Wei Zhang, Shunzhi He, Xiaoyan Zhang, Zhenteng Liu, Min Chu, Xuemei Liu, Hongchu Bao
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引用次数: 0
Abstract
Background: Hysteroscopic septum resection has been a widespread technique throughout the world in women with a septate uterus. The effectiveness of hysteroscopic septum resection before IVF was equivocal. This study aimed to investigate whether hysteroscopic septum resection could improve IVF outcomes for women with a septate uterus.
Methods: This retrospective case-control study was carried out from January 2017 to December 2022. We included subfertile women with septate uterus (n = 147), including 113 women undergoing hysteroscopic septum resection and 34 women opting for expectant management before IVF/ICSI. In addition, we selected 147 women with normal uteri using propensity score matching (PSM). The clinical outcomes of IVF/ICSI were compared by logistic regression and Cox proportional regression in each group.
Results: During follow-up time, clinical pregnancy occurred in 66 women who underwent hysteroscopic septum resection (58.41%), compared to 23 women opting for expectant management (67.65%, OR 1.783, 95% CI 0.725-4.380) and 87 women with normal uteri (59.18%, OR 2.601, 95% CI 1.202-5.631). Miscarriage occurred in 12 women who underwent hysteroscopic septum resection (18.18%) versus 5 women who had expectant management (21.74%, OR 1.098, 95% CI 0.323-3.734) and 8 women with normal uteri (9.20%, OR 0.278, 95% CI 0.078-0.997), while preterm birth occurred in 7 women who underwent hysteroscopic septum resection (10.61%) versus 1 women who had expectant management (4.35%, OR 0.509, 95% CI 0.056-4.666) and 9 women with normal uteri (10.34%, OR 1.472, 95% CI 0.291-7.447). Live birth occurred in 54 women following hysteroscopic septum resection (47.79%) compared to 18 women following expectant management (52.94%, OR 1.368, 95% CI 0.589-3.175) and 78 women with normal uteri (53.06%, OR 1.641, 95% CI 0.941-2.864).
Conclusions: Women who underwent hysteroscopic septum resection had lower clinical pregnancy rate and higher risk of miscarriage compared to those with normal uteri, but there was no significant difference in live birth rate between the groups.
Trial registration: This is a retrospective case-control study.
背景：宫腔镜下的子宫间隔切除术在世界范围内是一种广泛的技术。体外受精前宫腔镜中隔切除术的有效性尚不明确。本研究旨在探讨宫腔镜下子宫间隔切除术是否能改善有子宫间隔的女性的体外受精结果。方法：于2017年1月至2022年12月进行回顾性病例对照研究。我们纳入了有间隔子宫的低生育能力妇女（n = 147），包括113名接受宫腔镜下间隔切除术的妇女和34名在体外受精/ICSI前选择期待治疗的妇女。此外，我们选择了147名正常子宫的妇女，使用倾向评分匹配（PSM）。采用logistic回归和Cox比例回归比较各组IVF/ICSI的临床结局。结果：随访期间，66例宫腔镜中隔切除术妇女发生临床妊娠（58.41%），相比之下，23例妇女选择保守治疗（67.65%,OR 1.783, 95% CI 0.725-4.380）和87例正常子宫妇女（59.18%,OR 2.601, 95% CI 1.202-5.631）。宫腔镜下室间隔切除术中有12名女性（18.18%）发生流产，5名孕妇（21.74%,OR 1.098, 95% CI 0.323-3.734）和8名子宫正常的女性（9.20%,OR 0.278, 95% CI 0.078-0.997），而宫腔镜下室间隔切除术中有7名女性（10.61%）发生早产，1名孕妇（4.35%,OR 0.509, 95% CI 0.056-4.666）和9名子宫正常的女性（10.34%,OR 1.472, 95% CI 0.291-7.447）。宫腔镜下中隔切除术后54名妇女（47.79%）分娩成功，相比之下，18名妇女（52.94%,OR 1.368, 95% CI 0.589-3.175）和78名正常子宫妇女（53.06%,OR 1.641, 95% CI 0.941-2.864）分娩成功。结论：宫腔镜下行子宫间隔切除术的妇女临床妊娠率较正常子宫组低，流产风险较高，但两组间活产率无显著差异。试验注册：这是一项回顾性病例对照研究。
期刊介绍：
Reproductive Biology and Endocrinology publishes and disseminates high-quality results from excellent research in the reproductive sciences.
The journal publishes on topics covering gametogenesis, fertilization, early embryonic development, embryo-uterus interaction, reproductive development, pregnancy, uterine biology, endocrinology of reproduction, control of reproduction, reproductive immunology, neuroendocrinology, and veterinary and human reproductive medicine, including all vertebrate species.
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