Hysteroscopic metroplasty in diethylstilboestrol-exposed and hypoplastic uterus: a report on 24 cases

Abstract

The aim of this study was to determine the feasibility and safety of hysteroscopic metroplasty in cases of diethylstilboestrol-exposed and hypoplastic malformed uterus. Twenty-four patients were referred for primary infertility (n = 9), secondary infertility (n = 1) or infecundity (n = 14). Fifteen had been exposed to diethylstilboestrol in utero. All patients had a hypoplastic uterus and/or uterine deformity as seen by hysterosalpingography and each served as their own control. All patients underwent hysteroscopic metroplasty. Outcome measures included postoperative hysterosalpingography and the ability to conceive and to carry pregnancy to live birth. Postoperative hysterosalpingograms revealed improvement in 23 cases; the final result was considered excellent in 15 cases and 11 pregnancies occurred. The abortion rate decreased from 88% in previous pregnancies to 12.5%, and the rate of term deliveries increased from 3% to 87.5%. Ten patients were delivered after 30 weeks' gestation of healthy infants and one delivered more prematurely. Six deliveries were normal and four required a Caesarean section. We conclude that hysteroscopic metroplasty gives good results. This technique can be used in women with diethylstilboestrol-exposed or hypoplastic malformed uterus, suffering from severe infertility, recurrent pregnancy loss or implantation failures in an in-vitro fertilization programme.

Hysteroscopy in the evaluation of patients with recurrent pregnancy loss: a cohort study in a primary care population

“…Many of the defects are amendable to therapy and they usually have good outcomes; pregnancy rates have been reported from 63% to 87.5% [7,12,15]. Rates of pregnancy after hysteroscopic metroplasty in septated uterus [2], hypoplastic uterus, diethylstilbestrol-exposed uterus [5], or hysteroscopic lysis of intrauterine adhesions are reported to be high, with an 87% pregnancy rate postoperatively [5,12,13]. Some studies have suggested that hysteroscopic metroplasty with the Nd-YAG laser is a valuable new alternative technique for structural uterine defects (SUD) [3,4].…”

Transvaginal hydrolaparoscopy in the treatment of polycystic ovary syndrome

“…When present, 60% was related to a hypoplastic ''T''-shaped uterine cavity. A lateral metroplasty (34) was performed in these patients. The surgical correction of the additional female pathology in 31% of the patients will definitely have a positive effect on pregnancy rates and/or outcome.…”

Pelvic Imaging in Reproductive Endocrinology

“…50 Although authors reporting on small series recount positive impressions about the impact of surgery on subsequent reproductive outcome, 51 the efficacy of these procedures remains to be rigorously evaluated.…”