Qiao Xinyu, Liu Dong, Liu Chang, Pei Tianjiao, Ouyang Yunwei
Department of Reproductive Medicine, West China Second University Hospital, Sichuan University (Qiao, Pei), Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education (Qiao, Liu, Liu, Pei, and Ouyang), Chengdu, China.
Department of Reproductive Endocrinology, West China Second University Hospital, Sichuan University (Liu, Liu, and Ouyang), Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education (Qiao, Liu, Liu, Pei, and Ouyang), Chengdu, China.
J Minim Invasive Gynecol. 2025 Jan;32(1):57-63. doi: 10.1016/j.jmig.2024.09.009. Epub 2024 Sep 16.
This study aims to evaluate the reproductive outcomes after hysteroscopic adhesiolysis in patients experiencing recurrent pregnancy loss (RPL) combined with intrauterine adhesions (IUA).
Single-center retrospective cohort study.
International referral hospital for women with IUA and RPL.
Between January 2018 and June 2022, a cohort of 64 women diagnosed with RPL and IUA were studied, with a follow-up period of at least one year after hysteroscopic adhesiolysis.
All patients had a diagnosis of IUA from the diagnostic hysteroscopy and were treated with hysteroscopic adhesiolysis, utilizing intraoperative ultrasound monitoring as required.
Live birth rate and menstrual pattern change (subjective assessment) after hysteroscopic adhesiolysis.
In our cohort, 59.38% (38/64) achieved pregnancy following hysteroscopic adhesiolysis, with 92.11% (35/38) conceiving within two years of the procedure. The miscarriage rate was recorded at 17.19% (11/64), and the live birth rate stood at 42.19% (27/64). Throughout the extended follow-up period, 64.06% (41/64) of the patients reported increased menstrual blood volume and improvements in menstrual patterns posthysteroscopic adhesiolysis. Univariate analysis indicated that being aged ≥35 years (p = .026), having a history of infertility (p = .003), the presence of moderate or severe IUA (p = .023), and experiencing menstrual improvements postsurgery (p = .001) were independent predictors of live birth. Multivariate analysis further identified that women with a history of infertility had a reduced chance of live birth following hysteroscopic adhesiolysis (p = .008), while those who reported menstrual pattern improvements postoperatively had an increased probability of achieving a live birth (p = .031).
Our findings indicate that RPL and IUA patients without prior infertility and showing menstrual pattern improvement after hysteroscopic adhesiolysis, are more likely to achieve live births. Standardized hysteroscopic treatment, postoperative anti-adhesion care, and early pregnancy planning are key to improving fertility outcomes in these patients.
本研究旨在评估复发性流产（RPL）合并宫腔粘连（IUA）患者宫腔镜粘连松解术后的生殖结局。
单中心回顾性队列研究。
国际IUA和RPL女性转诊医院。
2018年1月至2022年6月，对64例诊断为RPL和IUA的女性进行研究，宫腔镜粘连松解术后随访至少一年。
所有患者经诊断性宫腔镜检查确诊为IUA，并根据需要在术中超声监测下接受宫腔镜粘连松解术治疗。
宫腔镜粘连松解术后的活产率和月经模式变化（主观评估）。
在我们的队列中，59.38%（38/64）的患者在宫腔镜粘连松解术后成功妊娠，其中92.11%（35/38）在术后两年内受孕。流产率为17.19%（11/64），活产率为42.19%（27/64）。在延长的随访期内，64.06%（41/64）的患者报告宫腔镜粘连松解术后月经量增加且月经模式改善。单因素分析表明，年龄≥35岁（p = 0.026）、有不孕史（p = 0.003）、存在中度或重度IUA（p = 0.023）以及术后月经改善（p = 0.001）是活产的独立预测因素。多因素分析进一步确定，有不孕史的女性在宫腔镜粘连松解术后活产的机会降低（p = 0.008），而术后报告月经模式改善的女性活产的概率增加（p = 0.031）。
我们的研究结果表明，既往无不孕史且宫腔镜粘连松解术后月经模式改善的RPL和IUA患者更有可能实现活产。标准化的宫腔镜治疗、术后抗粘连护理和早期妊娠计划是改善这些患者生育结局的关键。
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