Non-Invasive Isthmocele Treatment: A New Therapeutic Option During Assisted Reproductive Technology Cycles?

Abstract

Background: The objective of the study was to evaluate a new medical treatment strategy for infertile patients with isthmocele. Methods: This was a retrospective evaluation of the records of infertile patients with symptomatic isthmocele who received non-invasive isthmocele treatment (NIIT) before in vitro fertilization (IVF) treatment cycles. Isthmocele volumes were measured before and after NIIT. The IVF results and isthmocele-related complaints were also analyzed. The patients were treated with a depot gonadotropin-releasing hormone agonist for 3 months before frozen-thawed embryo transfer cycles. Results: The mean isthmocele volume was 471.06 ± 182.81 mm 3 (range: 289.43-765.4 mm 3) in fresh cycles, but was reduced to 47.94 ± 29.48 mm 3 (range: 18.70-105.6 mm 3) in frozen-thawed cycles (P < 0.05). Intrauterine fluid was observed in two patients during fresh cycles, but was absent after NIIT during frozen-thawed cycles. There was no brown bloody discharge on the tip of the embryo transfer catheter in any case after NIIT. Two patients became pregnant and underwent term cesarean delivery (25%). Conclusions: NIIT can serve as an alternative pretreatment option for patients with isthmocele during IVF cycles.

Intra-cavitary fluid resulted from caesarean section but not isthmocele compromised clinical pregnancy after IVF/ICSI treatment

“…Our data show that the proportion of ICF associated with hydrosalpinx or OHSS was less than 5%, as fluid associated with hydrosalpinx [ 21 ] and PCOS [ 27 ] has been confirmed to impact clinical outcomes, and most such patients underwent a frozen protocol in our centre. The potential cause of ICF may be explained by endometriosis, a finding that is supported by two other studies in non-tubal factor patients [ 28 , 29 ]. The possible mechanism is stenosis of the cervical canal and formation of isthmocele, which may induce fluid accumulation mechanically or menstrual dripping and can cause difficulty in embryo transfer.…”

“…ICF with a history of CS may result in effusion from the ectopic endometrium in the scar, which has been confirmed pathologically in 28% of hysterectomy specimens of 51 patients in Morris’ study [ 31 ]. Gurbuz et al [ 29 ] provided an indirect evidence by describing a non-invasive isthmocele treatment in which patients were treated with gonadotropin-releasing hormone agonist for 3 months before hormone replacement treatment in FET cycles, which results in 25% of live birth.…”

Reduced pregnancy and live birth rates after in vitro fertilization in women with cesarean section scar diverticulum: A retrospective cohort study

“…Patients with cesarean section scar diverticulum were reported to have a higher risk of being infertile, and minimally invasive hysteroscopic surgery could improve their fertility outcome. [5][6][7] Moreover, an existing isthmocele was reported to have a risk of around 40% to develop an endometrial cavity fluid during ovarian stimulation. Fluid in the cervical canal or uterine cavity could reduce pregnancy rates in women undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET).…”

Isthmocele—a neglected cause of secondary infertility and implantation failure: A case report

“…It is possible that certain patient‐related factors increase adhesion formation or impair wound healing. Furthermore, as isthmocele is a fluid‐filled pouch‐like defect, which resembles the hydrosalpinx condition, 10 the immunological aspect of uterine endometrium is also an interesting research area as the accumulation of blood and fluid may be associated with infection and chronic endometritis 11 which may lead to recurrent implantation failure. As a result, it would be advisable to assess the causes of chronic endometritis including isthmocele formation in cases of repeated implantation failure.…”