Long-Term Reproductive Outcomes after Hysteroscopic Treatment of Dysmorphic Uteri in Women with Reproductive Failure: An European Multicenter Study |
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| Affiliation: | 2. Department of Obstetrics and Gynecology, ZOL Hospitals, Genk, Belgium (Dr. Campo);3. European Academy of Gynaecological Surgery, Leuven, Belgium (Drs. Campo, Meier Furst, Di Cesare, and Ombelet);4. Second Unit of Obstetrics and Gynecology, Department of Biomedical Science and Human Oncology, Aldo Moro University, Bari, Italy (Dr. Bettocchi);5. Department of Women and Children''s Health, Unit of Gynecology and Obstetrics, University of Padua, Padua, Italy (Dr. Vitagliano);6. Department of Physiology, Hasselt University, Hasselt, Belgium (Dr. Ombelet);1. Department of Gynecologic Surgery (Drs. Béguinot, Botchorishvili, Comptour, Curinier, Campagne-Loiseau, Chauvet, Pouly, Rabischong, Canis, and Bourdel);2. Biostatistics Division (Direction de la Recherche Clinique et de l''Innovation) (Dr. Pereira);3. Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France, and Department of Surgery, Jean Perrin Comprehensive Center, Clermont-Ferrand, France (Dr. Béguinot).;1. Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, California (Drs. Movilla, Orlando, and Opoku-Anane);2. Department of Bioengineering, University of California San Diego, La Jolla, California (Ms. Wang) |
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| Abstract: | ObjectiveTo evaluate the long-term reproductive outcomes in patients with dysmorphic uterus treated by hysteroscopic metroplasty with miniaturized instruments.DesignRetrospective multicenter cohort study.SettingTertiary care university hospitals.PatientsThe study was conducted on 214 women with a dysmorphic uterus (T-shaped, infantilis, or other type of dysmorphic uterus according to the European Society of Human Reproduction and Embryology and the European Society for Gynaecological Endoscopy classification system) with history of primary unexplained infertility (group 1) or repeated (>2) early miscarriages (group 2). Dysmorphic uteri were diagnosed by office hysteroscopy and 3-dimensional transvaginal ultrasound (3D-TVS).InterventionsAll patients underwent in office hysteroscopic metroplasty using a continuous-flow hysteroscope with a 5 Fr operating channel introduced into the uterine cavity using the vaginoscopic approach. Longitudinal incisions were performed on the fibromuscular constriction rings in the isthmic area and in some cases on the other uterine walls with a 5 Fr bipolar electrode or scissors. At the end of the procedure, an antiadhesive gel was applied into the uterine cavity to minimize adhesion formation. Postsurgical assessment of the uterine cavity was carried out through office hysteroscopy and 3D-TVS. All patients were followed for at least 24 months.Measurements and Main ResultsThe metroplasty was completed in all cases, resulting in a significant increase of uterine cavity volume (100%) and optimization of uterine morphology in 211 of 214 women (98.6%). After 60 months, the overall clinical pregnancy rate was 72.9% (n = 156/214), and the live birth rate was 80.1% (n = 125/156). Specifically, 74 of 156 women (47.4%) conceived spontaneously (with a median time to pregnancy of 5.5 months), of whom 32.4% had previously failed 1 or more attempts at in vitro fertilization/intracytoplasmic sperm injection.ConclusionOur long-term follow-up data demonstrate that the hysteroscopic correction of dysmorphic uteri may result in a high live birth rate in women suffering from unexplained infertility or repeated miscarriages. |
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