Abstract
Objectives
To evaluate the outcome of hysteroscopic septal resection in patients with infertility and recurrent abortions.
Materials and methods
This was a retrospective clinical analysis of 170 patients who underwent hysteroscopic septal resection by monopolar electrode (Collin’s) knife. A second-look office hysteroscopy was performed in all cases within 2 months. The mean follow-up period was 28.5 months.
Results
The mean age of the patients was 25.6 years. The presenting clinical complaint was recurrent abortions in 68.2% patients, infertility in 17.6% patients and preterm deliveries in 14.1% patients. Final reproductive outcome was assessed for 152 patients, after excluding patients with other confounding factors, interfering in pregnancy outcome. There was a significant difference in reduction of number of miscarriages (91.5% pre-surgery; 12.9% post-surgery: p = 0.02) and increase in term deliveries (2.5% pre-surgery; 79.5% post-surgery: p = 0.01), while the number of preterm deliveries remained almost the same (6.1% pre-surgery; 7.5% post-surgery). Thirteen out of 23 infertile patients (56.5%) conceived after septal resection. The take home baby rate was increased from 8.5 to 87.1%. Cumulative first live birth rate revealed that 51.2% women had their first live birth within 10–15 months. There was an increased incidence (43.2%) of cesarean section in mode of delivery. In 11/170 patients, repeat hysteroscopy suggested the presence of uterine adhesions which needed hysteroscopic adhesiolysis and three patients required repeat septal resection.
Conclusions
Hysteroscopic septal resection for women with history of recurrent abortions, preterm deliveries and in women with infertility is a safe and effective method of choice for improving the obstetric outcome.
Similar content being viewed by others
References
Acien P (1997) Incidence of Mullerian defects in fertile and infertile women. Hum Reprod 12:1372–1376
Pellicer A (1997) Shall we operate on Mullerian defects? An introduction to the debate. Hum Reprod 12:1371–1372
Rock JA, Jones HW Jr (1977) The clinical management of the double uterus. Fertil Steril 28:798–806
Raga F, Bauset C, Remohi J, Bonilla-Musoles F, Simon C, Pellicer A (1997) Reproductive impact of congenital Müllerian anomalies. Hum Reprod 12:2277–2281
Nasri MN, Setchell ME, Chard T (1990) Transvaginal ultrasound for diagnosis of uterine malformations. Br J Obstet Gynaecol 97:1043–1045
Buttram VC, Gibbons WE (1979) Mullerian anomalies: a proposed classification (an analysis of 144 cases). Fertil Steril 32:40–46
Golan A, Langer R, Bukovsky I, Caspi E (1989) Congenital anomalies of the mullerian system. Fertil Steril 51:747–755
Perino A, Mengaclia L, Hamou J, Cittadini E (1987) Hysteroscopy for metroplasty of uterine septa: report of 24 cases. Fertil Steril 48:321–323
Homer HA, Li TC, Cooke ID (2000) The septate uterus: a review of management and reproductive outcome. Fertil Steril 73:1–14
Sladkevicius P, Valentin L, Marsál K (1994) Blood flow velocity in the uterine and ovarian arteries during menstruation. Ultrasound Obstet Gynecol 4:421–427
Burchell RC, Creed F, Rasoulpour M, Whitcomb M (1978) Vascular anatomy of the human uterus and pregnancy wastage. Br J Obstet Gynaecol 85:698–706
Speroff L, Glass RH, Kase NG (2005) Female infertility. In: Speroff L, Fritz MA (eds) Clinical gynecologic endocrinology and infertility, 7th edn. Lippincott Williams and Wilkins, Philadelphia PA, pp 1013–1067
Grimbizis G, Camus M, Clasen K, Tournaye H, De Munck L, Devroey P (1998) Hysteroscopic septum resection in patients with recurrent abortions or infertility. Hum Reprod 13:1188–1193
Buttram VC Jr, Gibbons WE (1979) Mullerian anomalies: a proposed classification (an analysis of 144 cases). Fertil Steril 32:40–48
American Fertility Society (1988) The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Mullerian anomalies and intrauterine adhesions. Fertil Steril 49:944–955
Barbot J (1995) Hysteroscopy and hysterography. Obstet Gynecol Clin North Am 22:591–603
Jurkovic D, Geipel A, Gruboeck K, Jauniaux E, Natucci R, Campbell S (1995) Three-dimensional ultrasound for the assessment of uterine anatomy and detection of congenital anomalies: a comparison with hysterosalpingography and two-dimensional sonography. Ultrasound Obstet Gynecol 5:233–237
Fischetti SG, Politi G, Lomeo F, Garozzo G (1995) Magnetic resonance in the evaluation of mullerian duct anomalies. Radiol Med (Torino) 89:105–111
Grimbizis GF, Camus M, Tarlatzis BC, Bontis JN, Devroey P (2007) Clinical implications of uterine malformations and hysteroscopic treatment results. Hum Reprod Update 7:161–174
Simon C, Martinez L, Pardo F, Tortajada M, Pellicer A (1991) Mullerian defects in women with normal reproductive outcome. Fertil Steril 56:1192–1193
Pabuçcu R, Gomel V (2004) Reproductive outcome after hysteroscopic metroplasty in women with septate uterus and otherwise unexplained infertility. Fertil Steril 81:1675–1678
Fedele L, Bianchi S, Frontino G (2006) Septums and synechiae: approaches to surgical correction. Clin Obstet Gynecol 49:767–788
Kresowik J, Ryan G, Syrop C, Voorhis BV (2009) Ultrasound guidance is superior to laparoscopic guidance during hysteroscopic resection of intrauterine synechiae and septa. Fertil Steril 92:S47
Litta P, Spiller E, Saccardi C, Ambrosini G, Caserta D, Cosmi E (2008) Resectoscope or Versapoint for hysteroscopic metroplasty. Int J Gynaecol Obstet 101:39–42
Taskin O, Sadik S, Onoglu A, Gokdeniz R, Erturan E, Burak F, Wheeler JM (2000) Role of endometrial suppression on the frequency of intrauterine adhesions after resectoscopic surgery. J Am Assoc Gynecol Laparosc 7:351–354
Israel R, March CM (1984) Hysteroscopic incision of the septate uterus. Am J Obstet Gynecol 149:66–73
Schenker JG, Margalioth EJ (1982) Intrauterine adhesions: an updated appraisal. Fertil Steril 37:593–610
Guida M, Acunzo G, Di Spiezio Sardo A, Bifulco G, Piccoli R, Pellicano M, Cerrota G, Cirillo D, Nappi C (2004) Effectiveness of auto- cross-linked hyaluronic acid gel in the prevention of intrauterine adhesions after hysteroscopic surgery: a prospective, randomized, controlled study. Hum Reprod 19:1461–1464
March CM, Israel R (1987) Hysteroscopic management of recurrent abortion caused by septate uterus. Am J Obstet Gynecol 156:834–842
Parsanezhad ME, Alborzi S, Zarei A, Dehbashi S, Shirazi LG, Rajaeefard A, Schmidt EH (2006) Hysteroscopic metroplasty of the complete uterine septum, duplicate cervix, and vaginal septum. Fertil Steril 85:1473–1477
Fedele L, Bianchi S (1995) Hysteroscopic metroplasty for the septate uterus. Obstet Gynecol Clin North Am 22:473–489
Fedele L, Bianchi S, Marchini M, Mezzopane R, DiNola G, Tozzi L (1996) Residual uterine septum of less than 1 cm after hysteroscopic metroplasty does not impair reproductive outcome. Hum Reprod 11:727–729
Leone FPG, Ragusa G, Lanzani C, Digrandi M, Ferrazzi E (2002) Cervical cerclage after hysteroscopic metroplasty. Ultrasound Obstet Gynecol s1:88
Proctor JA, Haney AF (2003) Recurrent first trimester pregnancy loss is associated with uterine septum but not with bicornuate uterus. Fertil Steril 80:1212–1215
Colacurci N, De Placido G, Mollo A, Carravetta C, De Franciscis P (1996) Reproductive outcome after hysteroscopic metroplasty. Eur J Obstet Gynecol Reprod Biol 66:147–150
Mollo A, De Franciscis P, Colacurci N, Cobellis L, Perino A, Venezia R, Alviggi C, De Placido G (2009) Hysteroscopic resection of the septum improves the pregnancy rate of women with unexplained infertility: a prospective controlled trial. Fertil Steril 91:2628–2631
Fernandez H, Al-Najjar F, Chauveaud-Lambling A, Frydman R, Gervaise A (2006) Fertility after treatment of Asherman’s syndrome stage 3 and 4. J Minim Invasive Gynecol 13:398–402
Conflict of interest statement
We have no financial relationship with any organization that sponsored the research.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Roy, K.K., Singla, S., Baruah, J. et al. Reproductive outcome following hysteroscopic septal resection in patients with infertility and recurrent abortions. Arch Gynecol Obstet 283, 273–279 (2011). https://doi.org/10.1007/s00404-009-1336-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-009-1336-1