OR = 0.032, 95% CI: 0.007–0.146) and above 6 (P < 0.0001, OR = 0.012, 95% CI: 0.002–0.073) in the no live birth group. The areas under the curves (AUCs) of the pre-HA and second-look hysteroscopy prediction models were 0.7552 and 0.8484, respectively. We established an objective and accurate method for evaluating the uterine cavity by hysteroscopy, and second-look hysteroscopy is more valuable than the fist hysteroscopy in predicting the live birth rate following HA. Visible bilateral fallopian tube ostia or adhesion scores were <4 in the second-look hysteroscopy might predict live birth after surgery.

Developing and validating a prediction model of live birth in patients with moderate-to-severe intrauterine adhesions: a new approach with endometrial morphology measurement by 3D transvaginal ultrasound

“…We previously found that an AFS score <4 was a favorable factor for live birth ( 10 ). However, this study did not find any correlation.…”

“…Assisted reproductive technology (ART) might be a better choice for patients with recurrent IUA ( 9 ). Visible bilateral fallopian tube ostia or American Fertility Society (AFS) scores of <4 in the hysteroscopic reexamination might predict better live birth ( 10 ). Thin endometrium and the upper and middle segments of endometrial absence have been found to be risk factors for live birth ( 11 ).…”

Artificial intelligence-driven prognostic system for conception prediction and management in intrauterine adhesions following hysteroscopic adhesiolysis: a diagnostic study using hysteroscopic images

“…In our previous study, we used machine learning algorithms such as decision trees and XGboost to predict the pregnancy outcomes of patients based on clinical data ( Li et al, 2022 ; Zhu et al, 2022 ; Li et al, 2023a ). Zhao et al (2022) also developed a logistic prediction model using clinical parameters such as age, preoperative AFS score, preoperative uterine cavity length, and visibility of bilateral fallopian tube ostia during hysteroscopy review. These methods achieved excellent predictive performance, with AUCs of 0.8–0.9.…”

“…Hysteroscopy can comprehensively analyze postoperative uterine cavity morphology and endometrial receptivity ( Smit et al, 2016 ; Craciunas et al, 2019 ), thus becoming the first-line assessment method in clinical practice. Moreover, some studies have shown that postoperative hysteroscopic assessment is more powerful in predicting the fertility outcomes of patients ( Xu et al, 2018 ; Zhao et al, 2022 ). However, without objective indicators, it has difficulties effectively integrating it with ART management for postoperative patients.…”

Platelet-Rich Plasma Improves Pregnancy Outcomes in Moderate to Severe Intrauterine Adhesion: A Retrospective Cohort Study

“…Intrauterine adhesion (IUA) is the secondary endometrial injury disease [ 1 ] that leads to amenorrhea, infertility, and poor pregnancy outcomes in assisted reproductive technology (ART) in women of childbearing age. The main etiology of IUA is pregnancy-related curettage, such as post-abortion, miscarriage, and postpartum curettage [ 2 , 3 , 4 ]. These procedures may result in the endometrial basal layer being too impaired to completely repair or restore the endometrium.…”