Wang, X., Hou, H., & Yu, Q. (2019). Fertility and pregnancy outcomes following hysteroscopic metroplasty of different sized uterine septa: A retrospective cohort study protocol. Medicine, 98(30), e16623. https://doi.org/10.1097/MD.0000000000016623
Wang X, Hou H, Yu Q. Fertility and pregnancy outcomes following hysteroscopic metroplasty of different sized uterine septa: A retrospective cohort study protocol. Medicine (Baltimore). 2019;98(30):e16623. doi:10.1097/MD.0000000000016623
Wang, Xi, et al. "Fertility and pregnancy outcomes following hysteroscopic metroplasty of different sized uterine septa: A retrospective cohort study protocol." Medicine, vol. 98, no. 30, 2019, pp. e16623.
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Complete uterine septum had fewer pregnancies than small after surgery
A retrospective study of 121 women found women with a complete uterine septum got pregnant less often after surgery than women with a small partial septum. After a year or more, about 7 out of 10 with a complete septum got pregnant. In this cohort, about 9 out of 10 with a small partial septum did.
Key Findings
Pregnancy after at least 12 months of follow-up: 71.43% with a complete septum (25 of 35 women) and 89.47% with a small partial septum (34 of 38 women), P = .048.
Vaginal delivery was 11.43% in the complete septum group and 34.21% in the small partial septum group (P = .01).
Pregnancy losses (labeled abortions in the paper) fell in every group after surgery: from 62.86% to 28.57% (complete septum), 79.17% to 14.58% (large partial), 68.42% to 18.42% (small partial).
Term deliveries rose from 0 before surgery to 45.71% (complete septum), 54.17% (large partial septum) and 65.79% (small partial septum).
The surgery had no serious immediate complications. A leftover septum appeared in 4 women and scar tissue inside the uterus (intrauterine adhesions) in 6. All 6 had a second operation.
Interpretation
This cohort study followed 121 women who had surgery to remove a uterine septum. Researchers compared each woman's pregnancy results before and after surgery. The authors note that removing a complete septum leaves a larger area of healing tissue, and they link this to the lower pregnancy rate in that group. The findings support larger studies of septum size and fertility outcomes after surgery.
RRM Context
Restorative reproductive medicine looks for the cause before treating. A septum is a cause that imaging and hysteroscopy can find. This cohort also screened out other causes, including a partner's abnormal semen analysis. Unexplained infertility means undiagnosed infertility, and the uterus is one place to look.
Our editorial summary of this paper, not the article's abstract.
Abstract
Different sizes of uterine septum between infertile women and patients with abortions may have a clinical relevance in reproductive performance after surgery. This study aimed to assess if the fecundity of women after surgical correction of the uterine septum is associated with septum size.A retrospective, single-center, cohort study was conducted in Peking Union Medical College Hospital using patients aged between 21 and 37 years. Hysteroscopic metroplasty was performed on 121 patients with a uterine septum. The septum size was assessed by ultrasonography and hysteroscopy. The subjects were divided into 3 groups: Group A consisted of 35 women with complete uterine septum (mean ± standard deviation (SD) age 28.29 ± 3.53; group B consisted of 48 women with uterine septum >2.5 cm (mean ± SD age 28.85 ± 3.63); and group C consisted of 48 women with uterine septum ≤2.5 cm (mean ± SD age 28.79 ± 3.74). Age and body mass index (BMI) were not significantly different among the 3 groups.No serious hysteroscopic complications occurred. However, uterine septa were observed in 4 cases after surgery and 6 cases of intrauterine adhesions were observed after long-term follow-up. The abortion rate decreased, and term delivery rate increased significantly in the 3 groups after hysteroscopic metroplasty. The infertility rate was significantly lower in group C after surgery. However, no significant difference was observed in the infertility rate between groups A and B. The recurrent abortion rate was significantly lower in group A than in groups B and C before surgery. After surgery, the infertility rate was significantly higher in group A than in group B (28.57% and 10.53%, respectively; P = .048). After at least 12-months of follow-up, the pregnancy rate in group A was significantly lower than that in group C (71.43% and 89.47%, respectively; P = .048).Uterine septum resection improves obstetrical outcomes. After surgery, the infertility rate was significantly higher in patients with complete uterine septum than in those with a large partial uterine septum, and the pregnancy rate in patients with complete uterine septum was lower than that in the patients with a small partial uterine septum.
How fertility-preserving surgery differs by approach: restorative (RRM), specialist, and conventional, across endometriosis, ovarian cysts, PMOS / PCOS, fibroids, tubal disease, Asherman's syndrome, adenomyosis, cesarean scar, pelvic adhesions, and male-factor causes including varicocele and obstruction.
