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Reproductive outcomes and risk factors of women with septate uterus after hysteroscopic metroplasty

BACKGROUND: Hysteroscopic metroplasty of the uterine septum has been the standard treatment strategy to improve reproductive outcomes, but there are still controversies about the appropriateness of metroplasty. In addition, there have been few studies of the factors related to reproductive outcomes...

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Autores principales: Chang, Yanan, Shen, Minghong, Wang, Sha, Guo, Zhengchen, Duan, Hua
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10285310/
https://www.ncbi.nlm.nih.gov/pubmed/37361532
http://dx.doi.org/10.3389/fendo.2023.1063774
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author Chang, Yanan
Shen, Minghong
Wang, Sha
Guo, Zhengchen
Duan, Hua
author_facet Chang, Yanan
Shen, Minghong
Wang, Sha
Guo, Zhengchen
Duan, Hua
author_sort Chang, Yanan
collection PubMed
description BACKGROUND: Hysteroscopic metroplasty of the uterine septum has been the standard treatment strategy to improve reproductive outcomes, but there are still controversies about the appropriateness of metroplasty. In addition, there have been few studies of the factors related to reproductive outcomes of women after surgery. The study aimed to evaluate the reproductive outcomes and the associated risk factors that influence reproductive outcomes after hysteroscopic metroplasty of women with septate uterus and the desire to conceive. METHODS: This study was an observational study. Cases were screened by searching electronic patient files, and demographic factors were collected. We conducted telephone follow-ups to collect the postoperative reproductive outcomes. The primary outcome of this study was live birth, and secondary outcomes were ongoing pregnancy, clinical pregnancy, early miscarriage, and preterm birth. Demographic variables included patients’ age, body mass index (BMI), the type of septum, infertility and miscarriage history, and complications including intrauterine adhesions, endometrial polyps, endometriosis, and adenomyosis were collected to perform univariate and multivariate analyses to predict the risk factors of reproductive outcomes after surgery treatment. RESULTS: In total, 348 women were evaluated and followed up. There were 95 cases (27.3%, 95/348) with combined infertility, 195 cases (56.0%, 195/348) with miscarriage history, and cases combined with intrauterine adhesions, endometrial polyps, endometriosis, and adenomyosis were 107 (30.7%, 107/348), 53 (15.2%, 53/348), 28 (8.0%, 28/348), and 5 (1.4%), respectively. Following surgery, the live birth rate and clinical pregnancy rate were significantly higher than prior to surgery (84.6% vs 3.7%, p= 0.000; and 78.2% vs 69.5%, p= 0.01, respectively), early miscarriage rate and preterm delivery rate were significantly lower (8.8% vs 80.6%, p= 0.000; and 7.0% vs 66.7%, p=0.000, respectively). After adjusting for body mass index, miscarriage history, and complications, multivariable logistic regression analysis revealed age ≥ 35 years and primary infertility as independent factors that affected postoperative clinical pregnancy (OR 4.025, 95% CI 2.063–7.851, p= 0.000; and OR 3.603, 95% CI 1.903–6.820, p= 0.000; respectively) and ongoing pregnancy (OR 3.420, 95% CI 1.812–6.455, p= 0.000; and OR 2.586, 95% CI 1.419–4.712, p= 0.002; respectively). CONCLUSIONS: Hysteroscopic metroplasty could lead to improved reproductive outcomes of women with septate uterus. Both age and primary infertility were independent factors for postoperative reproductive outcomes. TRIAL REGISTRATION: Chi ECRCT20210343
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spelling pubmed-102853102023-06-23 Reproductive outcomes and risk factors of women with septate uterus after hysteroscopic metroplasty Chang, Yanan Shen, Minghong Wang, Sha Guo, Zhengchen Duan, Hua Front Endocrinol (Lausanne) Endocrinology BACKGROUND: Hysteroscopic metroplasty of the uterine septum has been the standard treatment strategy to improve reproductive outcomes, but there are still controversies about the appropriateness of metroplasty. In addition, there have been few studies of the factors related to reproductive outcomes of women after surgery. The study aimed to evaluate the reproductive outcomes and the associated risk factors that influence reproductive outcomes after hysteroscopic metroplasty of women with septate uterus and the desire to conceive. METHODS: This study was an observational study. Cases were screened by searching electronic patient files, and demographic factors were collected. We conducted telephone follow-ups to collect the postoperative reproductive outcomes. The primary outcome of this study was live birth, and secondary outcomes were ongoing pregnancy, clinical pregnancy, early miscarriage, and preterm birth. Demographic variables included patients’ age, body mass index (BMI), the type of septum, infertility and miscarriage history, and complications including intrauterine adhesions, endometrial polyps, endometriosis, and adenomyosis were collected to perform univariate and multivariate analyses to predict the risk factors of reproductive outcomes after surgery treatment. RESULTS: In total, 348 women were evaluated and followed up. There were 95 cases (27.3%, 95/348) with combined infertility, 195 cases (56.0%, 195/348) with miscarriage history, and cases combined with intrauterine adhesions, endometrial polyps, endometriosis, and adenomyosis were 107 (30.7%, 107/348), 53 (15.2%, 53/348), 28 (8.0%, 28/348), and 5 (1.4%), respectively. Following surgery, the live birth rate and clinical pregnancy rate were significantly higher than prior to surgery (84.6% vs 3.7%, p= 0.000; and 78.2% vs 69.5%, p= 0.01, respectively), early miscarriage rate and preterm delivery rate were significantly lower (8.8% vs 80.6%, p= 0.000; and 7.0% vs 66.7%, p=0.000, respectively). After adjusting for body mass index, miscarriage history, and complications, multivariable logistic regression analysis revealed age ≥ 35 years and primary infertility as independent factors that affected postoperative clinical pregnancy (OR 4.025, 95% CI 2.063–7.851, p= 0.000; and OR 3.603, 95% CI 1.903–6.820, p= 0.000; respectively) and ongoing pregnancy (OR 3.420, 95% CI 1.812–6.455, p= 0.000; and OR 2.586, 95% CI 1.419–4.712, p= 0.002; respectively). CONCLUSIONS: Hysteroscopic metroplasty could lead to improved reproductive outcomes of women with septate uterus. Both age and primary infertility were independent factors for postoperative reproductive outcomes. TRIAL REGISTRATION: Chi ECRCT20210343 Frontiers Media S.A. 2023-06-08 /pmc/articles/PMC10285310/ /pubmed/37361532 http://dx.doi.org/10.3389/fendo.2023.1063774 Text en Copyright © 2023 Chang, Shen, Wang, Guo and Duan https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Endocrinology
Chang, Yanan
Shen, Minghong
Wang, Sha
Guo, Zhengchen
Duan, Hua
Reproductive outcomes and risk factors of women with septate uterus after hysteroscopic metroplasty
title Reproductive outcomes and risk factors of women with septate uterus after hysteroscopic metroplasty
title_full Reproductive outcomes and risk factors of women with septate uterus after hysteroscopic metroplasty
title_fullStr Reproductive outcomes and risk factors of women with septate uterus after hysteroscopic metroplasty
title_full_unstemmed Reproductive outcomes and risk factors of women with septate uterus after hysteroscopic metroplasty
title_short Reproductive outcomes and risk factors of women with septate uterus after hysteroscopic metroplasty
title_sort reproductive outcomes and risk factors of women with septate uterus after hysteroscopic metroplasty
topic Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10285310/
https://www.ncbi.nlm.nih.gov/pubmed/37361532
http://dx.doi.org/10.3389/fendo.2023.1063774
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