Centro Gutenberg, Málaga, Spain.
Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy.
Eur J Obstet Gynecol Reprod Biol. 2019 Dec;243:173-178. doi: 10.1016/j.ejogrb.2019.09.023. Epub 2019 Sep 21.
To evaluate the effectiveness of hysteroscopic outpatient metroplasty in women with T-shaped uterus and primary reproductive failure.
Prospective cohort study including nulliparous women with primary unexplained infertility, repeated in vitro fertilization (IVF) failure or recurrent spontaneous miscarriage and T-shaped uterus anomaly not diethylstilbestrol-related, diagnosed by 3D ultrasound and diagnostic hysteroscopy. Between January 2015 and December 2017, hysteroscopic metroplasty was performed in outpatient settings with a 5-mm diameter hysteroscope and 5-Fr operative scissors. After 3 months, expectant management was proposed to women with unexplained couple infertility or recurrent spontaneous miscarriages, and IVF treatment was proposed after 6 months without natural conception or immediately to couple with repeated IVF failure. Minimum follow-up was planned for 1 year.
A total of 63 women were included, and only 60 tried to conceive after metroplasty. Hysteroscopic procedures were performed without complications. Clinical pregnancy rate after metroplasty was 83.3% (n = 50/60) (p < 0.001), and the live birth rate was 63.3% (n = 38/60) (p < 0.001). Cesarean section rate was 26.3%. No pregnancy complications potentially related to uterine surgery were reported. The abortion rate was 12% (n = 6/50) (p < 0.001).
In women with primary reproductive failure and T-shaped uterus, hysteroscopic metroplasty seems to be effective to improve reproductive outcomes.
评估宫腔镜门诊子宫整形术治疗 T 型子宫伴原发性生殖失败的疗效。
前瞻性队列研究，纳入原发性不明原因不孕、反复体外受精（IVF）失败或复发性自然流产且与己烯雌酚无关的 T 型子宫畸形的未产妇，通过三维超声和诊断性宫腔镜检查进行诊断。2015 年 1 月至 2017 年 12 月，在门诊环境下使用 5mm 直径宫腔镜和 5Fr 手术剪刀进行宫腔镜子宫整形术。对于不明原因的夫妇不孕或复发性自然流产的患者，术后 3 个月建议期待治疗，对于无自然妊娠或重复 IVF 失败的夫妇，建议术后 6 个月行 IVF 治疗。计划最低随访时间为 1 年。
共纳入 63 例患者，其中仅有 60 例在子宫整形术后尝试妊娠。宫腔镜手术无并发症。子宫整形术后临床妊娠率为 83.3%（n=50/60）（p<0.001），活产率为 63.3%（n=38/60）（p<0.001）。剖宫产率为 26.3%。未报告与子宫手术相关的妊娠并发症。流产率为 12%（n=6/50）（p<0.001）。
对于原发性生殖失败和 T 型子宫的患者，宫腔镜子宫整形术似乎可以有效改善生殖结局。
