Reproductive outcomes in women with mild intrauterine adhesions; a systematic review and meta-analysis

Abstract

Background: Moderate to severe intrauterine adhesions (IUAs) may greatly impact fertility, predisposing to pregnancy and obstetric complications. The impact of mild IUAs on reproductive performance remains unclear. A systematic review and meta-analysis was performed to examine the long-term reproductive outcomes in women with hysteroscopic identified and treated mild IUAs mild intrauterine adhesions (IUAs) Methods: An electronic literature search was conducted using MEDLINE and EMBASE from inception to June 2019. All prospective cohort, cross-sectional studies or randomized controlled trials Clinical trials in which reproductive outcomes of women with mild IUAs, were reported were included. Results: Five studies, reporting on reproductive outcomes of 229 women with hysteroscopic identified and treated mild IUAs, were included. The pregnancy rate was 62.3% (142 of 228; 95% CI: 0.55-0.72, I 2 25%, p ¼ .21) and in 86.6% (123 of 142) a live birth was encountered (95% CI: 0.71-0.97) with 83.1% (108 out of 130) term deliveries (95% CI: 0.53-0.95). A miscarriage was reported in 10% (13 of 130; 95% CI: 0.02-0.26). Due to the lack of a control group, reproductive outcomes were compared to a general population. Pregnancy and live birth rates were significantly lower in women with identified and treated mild IUAs, 90% versus 62.3% and respectively 99.5% versus 86.6%. The miscarriage rate was similar. Data on obstetric and neonatal outcomes are lacking. Conclusions: Women with hysteroscopic identified and treated mild IUAs seem to have lower pregnancy and live birth rate compared to the general population. Future studies consisting of a large cohort of women with hysteroscopic identified and treated IUAs with structural followup and a control group are needed to confirm our findings.

The link between intrauterine adhesions and impaired reproductive performance: a systematic review of the literature

“…There is a link between IUAs and impaired reproductive performance [ 4 , 24 , 26 , 27 ]. The mechanisms and processes underlying the associations between IUAs and impaired fertility, pregnancy outcomes and obstetric complications have not been reported previously.…”

“…IUAs are a cause of significant morbidity [25][26][27]91], and the health burden and costs associated with IUAs are substantial [92]. The reproductive outcomes of women with IUAs remain limited and inefficient compared with those without IUAs, even after adhesiolysis [26,27].…”

“…The impact of intrauterine scarring on fertilization is complex. IUAs can have an adverse effect on fertility, predisposing to pregnancy and obstetric complications in subsequent pregnancies [ 4 , 24 , 26 , 27 ]. The aim of the current review is to examine possible mechanisms and (interconnected) processes to explain the compromised reproductive performance and outcomes in the case of pregnancy-related IUAs.…”

Complex Uterine Cavity Abnormalities Increase the Risk of Miscarriage in In Vitro Fertilization/Intracytoplasmic Sperm Injection in Fresh Cycle-Assisted Pregnancies

“…IUAs are reportedly responsible for increased spontaneous abortion rates and reduced live birth rates, reporting a 40% early abortion rate in untreated patients [30]. In one meta-analysis, pregnancy and live birth rates were found to be lower in women with mild IUAs treated by hysteroscopy than those in the general population [31]. Generally, the severity of IUAs correlates with pregnancy outcomes, with high rates of miscarriage and recurrence in severe adhesions.…”

A meta-analysis of obstetric and neonatal outcomes in patients after treatment of hysteroscopic adhesiolysis

“…However, a detailed distinction was not made between the placenta accreta spectrum, the analysis had no control group, and the final incidence of integration obtained was compared with the general population, which created a large bias (7). In 2021, Hooker reviewed 5 papers that analyzed the obstetric outcomes of mild intrauterine adhesions, but the associated obstetric complications were not mentioned (30). Our systematic evaluation includes obstetric complications and adds studies published in the last 3 years, thus providing updated data on the incidence of obstetric complications in patients with pregnancies after hysteroscopic adhesiolysis.…”