Hysteroscopic metroplasty for septate uterus and repetitive abortions: reproductive outcome

OBJECTIVES: The aim of this study is to assess fertility outcome and obstetrical prognosis of 63 patients after hysteroscopic section of uterine septa. MATERIALS AND METHODS: This is a retrospective study about 63 patients consulting for septate uterus and repeated pregnancy loss or abnormal fetal presentation between January 1988 and December 1996 in La Conception hospital in Marseille. Septal lysis was performed with microscissors or resectoscope. Statistical analysis was performed using the CHI2-test. RESULTS: The anatomical result was considered satisfactory in 57.1% of cases. Forty-five pregnancies were obtained, two after an IVF-program in 56 patients. Twenty-eight living children were born: twenty-six at term. Twenty patients delivered normally. Two women are still pregnant. Obstetrical prognosis of these patients is statistically improved by the treatment (P=0.001). CONCLUSION: Obstetrical prognosis of patients presenting repeated pregnancy loss and septate uterus is statistically improved by hysteroscopic metroplasty.     

Hysteroscopic metroplasty under laparoscopic guidance in infertile women with septate uteri: follow-up of reproductive outcome

OBJECTIVE: To evaluate the effectiveness of hysteroscopic metroplasty under laparoscopic guidance in the treatment of infertile women with a diagnosis of septate uterus and the impact of this surgical procedure on reproductive outcome. STUDY DESIGN: From January 1996 to December 2000, 36 women referred to our endoscopy center underwent hysteroscopic metroplasty. Follow-up covered the incidence of pregnancy, term pregnancies and mode of delivery. RESULTS: The mean age of the patients was 31.9 +/- 3.9 years (range, 23-39). One patient (3%) dropped out during follow-up. There were no intraoperative or postoperative complications. The mean interval from metroplasty to conception was 11.3 +/- 9.2 months (range, 2.0-35.5). Twenty of 35 (57%) women had a history of > or = 1 spontaneous abortions, and 18 of the 20 (90%) achieved pregnancy, with 15 of 18 (83%) term deliveries (10 vaginal deliveries and 5 cesarean sections). Fifteen of 35 patients (43%) were nulliparous, and 8 of 15 (53.3%) had term deliveries (1 cesarean section). CONCLUSION: Hysteroscopic metroplasty under laparoscopic guidance is safe, allows spontaneous delivery and short-term pregnancy planning, is particularly successful in infertile women with a history of > or = 1 spontaneous abortions.     

Hysteroscopic metroplasty in patients with a uterine septum and otherwise unexplained infertility

Objective

To evaluate the reproductive outcomes of patients with a uterine septum and otherwise unexplained infertility who underwent hysteroscopic metroplasty, and to compare them with those of patients with the same diagnosis who did not have hysteroscopic metroplasty.

Methods

The present retrospective study included 127 patients with diagnosis of a uterine septum and otherwise unexplained infertility. The reproductive outcomes of 102 patients who underwent hysteroscopic metroplasty (group 1) and 25 patients who rejected the operation (group 2) were compared.

Results

Of the 102 patients who underwent hysteroscopic metroplasty, 44 (43.1%) were able to achieve pregnancy, as compared with 5 (20%) of the 25 patients who did not undergo the operation (P = 0.03). The abortion rate was 11.4% (5/44) in group 1, compared with 60% (3/5) in group 2 (P = 0.02). The live birth rate was 35.3% (36/102) in group 1, as compared with 8% (2/25) in group 2 (P = 0.008).

Conclusions

The results indicate that hysteroscopic metroplasty improves reproductive outcome for patients with a uterine septum and otherwise unexplained infertility.     

Septate uterus: reproductive outcome after hysteroscopic metroplasty

OBJECTIVE: To evaluate hysteroscopic metroplasty and its effect on reproductive outcome. STUDY DESIGN: Seventy-five patients consulted for uterine septum between January 1996 to December 2000 at "La Sapienza" University in Rome were included in the study. RESULTS: Forty patients attempted pregnancy and a total of 30 spontaneous pregnancies resulted (75% pregnancy rate). The uterine cavity was normal at hysteroscopic follow-up in 68% of cases. CONCLUSION: Correction of uterine septum improves pregnancy outcome of patients. Broadening the indications for hysteroscopic metroplasty should be encouraged for patients who desire to conceive.     

Hysteroscopic metroplasty improves gestational outcome in women with recurrent spontaneous abortion

STUDY OBJECTIVE: To compare the reproductive outcome in women with recurrent spontaneous abortion (RSA) associated with septate uterus after hysteroscopic metroplasty compared with patients who did not undergo surgery. DESIGN: Longitudinal evaluation (Canadian Task Force classification II-2). SETTING: University of Rome, Tor Vergata-affiliated endoscopic unit. PATIENTS: Forty-eight consecutive women with septate uterus and RSA were enrolled in the study. INTERVENTIONS: Hysteroscopic metroplasty. MEASUREMENTS AND MAIN RESULTS: Reproductive outcome in terms of term pregnancy was significantly improved after hysteroscopic metroplasty compared with controls (76% vs. 20%). No differences were found in the prevalence of preterm delivery between groups (4% vs. 5%). CONCLUSION: Our data suggest that hysteroscopic septum incision can improve pregnancy outcome in patients with RSA associated with septate uterus.     

Hysteroscopic metroplasty: six years' experience

Seventy patients who underwent hysteroscopic metroplasty for uterine septa during a 6-year period were reviewed for subsequent gynecologic problems and obstetric outcome. Complete follow-up was obtained for 1 year in 60 patients and through the first pregnancy in 64. The 70 patients were divided into three groups based on obstetric history prior to surgery: 1) 40 with only first-trimester losses, 2) 15 whose histories included second-trimester losses or premature delivery, and 3) 15 with primary infertility. Long-term follow-up indicated no significant gynecologic abnormalities. Comparison of preoperative and postoperative obstetric outcomes indicated the following: 1) Hysteroscopic metroplasty was very effective in treating patients with septa and a history of first-trimester abortion; 2) patients with first-trimester loss and either second-trimester abortion or preterm birth benefited from metroplasty but were still at risk for preterm labor; and 3) hysteroscopic metroplasty does not "cure" unexplained infertility. When compared with abdominal metroplasty for efficacy, morbidity, and cost, hysteroscopic metroplasty appears to be the treatment of choice in patients with uterine septa associated with pregnancy loss. Those patients with a history of second-trimester loss and third-trimester preterm delivery continue to require close monitoring in subsequent pregnancies.     

Hysteroscopic metroplasty of the Class Va uterus with preservation of the cervical septum

OBJECTIVE: To assess the safety and efficacy of hysteroscopic resection of the uterine septum in patients with a Class Va septate uterus. DESIGN: Retrospective clinical study. SETTING: University outpatient surgical center. PATIENT(S): Twenty-one patients with Class Va uterus treated between 1985-1998 in the senior author's academic practice. INTERVENTION(S): Hysteroscopic metroplasty with preservation of cervical septum. MAIN OUTCOME MEASURE(S): Intraoperative and postoperative complications; postoperative cumulative pregnancy and delivery rates. RESULT(S): No long-term complications were encountered. Fourteen of 15 women who attempted pregnancy postoperatively delivered viable neonates; the 15th is in an ongoing pregnancy. CONCLUSION(S): Surgical correction of the complete uterine septum with preservation of the cervical septum is associated with low morbidity and satisfactory postoperative obstetric outcome.     

Reproductive outcome following resectoscope metroplasty in women having a complete uterine septum with double cervix and vagina

Objective

To evaluate reproductive outcomes in women with complete uterine septum with double cervix and vagina following resectoscope metroplasty.

Methods

The pregnancy outcomes of 21 women who underwent vaginal and uterine septum resection were compared with those of 15 untreated women with similar clinical characteristics. The Fisher exact test and the Mann-Whitney test were used for statistical analysis.

Results

Cycle fecundity was better (33.4% ± 28.5% vs 12.2% ± 4.7%; P = 0.046), the rate of term delivery significantly increased (P < 0.05), and the rate of spontaneous abortion decreased (P < 0.05) in the treatment group.

Conclusion

Resectoscope metroplasty was found to improve the pregnancy outcomes of women having primary infertility or a history of pregnancy loss associated with a complete uterine septum with double cervix and vagina.     

Hysteroscopic treatment of the uterine septum: a clinician's experience

OBJECTIVE: I reviewed my experience with the diagnosis and hysteroscopic treatment of uterine septa. STUDY DESIGN: This article is a retrospective review of cases from 1992-1999. A septate uterus was diagnosed in a total of 40 patients, and all were treated by hysteroscopic resection. RESULTS: The rate of preoperative pregnancy loss was 77.4%, and the uncomplicated delivery rate was 6.5%. After hysteroscopic septum resection 21 patients reported a total of 22 pregnancies with an 18.2% miscarriage rate and a 77.3% uncomplicated delivery rate. CONCLUSION: Hysteroscopic treatment of uterine septa is a safe, simple, and effective procedure. It can be used for all types of uterine septa, it attains optimal obstetric outcomes, and it should be undertaken whenever a uterine septum is diagnosed.     

宫腔镜子宫纵隔切开术治疗纵隔子宫

诊断纵隔子宫的金标准仍然是宫腔镜联合腹腔镜手术。文章阐述宫腔镜子宫纵隔切开术的手术技巧,回顾分析190例纵隔子宫患者术后的妊娠结局。宫腔镜下子宫纵隔切开术可减少流产率,提高活产率。宫腔镜下子宫纵隔矫形手术安全,并发症少,可明显改善纵隔子宫合并不良孕产史患者的妊娠结局。     

Hysteroscopic metroplasty: the role of ultrasound in the diagnosis and monitoring of patients with uterine septa

52 patients with septate uterus underwent hysteroscopic metroplasty in the Obstetric and Gynecologic Clinic "R" in Palermo. In this group of patients ultrasound examinations were also performed in order to define their role in diagnosis of type of malformations and in monitoring the endoscopic surgical procedure. Preliminary results seem to indicate that real-time ultrasound is a reliable technique for both purposes.     

Incidence of sperm aneuploidy in relation to semen characteristics and assisted reproductive outcome.

OBJECTIVE: To evaluate the incidence of sperm aneuploidy in men screened for infertility and identify any eventual relation with assisted reproductive outcome. DESIGN: Controlled prospective study. SETTING: University hospital-based IVF program. PATIENT(S): Infertile couples who were screened for sperm aneuploidy and evaluated for IVF treatment. INTERVENTION(S): Fluorescence in situ hybridization was used to identify chromosomes 18, 21, X, and Y. The assisted reproductive techniques of IVF and intracytoplasmic sperm injection were used for infertility treatment. MAIN OUTCOME MEASURE(S): The incidence of sperm aneuploidy, semen parameters, fertilization rate, pregnancy characteristics, and rate of neonatal malformations were determined. RESULT(S): Oligozoospermic and teratozoospermic men had a significantly higher incidence of chromosomal abnormalities than men with normal semen parameters (2.7% vs. 1.8%). The increased frequency of sperm aneuploidy did not appear to affect pregnancy losses or the occurrence of neonatal malformations. CONCLUSION(S): Suboptimal semen samples had a higher incidence of aneuploidy. In this study, the increased frequency of chromosomal abnormalities did not have a direct effect on the fertilization rate, pregnancy characteristics, or neonatal outcome.