Reproductive outcome following hysteroscopic septal resection in patients with infertility and recurrent abortions.

OBJECTIVES

To evaluate the outcome of hysteroscopic septal resection in patients with infertility and recurrent abortions.

MATERIALS AND METHODS

This was a retrospective clinical analysis of 170 patients who underwent hysteroscopic septal resection by monopolar electrode (Collin's) knife. A second-look office hysteroscopy was performed in all cases within 2 months. The mean follow-up period was 28.5 months.

RESULTS

The mean age of the patients was 25.6 years. The presenting clinical complaint was recurrent abortions in 68.2% patients, infertility in 17.6% patients and preterm deliveries in 14.1% patients. Final reproductive outcome was assessed for 152 patients, after excluding patients with other confounding factors, interfering in pregnancy outcome. There was a significant difference in reduction of number of miscarriages (91.5% pre-surgery; 12.9% post-surgery: p = 0.02) and increase in term deliveries (2.5% pre-surgery; 79.5% post-surgery: p = 0.01), while the number of preterm deliveries remained almost the same (6.1% pre-surgery; 7.5% post-surgery). Thirteen out of 23 infertile patients (56.5%) conceived after septal resection. The take home baby rate was increased from 8.5 to 87.1%. Cumulative first live birth rate revealed that 51.2% women had their first live birth within 10-15 months. There was an increased incidence (43.2%) of cesarean section in mode of delivery. In 11/170 patients, repeat hysteroscopy suggested the presence of uterine adhesions which needed hysteroscopic adhesiolysis and three patients required repeat septal resection.

CONCLUSIONS

Hysteroscopic septal resection for women with history of recurrent abortions, preterm deliveries and in women with infertility is a safe and effective method of choice for improving the obstetric outcome.