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Uterine Anomalies and Recurrent Pregnancy Loss
Published in Howard J.A. Carp, Recurrent Pregnancy Loss, 2020
Daniel S. Seidman, Mordechai Goldenberg
A bicornuate uterus results from partial non-fusion of the Müllerian ducts (Figure 12.4). The central myometrium may extend to the level of the internal cervical os (bicornuate unicollis) or external cervical os (bicornuate bicollis). The latter is distinguished from uterus didelphys as there is some degree of fusion between the two horns, while in uterus didelphys, the two horns and cervices are separated completely. In addition, the horns of the bicornuate uteri are not fully developed; typically, they are smaller than those of didelphys uteri. Bicornuate uteri are probably the most common uterine anomaly after septate and arcuate uterus [17]. The reproductive outcome seems to be directly correlated with the severity of fundal indentation. It is generally considered that the bicornuate uterus does not directly affect infertility but may be linked with RPL. Bicornuate uterus can be corrected surgically by metroplasty.
Recurrent Pregnancy Loss
Published in Steven R. Bayer, Michael M. Alper, Alan S. Penzias, The Boston IVF Handbook of Infertility, 2017
Benjamin Lannon, Alison E. Zimon
An improvement in obstetrical outcome after surgical correction of uterine anomalies has been best established in cases of uterine septi. Uterine septi are the most commonly diagnosed congenital uterine anomalies associated with early pregnancy loss and have been found to confer a risk of RPL of up to 79% [12]. Hysteroscopic metroplasty has been shown to decrease the chance of pregnancy loss to <15% and increase the chance of live birth from <20% to 35%–80% [6,11]. In cases of incidental diagnosis of uterine septi, it is not unreasonable to consider hysteroscopic myomectomy for prevention of pregnancy loss, though this approach is not universally advocated. Patients with Asherman’s syndrome similarly benefit from surgical intervention via hysteroscopic adhesiolysis, which increases the chance for live birth and reduces rates of first- and second-trimester losses. The outcomes after hysteroscopic adhesiolysis are associated with severity of disease. The term pregnancy rate after surgical intervention may be upward of 81% and 66% for mild (American Fertility Society [AFS] Stage I) and moderate (AFS Stage II) disease, respectively. Given the partially irrecoverable losses to endometrial function in Asherman’s syndrome, relatively high rates of pregnancy failure and relatively low chance for live birth (32% or less) are observed in patients with severe disease (AFS Stage III) after successful surgical resection [6]. In cases of polyps and fibroids, the link between etiology is less well established and decreased pregnancy loss rates have been demonstrated, but not consistently, in studies examining the impact of open myomectomy, hysteroscopic myomectomy, and hysteroscopic polypectomies on RPL (Table 15.2) [6].
Habitual Abortion
Published in E. Nigel Harris, Thomas Exner, Graham R. V. Hughes, Ronald A. Asherson, Phospholipid-Binding Antibodies, 2020
Dwight D. Pridham, Christine L. Cook
The surgical correction of bicornuate or didelphic uteri involves a laparotomy with metroplasty (reunification of the uterine horns). Cesarean section is recommended for delivery following this operation. Metroplasty can yield >80% term pregnancies in patients who have had previously poor reproductive performance.17 Because of the likelihood of successful pregnancy, patients with a coincidental finding of uterine defects should not undergo surgery unless several SABs occur. All other causes of HAB should be excluded prior to surgical correction.
Second look hysteroscopy following hysteroscopic septum resection improves reproductive outcomes in patients undergoing ICSI
Published in Journal of Obstetrics and Gynaecology, 2022
Bulat Aytek Sık, Ozkan Ozdamar, Ozan Ozolcay, Alper Sismanoglu, Yilda Arzu Aba, Serkan Oral, Mehmet Koc
A total of 300 infertile women who underwent hysteroscopic metroplasty, either once or twice, due to partial or complete uterine septum, which was followed by ICSI-ET was included in the study. Two groups were constructed and reproductive outcomes were retrospectively compared between the groups. Group 1 comprised of women who underwent one hysteroscopic septum resection prior to ICSI-ET (n = 154) and Group 2 consisted those who necessitated a secondary hysteroscopic resection due to an evidence of residual uterine septum after the first hysteroscopic procedure (n = 146). Demographic characteristics are shown in Table 1. Age, BMI, female factor infertility aetiology, uterine cavity length, septum length and male factor parameters did not significantly differ between the groups.