title: Hysteroscopic outpatient metroplasty to expand dysmorphic uteri (HOME-DU technique): a pilot study.
abstract: The new classification system of uterine anomalies from the European Society of Human Reproduction and Embryology and the European Society for Gynaecological Endoscopy defines T-shaped and tubular-shaped infantilis uteri as 'dysmorphic'. Such malformations have been proven to be associated with poor reproductive performance. A prospective observational study was conducted with 30 infertile women with dysmorphic uterus who underwent the novel Hysteroscopic Outpatient Metroplasty to Expand Dysmorphic Uteri (HOME-DU ) technique. Incisions are made on the uterine walls with a 5 Fr bipolar electrode. The procedure was conducted in outpatients under conscious sedation, using a 5-mm office hysteroscope. The technique was successful in all cases without complications. A net increase of uterine volume was found, as measured at hysteroscopy and three-dimensional transvaginal ultrasound (P < 0.001). Uterine morphology improved in all patients but one. At mean follow-up of 15 months, clinical pregnancy rate was 57% and term delivery rate 65%. These early data support HOME-DU as safe and effective in expanding the volume and normalizing the appearance of the uterine cavity of dysmorphic uteri. Although the cohort was small, pregnancy and live births outcomes were favourable in this poor-prognosis group, implying desirable benefits, which should be compared with other techniques.
authors.affiliation: Department of Gynecology and Obstetrics, University of Naples 'Federico II', Italy. Electronic address: cdispie@tin.it.
authors.forename: A
authors.initials: A
authors.lastname: Di Spiezio Sardo
authors.affiliation: Department of Molecular and Developmental Medicine, Section of Obstetrics and Gynecology, University of Siena, Siena, Italy; U.O.C. Obstetrics and Gynecology, 'San Iacopo' Hospital, Pistoia, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Florio
authors.affiliation: Department of Gynecology and Obstetrics, University of Naples 'Federico II', Italy.
authors.forename: G
authors.initials: G
authors.lastname: Nazzaro
authors.affiliation: Department of Gynecology and Obstetrics, University of Naples 'Federico II', Italy.
authors.forename: M
authors.initials: M
authors.lastname: Spinelli
authors.affiliation: Fetal Medicine & Surgery Unit, G. Gaslini Institute, Genoa, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Paladini
authors.affiliation: Department of Gynecology and Obstetrics, University of Naples 'Federico II', Italy.
authors.forename: C
authors.initials: C
authors.lastname: Di Carlo
authors.affiliation: Department of Gynecology and Obstetrics, University of Naples 'Federico II', Italy.
authors.forename: C
authors.initials: C
authors.lastname: Nappi
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D007247:Infertility, Female / Q000601:surgery* / Q000628:therapy; D010045:Outpatients; D010865:Pilot Projects; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography; D014564:Urogenital Abnormalities / Q000601:surgery*; D014599:Uterus / Q000002:abnormalities* / Q000033:anatomy & histology / Q000601:surgery; D014621:Vagina / Q000000981:diagnostic imaging
keywords: dysmorphic uterus; office hysteroscopy; three-dimensional transvaginal ultrasound; uterine malformation; uterine volume