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Operative hysteroscopy for treatment of intrauterine pathologies does not interfere with later endometrial development in patients undergoing in vitro fertilization

Archives of Gynecology and Obstetrics volume 293, pages 1097–1100 (2016)Cite this article

Abstract

Purpose

Operative hysteroscopy procedure is extensively used for the treatment of intrauterine abnormalities that can potentially cause infertility. To date, there are little data addressing the effect of operative hysteroscopy that applies electrical current for excision and its subsequent effect on endometrial thickness. This study was aimed to assess the effect of thermal resection used in operative hysteroscopy on endometrial thickness and on fertility outcome in women undergoing in vitro fertilization (IVF).

Methods

A retrospective study conducted at Hadassah-Hebrew University Medical Center, a tertiary referral center. Included were IVF women who underwent an operative hysteroscopy throughout the years 2000–2010 for intrauterine pathologies.

Results

Throughout the years 2000–2010, 41 IVF women who underwent an operative hysteroscopy using electric current between their 82 IVF cycles were studied. The mean age of women at the time of the intervention was 37.1 years (36.7 and 37.5 at the IVF cycles before and after intervention, respectively). The maximal endometrial thickness before operative hysteroscopy was 10.7 mm compared to 9.5 mm after all procedures (P < 0.001). Excluding polypectomy cases (n = 24) the endometrial thickness was 9.9 mm before vs. 9.1 mm after operative hysteroscopy (P < 0.001). The clinical pregnancy rate was 19.5 % before as compared to 24.4 % after operative hysteroscopy (NS). The take home baby rate (THBR), however, was significantly increased following operative hysteroscopy for all indications from 2.4 to 12.2 % (P < 0.05).

Conclusion

Despite the small change in endometrial thickness, our results indicate that using electric current is safe to treat intrauterine pathologies.

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References

  1. Bosteels J, Weyers S, Puttemans P, Panayotidis C, Van Herendael B, Gomel V, Mol BW, Mathieu C, D’Hooghe T (2010) The effectiveness of hysteroscopy in improving pregnancy rates in subfertile women without other gynaecological symptoms: a systematic review. Hum Reprod Update 16:1–11

    Article  PubMed  Google Scholar 

  2. Pabuccu R, Gomel V (2004) Reproductive outcome after hysteroscopic metroplasty in women with septate uterus and otherwise unexplained infertility. Fertil Steril 81:1675–1678

    Article  PubMed  Google Scholar 

  3. 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

    Article  PubMed  Google Scholar 

  4. Richter KS, Bugge KR, Bromer JG, Levy MJ (2007) Relationship between endometrial thickness and embryo implantation, based on 1,294 cycles of in vitro fertilization with transfer of two blastocyst-stage embryos. Fertil Steril 87:53–59

    Article  PubMed  Google Scholar 

  5. Zhang X, Chen CH, Confino E, Barnes R, Milad M, Kazer RR (2005) Increased endometrial thickness is associated with improved treatment outcome for selected women undergoing in vitro fertilization-embryo transfer. Fertil Steril 83:336–340

    Article  PubMed  Google Scholar 

  6. Al-Ghamdi A, Coskun S, Al-Hassan S, Al-Rejjal R, Awartani K (2008) The correlation between endometrial thickness and outcome of in vitro fertilization and embryo transfer (IVF-ET) outcome. Reprod Biol Endocrinol. doi:10.1186/1477-7827-6-37

    PubMed  PubMed Central  Google Scholar 

  7. Reidenbach HD (1993) Fundamentals of bipolar high-frequency surgery. Endosc Surg Allied Technol 1:85–90

    CAS  PubMed  Google Scholar 

  8. Brill AI (2000) Energy systems for operative hysteroscopy. Obstet Gynecol Clin North Am 27:317–326

    CAS  Article  PubMed  Google Scholar 

  9. Asherman JG (1950) Traumatic intra-uterine adhesions. J Obstet Gynaecol Br Emp 57:892–896

    CAS  Article  PubMed  Google Scholar 

  10. Narvekar SA, Gupta N, Shetty N, Kottur A, Srinivas M, Rao KA (2010) Does local endometrial injury in the nontransfer cycle improve the IVF-ET outcome in the subsequent cycle in women with previous unsuccessful IVF? A randomized controlled pilot study. J Hum Reprod Sci 3:15–19

    Article  PubMed  PubMed Central  Google Scholar 

  11. Barash A, Dekel N, Fieldust S, Segal I, Schechtman E, Granot I (2003) Local injury to the endometrium doubles the incidence of successful pregnancies in women undergoing in vitro fertilization. Fertil Steril 79:1317–1322

    Article  PubMed  Google Scholar 

  12. Zhou L, Li R, Wang R, Huang HX, Zhong K (2008) Local injury to the endometrium in controlled ovarian hyperstimulation cycles improves implantation rates. Fertil Steril 89:1166–1176

    Article  PubMed  Google Scholar 

  13. Bahar R, Shimonovitz M, Benshushan A, Shushan A (2013) Case-control study of complications associated with bipolar and monopolar hysteroscopic operations. J Minim Invasive Gynecol 20:376–380

    Article  PubMed  Google Scholar 

  14. Paulson RJ, Sauer MV, Lobo RA (1990) Factors affecting embryo implantation after human in vitro fertilization: a hypothesis. Am J Obstet Gynecol 163:2020–2023

    CAS  Article  PubMed  Google Scholar 

  15. Paulson RJ, Sauer MV, Lobo RA (1990) Embryo implantation after human in vitro fertilization: importance of endometrial receptivity. Fertil Steril 53:870–874

    CAS  PubMed  Google Scholar 

  16. Rackow BW, Jorgensen E, Taylor HS (2011) Endometrial polyps affect uterine receptivity. Fertil Steril 95:2690–2692

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  17. Rackow BW, Taylor HS (2010) Submucosal uterine leiomyomas have a global effect on molecular determinants of endometrial receptivity. Fertil Steril 93:2027–2034

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  18. Taylor E, Gomel V (2008) The uterus and fertility. Fertil Steril 89:1–16

    Article  PubMed  Google Scholar 

  19. Bettocchi S, Achilarre MT, Ceci O, Luigi S (2011) Fertility-enhancing hysteroscopic surgery. Semin Reprod Med 29:75–82

    Article  PubMed  Google Scholar 

  20. Perez-Medina T, Bajo-Arenas J, Salazar F, Redondo T, Sanfrutos L, Alvarez P, Engels V (2005) Endometrial polyps and their implication in the pregnancy rates of women undergoing intrauterine insemination: a prospective, randomized study. Hum Reprod 20:1632–1635

    Article  PubMed  Google Scholar 

  21. Duffy S, Reid PC, Sharp F (1992) In-vivo studies of uterine electrosurgery. Br J Obstet Gynaecol 99:579–582

    CAS  Article  PubMed  Google Scholar 

  22. Guven S, Kart C, Unsal MA, Yildirim O, Odaci E, Yulug E (2014) Endometrial injury may increase the clinical pregnancy rate in normoresponders undergoing agonist protocol ICSI cycles with single embryo transfer. Eur J Obstet Gynecol Reprod Biol 173:58–62

    Article  PubMed  Google Scholar 

  23. Yeung TW, Chai J, Li RH, Lee VC, Ho PC, Ng EH (2014) The effect of endometrial injury on ongoing pregnancy rate in unselected subfertile women undergoing in vitro fertilization: a randomized controlled trial. Hum Reprod 29:2474–2481

    Article  PubMed  Google Scholar 

  24. Shohayeb A, El-Khayat W (2012) Does a single endometrial biopsy regimen (S-EBR) improve ICSI outcome in patients with repeated implantation failure? A randomised controlled trial. Eur J Obstet Gynecol Reprod Biol 164:176–179

    Article  PubMed  Google Scholar 

  25. Gibreel A, El-Adawi N, Elgindy E, Al-Inany H, Allakany N, Tournaye H (2015) Endometrial scratching for women with previous IVF failure undergoing IVF treatment. Gynecol Endocrinol 31:313–316

    Article  PubMed  Google Scholar 

  26. Nastri CO, Ferriani RA, Raine-Fenning N, Martins WP (2013) Endometrial scratching performed in the non-transfer cycle and outcome of assisted reproduction: a randomized controlled trial. Ultrasound Obstet Gynecol 42:375–382

    CAS  Article  PubMed  Google Scholar 

  27. Emanuel MH, Wamsteker K (2005) The intra uterine morcellator: a new hysteroscopic operating technique to remove intrauterine polyps and myomas. J Minim Invasive Gynecol 12:62–66

    Article  PubMed  Google Scholar 

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Author notes

    Affiliations

    1. Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University-Hadassah Medical School, P.O. Box 12000, 91120, Jerusalem, Israel

      Liron Kogan, Uri Dior, Henry H. Chill, Gilad Karavani, Ariel Revel, Asher Shushan & Alex Simon

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    1. Liron Kogan
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    2. Uri Dior
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    3. Henry H. Chill
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    4. Gilad Karavani
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    5. Ariel Revel
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    6. Asher Shushan
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    7. Alex Simon
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    Corresponding author

    Correspondence to Gilad Karavani.

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    Ethical standards

    This study was approved by the Institutional Review Board (IRB) ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The manuscript does not contain clinical studies or patient data.

    Conflict of interest

    The authors declare that they have no conflict of interest.

    Additional information

    L. Kogan and U. Dior contributed equally to this study.

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    Cite this article

    Kogan, L., Dior, U., Chill, H.H. et al. Operative hysteroscopy for treatment of intrauterine pathologies does not interfere with later endometrial development in patients undergoing in vitro fertilization. Arch Gynecol Obstet 293, 1097–1100 (2016). https://doi.org/10.1007/s00404-015-3988-3

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    • DOI: https://doi.org/10.1007/s00404-015-3988-3

    Keywords

    • Operative hysteroscopy
    • IVF
    • Endometrial thickness
    • THBR