Optimal waiting period for subsequent fertility treatment after various hysteroscopic surgeries

Yang, Jyh‐Chin; Chen, Mei-Jou; Chen, Chin-Der; Chen, Shee‐Uan; Ho, Hong Nerng; Yang, Yu Shih

doi:10.1016/j.fertnstert.2013.01.137

Cited by 108 publications

(87 citation statements)

References 28 publications

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“…Hysteroscopic metroplasty may have good obstetric outcomes and rare complications as reported in non-controlled reports (Nouri et al , 2010; Valle and Ekpo, 2013), but abnormal anatomic results (ARs) occur with wide variation (Porcu et al , 2000; Mollo et al , 2011; Yang et al , 2013; Ludwin et al , 2014a). Abnormal anatomic results may include a residual septum (RS) at the uterine fundus and isolated intrauterine adhesions in other locations (IUA-OLs) (Ludwin et al , 2014a).…”

Section: Introductionmentioning

confidence: 99%

Role of morphologic characteristics of the uterine septum in the prediction and prevention of abnormal healing outcomes after hysteroscopic metroplasty

Ludwin

Pityński

et al. 2014

Human Reproduction

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STUDY QUESTIONCan morphologic measurements (width, length and surface area) of the uterine septum predict healing-dependent abnormal anatomic results [ARs; residual septum (RS) and intrauterine adhesions in other locations (IUA-OLs)] after complete hysteroscopic metroplasty (HM)?SUMMARY ANSWERSignificant predictors of ARs are the septal width and, to a lesser extent, septal surface area.WHAT IS KNOWN ALREADYAnatomic results after hysteroscopic metroplasty have very large variation. A RS >1 cm and IUA-OLs can aggravate reproductive outcomes, resulting in the need for reoperation. New criteria for diagnosing a uterine septum according to the European Society of Human Reproduction and Embryology (ESHRE) and European Society for Gynaecological Endoscopy (ESGE) have been suggested (ESHRE-ESGE criteria). Autocross-linked hyaluronic acid gel (autocross-linked polysaccharide) has an antiadhesive effect.STUDY DESIGN, SIZE, DURATIONA prospective, observational cohort study was performed with 96 women consecutively enrolled between 2007 and 2012.PARTICIPANTS/MATERIALS, SETTING, METHODSWomen who had uterine septum and previous miscarriage or infertility presented for evaluation at a university hospital, private hospital or private medical center were included. Preoperative septal width, length and surface area were determined with three-dimensional sonohysterography. Women were treated by hysteroscopy in a standardized manner with three- or four-dimensional transrectal ultrasound guidance (complete resection). Patients received either no adhesion barrier (49 patients) or adhesion barrier with autocross-linked polysaccharide (47 patients). Anatomic results were assessed with three-dimensional sonohysterography and second-look hysteroscopy. Healing-dependent ARs were reported using both American Society of Reproductive Medicine (ASRM) criterion of RS length >1 cm (ASRM>1 cm criterion) and ESHRE-ESGE criteria. Univariate and multivariate logistic regression were used to identify predictors of RS, IUA-OLs and ARs.MAIN RESULTS AND ROLE OF CHANCEIn patients who had no adhesion barrier, ARs were diagnosed in 11 of 49 patients (23%) using the ASRM > 1 cm criterion and in 20 of 49 patients (41%) using the ESHRE-ESGE criteria for RS [odds ratio (OR)ESHRE-ESGE:ASRM, 2.4, P = 0.05]. In the patients who had autocross-linked polysaccharide, ARsASRM > 1 cm were diagnosed in 2 of 47 patients (4%) and ARsESHRE-ESGE in 4 of 47 patients (9%). RSESHRE-ESGE was diagnosed significantly more often than RSASRM > 1 cm 19 of 96 (20%) versus 5 of 96 (5%) in all patients (ORESHRE-ESGE:ASRM > 1 cm = 4.5, P < 0.01). In patients who had no adhesion barrier, logistic regression with ASRM > 1 cm and ESHRE-ESGE criteria showed that the width and surface area were predictors of ARs. Models adjusted by patient group confirmed the significance of width as a predictor of ARsASRM > 1 cm [OR for width, 3.5 (P < 0.01); OR for group, 0.22 (P < 0.01)], width as a predictor of ARsESHRE-ESGE [OR for width, 2.2 (P < 0.01); OR for group, 0.26 (P < 0.01)] and surface area...

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Section: Introductionmentioning

confidence: 99%

Role of morphologic characteristics of the uterine septum in the prediction and prevention of abnormal healing outcomes after hysteroscopic metroplasty

Ludwin

Pityński

et al. 2014

Human Reproduction

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“…The duration of the endometrial wound healing differs according to the type of pathology as reported by Yang and coworkers in a prospective cohort study of 163 women undergoing operative hysteroscopy [5]. At second-look hysteroscopy 1 month after operative hysteroscopy, more women achieved a full healing of the endometrial cavity after removal of endometrial polyps (32/37 women or 86 %) compared to adhesiolysis (30/45 women or 67 %), metroplasty (3/16 women or 19 %), or myomectomy (12/65 women or 18 %) (P<0.05).…”

Section: Introductionmentioning

confidence: 91%

Belgian consensus on adhesion prevention in hysteroscopy and laparoscopy

Verguts

Bosteels

Roberta³

et al. 2015

Gynecol Surg

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Intrauterine and intraabdominal adhesions are a major cause for infertility. The most recent investigations have demonstrated the potential of intraperitoneal adhesion barriers combined with good surgical technique to reduce adhesion formation. For intrauterine adhesions we suggest to minimize unipolar and bipolar instrumentation whenever possible. We advocate the use of estrogens for 10 days after adhesiolysis: 2dd two tablets of estradiol 2 mg. Instillation of Hyalobarrier Gel Endo actually is not reimbursed but may have a beneficial effect after myomectomy or adhesiolysis. Concerning laparoscopic and laparotomic prevention of adhesion also, meticulous surgical technique is of the utmost importance. Residual blood should be avoided by careful hemostasis and rinsing with Ringer's lactate with heparin. Preferably braided sutures are not to be left in the abdominal cavity. We advise to avoid unipolar and bipolar cauterization when possible and to replace with ultrasonic or laser energy. The use of floatation barriers does not seem to add substantial benefit in the prevention of adhesions. Gel barriers (Hyalobarrier Gel Endo® or Intercoat®) are proven to have a significant effect on adhesion prevention. As for sheets, there is enough evidence that they prevent adhesions. The use of NSAID in the prevention of pain and/or corticosteroids in the prevention of postoperative nausea is already mainstay after surgery and can be further endorsed in the prevention of adhesions.

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“…Yang et al ont étudié dans une étude prospective le délai de cicatrisation endométriale selon le type de résection hystéroscopique : une cicatrisation endométriale est géné-ralement obtenue en 1 à 2 mois pour la polypectomie et la section de cloison et à 3 mois pour la myomectomie et la cure de synéchie [153].…”

Section: Réalisation D'une Hystéroscopie Précoceunclassified