One-step outpatient diagnosis and treatment of European Society of Human Reproduction and Embryology and European Society for Gynaecological Endoscopy class U1 and U2 congenital Müllerian anomalies.

RESEARCH QUESTION

What is the feasibility and efficacy of a one-step outpatient diagnosis and treatment of class U1 and U2 congenital Müllerian anomalies?

DESIGN

Prospective, observational, non-pharmacological study conducted at the University of Naples Federico II, Italy. A total of 100 patients (aged 18-45 years) with a diagnosis of dysmorphic or septate uterus (class U1 or U2, according to the ESHRE-ESGE classification), and either a history of long-standing unexplained infertility, recurrent pregnancy loss, or both, were included. Outpatient three-dimensional pre-operative transvaginal ultrasonographic (3D-TVS-US) examination, see-and-treat hysteroscopy and immediate post-surgery 3D-TVS-US were carried out in a single access. Two months later, 3D-TVS-US and outpatient hysteroscopy were carried out again. A comparison with a historical cohort of 100 consecutive patients treated with traditional multi-step approach was also carried out.

RESULTS

The excellent feasibility of the one-step approach has been reported: at 2 months' follow-up using 3D-TVS-US, statistically significant (P < 0.001, all) improvement of morphology and volume of the uterine cavity after metroplasty was observed. Only six patients (50% of those with a complete septate uterus) required a second surgical step. This one-step approach has shown the same efficacy but differences in indirect costs and time from first diagnosis (P < 0.001) to the restoration of the uterine cavity, compared with the multi-step approach.

CONCLUSION

The results support the safety, tolerability and efficacy of one-step approach in diagnosing and treating uterine malformation in a single outpatient visit, and is, therefore, a time-saving treatment for a patient looking to achieve pregnancy.