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Factors That Impact Fertility after Hysteroscopic Adhesiolysis for Intrauterine Adhesions and Amenorrhea: A Retrospective Cohort Study.
J Minim Invasive Gynecol. 2020 01; 27(1):54-59.JM

Abstract

STUDY OBJECTIVE

To identify factors that affect reproductive outcomes after hysteroscopic adhesiolysis in patients with severe intrauterine adhesions (IUAs, scored between 9 and 12 according to the American Fertility Society classification) and amenorrhea.

DESIGN

A retrospective cohort study.

SETTING

A university-affiliated hospital.

PATIENTS

One hundred fifty-one patients with severe IUAs and amenorrhea.

INTERVENTION

Patients were diagnosed via hysteroscopy and underwent at least 1 hysteroscopic adhesiolysis between May 2012 and January 2016.

MEASUREMENTS AND MAIN RESULTS

Of 151 patients, 12 were lost to follow-up, and 139 were included in the study with a follow-up period ranging from 2 to 6 years. Of the 139 evaluable patients, 107 (77%) recovered with a normal uterine cavity (free of IUAs), 28 (20.1%) had improved uterine cavity (fewer IUAs), and 4 (2.9%) showed no improvement. Moreover, 79 patients (56.8%) recovered with normal menstruation, 54 (38.9%) showed increased frequency of menstruation, and 6 (4.3%) had persistent amenorrhea. Seventy-seven (55.4%) became pregnant, of whom 13 had a spontaneous miscarriage, 11 birthed prematurely (at 31-36 gestational weeks), 44 experienced term delivery, and 9 were still pregnant at the end of the study. Age >32 years (p = .002, odds ratio [OR] = 3.442), >2 surgeries (p = .027, OR = 2.969), cervical canal adhesions (p = .047, OR = 2.112), and disease course >6 months (p = .037, OR = 2.335) were risk factors for infertility in patients with severe IUAs and amenorrhea.

CONCLUSION

Younger age, earlier treatment within the disease course, fewer cervical canal adhesions, and fewer surgical procedures improve the reproductive outcome in patients with severe IUAs and amenorrhea.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, Hunan, China (all authors).Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, Hunan, China (all authors).Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, Hunan, China (all authors).Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, Hunan, China (all authors).Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, Hunan, China (all authors). Electronic address: 1196350112@qq.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30880159

Citation

Chen, Lixing, et al. "Factors That Impact Fertility After Hysteroscopic Adhesiolysis for Intrauterine Adhesions and Amenorrhea: a Retrospective Cohort Study." Journal of Minimally Invasive Gynecology, vol. 27, no. 1, 2020, pp. 54-59.
Chen L, Xiao S, He S, et al. Factors That Impact Fertility after Hysteroscopic Adhesiolysis for Intrauterine Adhesions and Amenorrhea: A Retrospective Cohort Study. J Minim Invasive Gynecol. 2020;27(1):54-59.
Chen, L., Xiao, S., He, S., Tian, Q., & Xue, M. (2020). Factors That Impact Fertility after Hysteroscopic Adhesiolysis for Intrauterine Adhesions and Amenorrhea: A Retrospective Cohort Study. Journal of Minimally Invasive Gynecology, 27(1), 54-59. https://doi.org/10.1016/j.jmig.2018.12.023
Chen L, et al. Factors That Impact Fertility After Hysteroscopic Adhesiolysis for Intrauterine Adhesions and Amenorrhea: a Retrospective Cohort Study. J Minim Invasive Gynecol. 2020;27(1):54-59. PubMed PMID: 30880159.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Factors That Impact Fertility after Hysteroscopic Adhesiolysis for Intrauterine Adhesions and Amenorrhea: A Retrospective Cohort Study. AU - Chen,Lixing, AU - Xiao,Songshu, AU - He,Sili, AU - Tian,Qi, AU - Xue,Min, Y1 - 2019/03/14/ PY - 2018/09/13/received PY - 2018/12/05/revised PY - 2018/12/10/accepted PY - 2019/3/19/pubmed PY - 2020/8/20/medline PY - 2019/3/19/entrez KW - Infertility KW - Intrauterine adhesions KW - Reproductive outcome KW - Risk factors SP - 54 EP - 59 JF - Journal of minimally invasive gynecology JO - J Minim Invasive Gynecol VL - 27 IS - 1 N2 - STUDY OBJECTIVE: To identify factors that affect reproductive outcomes after hysteroscopic adhesiolysis in patients with severe intrauterine adhesions (IUAs, scored between 9 and 12 according to the American Fertility Society classification) and amenorrhea. DESIGN: A retrospective cohort study. SETTING: A university-affiliated hospital. PATIENTS: One hundred fifty-one patients with severe IUAs and amenorrhea. INTERVENTION: Patients were diagnosed via hysteroscopy and underwent at least 1 hysteroscopic adhesiolysis between May 2012 and January 2016. MEASUREMENTS AND MAIN RESULTS: Of 151 patients, 12 were lost to follow-up, and 139 were included in the study with a follow-up period ranging from 2 to 6 years. Of the 139 evaluable patients, 107 (77%) recovered with a normal uterine cavity (free of IUAs), 28 (20.1%) had improved uterine cavity (fewer IUAs), and 4 (2.9%) showed no improvement. Moreover, 79 patients (56.8%) recovered with normal menstruation, 54 (38.9%) showed increased frequency of menstruation, and 6 (4.3%) had persistent amenorrhea. Seventy-seven (55.4%) became pregnant, of whom 13 had a spontaneous miscarriage, 11 birthed prematurely (at 31-36 gestational weeks), 44 experienced term delivery, and 9 were still pregnant at the end of the study. Age >32 years (p = .002, odds ratio [OR] = 3.442), >2 surgeries (p = .027, OR = 2.969), cervical canal adhesions (p = .047, OR = 2.112), and disease course >6 months (p = .037, OR = 2.335) were risk factors for infertility in patients with severe IUAs and amenorrhea. CONCLUSION: Younger age, earlier treatment within the disease course, fewer cervical canal adhesions, and fewer surgical procedures improve the reproductive outcome in patients with severe IUAs and amenorrhea. SN - 1553-4669 UR - https://www.unboundmedicine.com/medline/citation/30880159/Factors_That_Impact_Fertility_after_Hysteroscopic_Adhesiolysis_for_Intrauterine_Adhesions_and_Amenorrhea:_A_Retrospective_Cohort_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1553-4650(19)30125-6 DB - PRIME DP - Unbound Medicine ER -