Reproductive outcome after hysteroscopic septoplasty in septate uterus and unexplained infertility: prospective cohort study
BackgroundSeptate uterus is the most common congenital malformation of the uterus in normal population and also patients with recurrent abortions. Pathogenesis of the disease is incompletely elucidated. It is clarified that incomplete absorption of paramesonephric ducts in the first trimester is responsible for septum formation. Hysteroscopy is known as the standard diagnostic and therapeutic procedure for septate uterus. In this study، our aim was to evaluated the effects of hysteroscopic septal resection in improving pregnancy outcomes in patients with unexplained infertility or recurrent abortion.
MethodsProspective cohort study was conducted in a Tehran University Medical Sci-ences affiliated hospital from April 2012 to May 2013. Eight patients were excluded from the study because of non-reproductive related complains. The other 40 patients went through a prospective cohort study and were treated for septate uterus. All patients had complete history taken and underwent physical examination. Septum size was measured by hysteroscopy. Patients underwent hysteroscopic metroplasty with resectoscope with an equatorial semicircular loop cutting 12 with monopolar energy. Some septum resected by 5 french hysteroscopic scissor. The patients were visited 2 month later for evaluated surgical outcome. This assessment was done by hysterosalpingography (HSG). Patient’s reproductive outcome were followed for 10. 33 (SD: ±6. 43) months.
ResultsThe mean age in patients was 31. 5 (SD; ±3. 02) years. In whole، 48 patients un-derwent hysteroscopic metroplasty. In 52. 1% length of septum occupied two third of uterine cavity. Eight patients were excluded from the study because of non-reproductive related complains. There were 29 pregnant patients (72. 5%). Fifteen patients became pregnant without intervention (51. 7%). 14 patients had pregnancy under ART، while the pregnancy did not occur in 11 patients (27. 5%) during this period. Among pregnant population there were 9 miscarriage (31%)، 3 preterm (13. 3%) and 17 term delivery (50%). Live birth rate in our study was 68. 9%. In control hysterosalpingography (HSG)، no patients had adhesion or residual ridge.
ConclusionThe findings of this study indicate that hysteroscopic septoplasty is ac-ceptable for improving reproductive outcomes in patients with septate uterus.
Tehran University Medical Journal, Volume:72 Issue:3, 2014
155 - 160
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