1. Long-Term Reproductive Outcomes after Hysteroscopic Treatment of Dysmorphic Uteri in Women with Reproductive Failure: An European Multicenter Study
- Author
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Cristina Di Cesare, Amerigo Vitagliano, Attilio Di Spiezio Sardo, Stefano Bettocchi, Fabrizia Santangelo, Brunella Zizolfi, Rose Meier Furst, Rudi Campo, Willem Ombelet, Di Spiezio Sardo, A., Campo, R., Zizolfi, B., Santangelo, F., Meier Furst, R., Di Cesare, C., Bettocchi, S., Vitagliano, A., and Ombelet, W.
- Subjects
Adult ,medicine.medical_specialty ,T-shaped uterus ,Pregnancy Rate ,Metroplasty ,medicine.medical_treatment ,Uterus ,Hysteroscopy ,Intracytoplasmic sperm injection ,Recurrent miscarriage ,Pregnancy ,Retrospective Studie ,Medicine ,Live birth ,Clinical pregnancy ,Hysteroscopic metroplasty ,Infantilis uteru ,Unexplained infertility ,Dysmorphic uterus ,Infantilis uterus ,Infertility ,Office hysteroscopy ,medicine.diagnostic_test ,business.industry ,Obstetrics ,Urogenital Abnormalitie ,Pregnancy Outcome ,Obstetrics and Gynecology ,medicine.disease ,T-shaped uteru ,Europe ,medicine.anatomical_structure ,Tissue Adhesion ,Treatment Outcome ,Uteru ,Uterine Disease ,Female ,Laparoscopy ,Uterine cavity ,Cohort Studie ,business ,Infertility, Female ,Dysmorphic uteru ,Human - Abstract
Objective To evaluate the long-term reproductive outcomes in patients with dysmorphic uterus treated by hysteroscopic metroplasty with miniaturized instruments. Design Retrospective multicenter cohort study. Setting Tertiary care university hospitals. Patients The 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). Interventions All 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 Results The 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. Conclusion Our 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.
- Published
- 2020