Efficiency and pregnancy outcome of serial intrauterine device-guided hysteroscopic adhesiolysis of intrauterine synechiae.
OBJECTIVE
To highlight the efficiency of intrauterine device (IUD) guidance during hysteroscopic adhesiolysis for severe intrauterine adhesions.


METHODS
A prospective, randomized trial.


METHODS
Private tertiary and referral infertility clinic.


METHODS
Seventy-one subfertile patients who underwent hysteroscopic treatment of intrauterine synechiae or adhesions.


METHODS
Thirty-six women in group 1 were initially examined by laparoscopy-hysteroscopy at first look, and an IUD was inserted during hysteroscopic adhesiolysis. The adhesions were further lysed by the guidance of IUD during the second-look office hysteroscopy, 1 week later. Patients were prescribed 2 months of estrogen as well as P therapy, and the IUD was removed by the end of this period. The uterine cavity was evaluated, and adhesions were further lysed by a third-look office hysteroscopy, 1 week after the removal of IUD. Thirty-five women in group 2 were similarly examined by first-look office hysteroscopy, and an IUD was inserted during hysteroscopic adhesiolysis. These patients did not undergo early intervention of office hysteroscopy, 1 week after the first procedure. They also used 2 months of estrogen and P therapy. The IUD was removed by the end of this period, and the uterine cavity was evaluated and adhesions were further lysed during a second-look office hysteroscopy.


METHODS
Pregnancy rate and live birth rate.


RESULTS
Spontaneous pregnancy rates after treatment were 17/36 (47.2%) and 11/35 (30%), and live birth rates were 10/36 (28%) and 7/35 (20%) in groups 1 and 2, respectively. These differences between the two groups were not statistically significant.


CONCLUSIONS
The method described especially for early intervention may prevent complications during the treatment of severe intrauterine adhesions and may present a secure and effective alternative for constructive clinical outcomes.
Pabuccu
Recai
R
Centrum Clinic, Ankara, Turkey. rpabuccu@hotmail.com
Onalan
Gogsen
G
Kaya
Cemil
C
Selam
Belgin
B
Ceyhan
Temel
T
Ornek
Turkan
T
Kuzudisli
Ebru
E
D000328:Adult; D004967:Estrogens / Q000008:administration & dosage; D004966:Estrogens, Conjugated (USP) / Q000008:administration & dosage; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects; D007247:Infertility, Female / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D007434:Intrauterine Devices; D010535:Laparoscopy / Q000009:adverse effects; D050498:Live Birth; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage; D011247:Pregnancy; D018873:Pregnancy Rate; D011372:Progestins / Q000008:administration & dosage; D011446:Prospective Studies; D013997:Time Factors; D000267:Tissue Adhesions; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000150:complications / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*
D004967:Estrogens; D004966:Estrogens, Conjugated (USP); D011372:Progestins; D017258:Medroxyprogesterone Acetate