Reproductive outcomes of office hysteroscopic metroplasty in women with unexplained infertility with dysmorphic uterus

Abstract

Objective:The correlation between dysmorphic uterus and infertility still remains enigmatic. We evaluated the reproductive outcomes of metroplasty via office hysteroscopy in unexplained infertile women with dysmorphic uteri.Materials and Methods:In this retrospective cohort study, metroplasty via office hysteroscopy using a bipolar system was performed to 272 women with unexplained infertility with dysmorphic uteri from January 2013 to January 2016. Of all the patients, 162 had primary infertility, and 110 had secondary infertility.Results:In the primary infertility group, the clinical pregnancy rate was 45.68% (74/162) and the live birth rate was 38.9% (63/162), and in the secondary infertility group, the clinical pregnancy rate was 55.45% (61/110) and the live birth rate was 49% (54/110) after metroplasty. In the secondary infertility group, the miscarriage rate and especially the ectopic pregnancy rate declined dramatically [from 84.5% (93/110) to 9.8% (6/61) and from 15.5% (17/110) to 1.6% (1/61), respectively] (p<0.01).Conclusion:Reproductive outcome can be impaired by Müllerian anomalies, hence, infertile women with dysmorphic uteri should undergo hysteroscopy to improve reproductive outcomes. Our study demonstrated that office hysteroscopic metroplasty of a dysmorphic uterus might improve fertility, particularly in patients with unexplained infertility with dysmorphic uteri, which was an ignored factor previously. Office hysteroscopy is an alternative option in terms of non-invasive procedure.

Definition, prevalence, clinical relevance and treatment of T‐shaped uterus: systematic review

“…The most accepted definition of RIF in the literature is three consecutive failed IVF attempts with transfer of one to two embryos of high‐grade quality, and based on this definition, the expected prevalence of RIF is approximately 10% 143 . Considering this 10% expected prevalence of three consecutive negative pregnancy tests following embryo transfer (the studies on T‐shaped uterus did not mention the quality of the embryos transferred and therefore the expected prevalence would be higher), we found that one study showed a much higher incidence (35.1%) 123 of RIF in women with T‐shaped uterus, one reported a similar proportion (14.3%) 126 and one reported a lower proportion (3.7%) 128 of RIF in women with T‐shaped uterus.…”

“…We evaluated 132 potentially eligible records in full text, of which 112 were excluded because T‐shaped uterus was related to DES exposure ( n = 64) 5,13–75 ; the article was not related to T‐shaped uterus ( n = 26) 76–101 ; the study included fewer than 10 women with a T‐shaped uterus ( n = 15) 4,102–115 ; no detailed results for T‐shaped uterus were reported ( n = 4) 116–119 ; and the article was a descriptive review ( n = 3) 120–122 . Therefore, 20 studies were eventually included in this systematic review 2,9,123–140 (Figure 1).…”

“…Since there are concerns that T‐shaped uterus may be associated with poor reproductive outcome, some authors are proposing hysteroscopic metroplasty as potential treatment for T‐shaped uterus in patients with a history of impaired reproductive outcome. Recently, a cascade of surgical reports on metroplasty of T‐shaped uterus has been published 2,123,125–130,135–137,139 (Table S2). All the studies mentioned improvement of reproductive outcome in patients with T‐shaped uterus after metroplasty: eight studies reported an increase in pregnancy rate 123,125–128,135,137,139 , seven studies reported increase in live‐birth rate 2,123,125,127,129,130,135 , five studies reported reduction in miscarriage rate 2,127–129,137 , four studies reported increased term‐delivery rate 128,135–137 and one study reported reduction in ectopic‐pregnancy rate 128 (Table 3).…”

Dysmorphic Uteri: Obstetric Results after Hysteroscopic Office Metroplasty in Infertile and Recurrent Pregnancy Loss Patients. A Prospective Observational Study

“…Studies such as the ones conducted by Şükür et al [ 13 ] and Giacomucci et al [ 14 ] compare obstetric results in patients diagnosed with all three types of malformations, whereas the retrospective studies by Ferro et al [ 6 ], Ducellier-Azzola et al [ 3 ] and Haydardedeoğlu et al [ 15 ], as well as the prospective studies by Di Spiezio Sardo et al [ 12 ] and Alonso-Pacheco et al [ 4 ] only evaluate obstetric results in patients with dysmorphic uteri before and after HOME-DU. All of them conclude that there is a statistically significant increase in the rates of spontaneous conception and live birth after HOME-DU.…”

Útero em forma de \"T\": definição, critérios diagnósticos, prevalência, implicações clínicas e tratamento

“…antecedentes de resultados reprodutivos ruins: infertilidade(13,26,27), abortamento(20,21,(26)(27)(28), aborto de repetição(20,21,(26)(27)(28), parto pré-termo(29,30), falha de implantação(20,21,27- 29,31) e gravidez ectópica(29). Não há dados referentes a desfechos reprodutivos do útero em "T" na população geral; não se sabe, portanto, quantas mulheres conseguem alcançar gravidez bem-sucedida apesar de ter útero em "T", pois elas não chegam aos serviços de medicina reprodutiva.…”