Introduction: Uterine septum is one of the most common congenital abnormalities in women that leads to numerous gynecological problems and adverse obstetrics outcomes. This study aimed to evaluate the effects of Hysteroscopic Resection on pregnancy outcomes in women undergone the surgery.
Methods: In this quasi-experimental study, 90 women were included from April 2016 to June 2018 from patients attending to Rasoul Akram hospital of Tehran. The inclusion criteria included: the age lower than 35 years old, primary infertility, idiopathic recurrent spontaneous abortion, BMI between 19 and 30, and having informed consen. Septum was resected by scissor upward and lateral. After 10 months of follow-up in average, we assessed rate of live births, abortions, birth weight and presentation.
Results: 82 individuals were assessed for occurrence of conception (response rate=91%). The mean age of patients was 30.01 ± 6.76 years and the mean BMI was 26.25 ± 4.88. Out of 82 patients, 36 patients were pregnant, of whom 16 (44.4%) had abortions. 5 (14.9%) of the pregnancies ended with preterm birth, and 6 (17%) ended with stillbirth.
Conclusion: The present study showed that the infertile patients with uterine septum and with no other causes of infertility were more likely to be pregnant compared to other patients with idiopathic infertility. Our study showed that post-operation fertility following Hysteroscopic Resection was lower than that in previous reports. According to the findings of this study, scissors may be safe, effective and cost-effective method for removing uterine septa.
Tonguc EA, Var T, Batioglu S. Hysteroscopic metroplasty in patients with a uterine septum and otherwise unexplained infertility. International Journal of Gynecology & Obstetrics. 2011;113(2):128-30.
Nouri K, Ott J, Huber JC, Fischer E-M, Stögbauer L, Tempfer CB. Reproductive outcome after hysteroscopic septoplasty in patients with septate uterus-a retrospective cohort study and systematic review of the literature. Reproductive Biology and Endocrinology. 2010;8(1):52.
Sadler TW. Langman's medical embryology: Lippincott Williams & Wilkins; 2011.
Davis GL. Systematic embryology of the angiosperms. Systematic embryology of the angiosperms. 1967.
Needham J, Biochemiker R. Chemical embryology: University Press Cambridge; 1931.
Shokeir T, Abdelshaheed M, El-Shafie M, Sherif L, Badawy A. Determinants of fertility and reproductive success after hysteroscopic septoplasty for women with unexplained primary infertility: a prospective analysis of 88 cases. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2011;155(1):54-7.
Hollett-Caines J, Vilos GA, Abu-Rafea B, Ahmad R. Fertility and pregnancy outcomes following hysteroscopic septum division. Journal of Obstetrics and Gynaecology Canada. 2006;28(2):156-9.
Bendifallah S, Faivre E, Legendre G, Deffieux X, Fernandez H. Metroplasty for AFS Class V and VI septate uterus in patients with infertility or miscarriage: reproductive outcomes study. Journal of minimally invasive gynecology. 2013;20(2):178-84.
Masihi S, Barati M, Marmazi F. Uterine septum dimensions in patients with infertility and recurrent abortion and the outcomes of hystroscopic metroplasty. Journal of Kerman University of Medical Sciences. 2010;17(2):161-6.
Speroff L, Fritz MA. Clinical gynecologic endocrinology and infertility: lippincott Williams & wilkins; 2005.
Paradisi R, Barzanti R, Natali F, Guerrini M, Battaglia C, Seracchioli R, et al. Hysteroscopic metroplasty: reproductive outcome in relation to septum size. Archives of gynecology and obstetrics. 2014;289(3):671-6.
Chen S-Q, Deng N, Jiang H-Y, Li J-B, Lu S, Yao S-Z. Management and reproductive outcome of complete septate uterus with duplicated cervix and vaginal septum: review of 21 cases. Archives of gynecology and obstetrics. 2013;287(4):709-14.
Chan Y, Jayaprakasan K, Tan A, Thornton J, Coomarasamy A, Raine‐Fenning N. Reproductive outcomes in women with congenital uterine anomalies: a systematic review. Ultrasound in Obstetrics & Gynecology. 2011;38(4):371-82.
Ginther O, Pierson R. Ultrasonic anatomy and pathology of the equine uterus. Theriogenology. 1984;21(3):505-16.
Roy K, Singla S, Baruah J, Kumar S, Sharma J, Karmakar D. Reproductive outcome following hysteroscopic septal resection in patients with infertility and recurrent abortions. Archives of gynecology and obstetrics. 2011;283(2):273-9.
Ventolini G, Zhang M, Gruber J. Hysteroscopy in the evaluation of patients with recurrent pregnancy loss: a cohort study in a primary care population. Surgical endoscopy. 2004;18(12):1782-4.
Venturoli S, Colombo F, Vianello F, Seracchioli R, Possati G, Paradisi R. A study of hysteroscopic metroplasty in 141 women with a septate uterus. Archives of gynecology and obstetrics. 2002;266(3):157-9.
Pai HD, Kundnani MT, Palshetkar NP, Pai RD, Saxena N. Reproductive performance after hysteroscopic metroplasty in women with primary infertility and septate uterus. Journal of gynecological endoscopy and surgery. 2009;1(1):17.
Selvaraj P, Selvaraj K. Reproductive outcome of septate uterus following hysteroscopic septum resection. Journal of human reproductive sciences. 2010;3(3):143.
Pabuçcu R, Gomel V. Reproductive outcome after hysteroscopic metroplasty in women with septate uterus and otherwise unexplained infertility. Fertility and sterility. 2004;81(6):1675-8.
Dural O, Yasa C, Bastu E, Ugurlucan FG, Can S, Yilmaz G, et al. Reproductive outcomes of hysteroscopic septoplasty techniques. JSLS: Journal of the Society of Laparoendoscopic Surgeons. 2015;19(4).
Porcu G, Cravello L, D’Ercole C, Cohen D, Roger V, de Montgolfier R, et al. Hysteroscopic metroplasty for septate uterus and repetitive abortions: reproductive outcome. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2000;88(1):81-4.
Esmaeilzadeh S, Delavar MA, Andarieh MG. Reproductive outcome following hysteroscopic treatment of uterine septum. Materia Socio-Medica. 2014;26(6):366.