Efficiency and pregnancy outcome of serial intrauterine device-guided hysteroscopic adhesiolysis of intrauterine synechiae.

Abstract

OBJECTIVE:

To highlight the efficiency of intrauterine device (IUD) guidance during hysteroscopic adhesiolysis for severe intrauterine adhesions.

DESIGN:

A prospective, randomized trial.

SETTING:

Private tertiary and referral infertility clinic.

PATIENT(S):

Seventy-one subfertile patients who underwent hysteroscopic treatment of intrauterine synechiae or adhesions.

INTERVENTION(S):

Thirty-six women in group 1 were initially examined by laparoscopy-hysteroscopy at first look, and an IUD was inserted during hysteroscopic adhesiolysis. The adhesions were further lysed by the guidance of IUD during the second-look office hysteroscopy, 1 week later. Patients were prescribed 2 months of estrogen as well as P therapy, and the IUD was removed by the end of this period. The uterine cavity was evaluated, and adhesions were further lysed by a third-look office hysteroscopy, 1 week after the removal of IUD. Thirty-five women in group 2 were similarly examined by first-look office hysteroscopy, and an IUD was inserted during hysteroscopic adhesiolysis. These patients did not undergo early intervention of office hysteroscopy, 1 week after the first procedure. They also used 2 months of estrogen and P therapy. The IUD was removed by the end of this period, and the uterine cavity was evaluated and adhesions were further lysed during a second-look office hysteroscopy.

MAIN OUTCOME MEASURE(S):

Pregnancy rate and live birth rate.

RESULT(S):

Spontaneous pregnancy rates after treatment were 17/36 (47.2%) and 11/35 (30%), and live birth rates were 10/36 (28%) and 7/35 (20%) in groups 1 and 2, respectively. These differences between the two groups were not statistically significant.

CONCLUSION(S):

The method described especially for early intervention may prevent complications during the treatment of severe intrauterine adhesions and may present a secure and effective alternative for constructive clinical outcomes.

• Authors: Recai Pabuccu, Gogsen Onalan, Cemil Kaya, Belgin Selam, Temel Ceyhan, Turkan Ornek, Ebru Kuzudisli
• Journal: Fertility and sterility (Fertil Steril) Vol. 90 Issue 5 Pg. 1973-7 (Nov 2008) ISSN: 1556-5653 [Electronic] United States
• PMID: 18774563 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Estrogens
• Estrogens, Conjugated (USP)
• Progestins
• Medroxyprogesterone Acetate

Topics

• Adult
• Estrogens (administration & dosage)
• Estrogens, Conjugated (USP) (administration & dosage)
• Female
• Fertilization in Vitro
• Humans
• Hysteroscopy (adverse effects)
• Infertility, Female (drug therapy, etiology, pathology, surgery)
• Intrauterine Devices
• Laparoscopy (adverse effects)
• Live Birth
• Medroxyprogesterone Acetate (administration & dosage)
• Pregnancy
• Pregnancy Rate
• Progestins (administration & dosage)
• Prospective Studies
• Time Factors
• Tissue Adhesions
• Treatment Outcome
• Uterine Diseases (complications, drug therapy, pathology, surgery)