Operative Hysteroscopy in Infertility Patients and Its Complications.

The problem of infertility is increasing over the years and so are the couples seekingmedical help for it. Estimates of infertility in India goes to around 10 - 15 percent.Hence evaluation of the couple with the help of history and accompanyinginvestigations are foremost required. Various modalities are available foridentifying the cause. One such cause is abnormalities in the uterine cavity. Thisstep is important because its inner layer, called endometrium is responsible forimplantation of the embryo in the blastocyst stage. For such assessment of theuterine cavity, the gold standard procedure is the diagnostic hysteroscopy. Itinvolves direct visualization of the cavity and simultaneous correction of theintrauterine pathology. Hysteroscopy is a simple procedure with low risk ofcomplication; moreover, complications occur with operative procedures mostcommonly. This study aims to evaluate these complications and critically appraisethe changes in trend of complications.METHODSThis is an observational study. Study included 32 patients with infertilityundergoing operative hysteroscopy at obstetrics and gynaecology department inour hospital.RESULTSAmong the 32 patients, the most common hysteroscopic procedure was lateral wallmetroplasty (40.6%) followed by septal resection (25%). Polypectomy, adhesiolysisand tubal cannulation. Complication rate was 6.25 percent, among which post-opinfection and bleeding per vaginum were the most important

A case of successful conception after Jone's metroplasty in woman with recurrent pregnancy loss with septate uterus

Anomalies of the reproductive tract are common and are seen in approximately 3-5% of the general population. These are usually asymptomatic, but are sometimes associated with recurrent pregnancy loss or infertility. Among these anomalies, septate uterus is the most common anomaly to be associated with obstetric complications and infertility. A 27 years old female patient P0A2L0 with first spontaneous abortion at 3 months and second spontaneous abortion at 4 months came to OPD with complaint of recurrent pregnancy loss. She was advised USG of pelvic region which shows septate uterus with normal cervix, fallopian tubes and ovaries. Patient prepared for DHL complete septum present normal B/L ostium and Jone's metroplasty done in which wedge shaped incision kept on uterine fundus, common cavity created by un roofing septum myometrium closed and AT the end Copper T 375 placed in intrauterine cavity for 6 months. 1 year after surgery patient came with UPT positive for antenatal visit at sola civil. Patient is now with 30 weeks of pregnancy with normal single intrauterine live cephalic fetus, metroplasty is an accepted method of treatment in women with recurrent abortions and septate uterus and it significantly improves the subsequent reproductive outcome. combined data from several published series and reported that the incidence of spontaneous abortion and preterm delivery rate decreases significantly after metroplasty, whereas, the incidence of term delivery rate increases.

Successful outcome in a perplexing case of Roberts uterus: a rare uterine anomaly, a rare case report with review of literature

Robert uterus is a rare Mullerian development anomaly with very few cases reports available. It presents with triad of morphologic features of - Blind hemi cavity with or without unilateral hematometra, contralateral unicornuate uterine cavity and normal uterine fundus with or without small external indentation. The major difficulty lies in making the diagnosis of Robert’s uterus. All the reported cases of Robert’s uterus have been managed differently according to patient’s complaints. A 25-year-old married female, resident of Agra presented to gynecology OPD of Dr RML Hospital and associated PGIMER in June 2013, with primary infertility and cyclical left sided dysmenorrhoea since menarche. Patient was consulting at her hometown Agra for 2 years and had an USG and MRI pelvis report of Feb. 2013 with her showing unicornuate uterus with rudimentary horn. Infertility investigations were done in our hospital. HSG report was of localized spill on right with left tubal block. Patient was posted for diagnostic hystero-laproscopy which was further followed by laprotomy, after which we could reach to a diagnosis of Robert uterus with non-communicating left cavity and with severe endometriosis. Patient needed a second hysteroscopy for lysis of septum and subsequently conceived with IVF. She delivered a healthy male baby of 2.65 kg by elective LSCS at 37 weeks with associated breech presentation with gestational hypertension with severe IHCP on 20 June 2019. Paediatric surgeons and gynecologists should be aware of this rare atypical obstructive Mullerian malformation and its management to avoid inappropriate management delays in these patients. A timely diagnosis and definite treatment have a great impact on future reproductive and endocrine function.

Correção histeroscópica de útero septado completo / Hysteroscopic correction of complete septate uterus

As anomalias congênitas do trato genital feminino são condições relativamente comuns que podem levar com frequência a problemas reprodutivos. Atualmente, a abordagem cirúrgica da maioria das malformações uterinas tem sido realizada por via endoscópica, tendo a histeroscopia, com sua segurança e baixa invasividade, substituído a correção cirúrgica por via abdominal, praticamente em desuso. Com o advento da cirurgia histeroscópica, a realização de metroplastia se tornou um procedimento simples, com ótimos resultados reprodutivos. O caso clínico apresentado relata o resultado de uma correção cirúrgica endoscópica de uma malformação uterina pouco comum: útero septado completo. A dificuldade cirúrgica na abordagem da doença está na presença de dupla vagina e, sobretudo, na presença de dois colos uterinos que implicam a utilização de estratégias endoscópicas especiais para superar os obstáculos. Os autores detalham sua experiência com esse tipo de metroplastia. Uma boa prática endoscópica aliada a modernas técnicas de imagem permitem, também nesses casos, uma completa restituição da integridade da cavidade uterina, melhorando o potencial reprodutivo dessas pacientes.(AU)

Congenital malformations of the female genital tract are relatively common conditions that can often lead to reproductive problems. Currently, the surgical approach to most uterine malformations has been performed endoscopically, and hysteroscopy, with its safety and low invasiveness, has been replacing abdominal surgical correction, practically in disuse. With the advent of hysteroscopic surgery, the realization of metroplasty became a simple procedure, with excellent reproductive results. The clinical case presented, reports the result of an endoscopic surgical correction of an uncommon uterine malformation: complete septate uterus. The surgical difficulty in approaching the disease is in the presence of double vagina, and, especially, in the presence of two uterine cervix that imply the use of special endoscopic strategies to overcome obstacles. The authors detail their experience with this type of metroplasty. A good endoscopic experience combined with modern imaging techniques also allows in these cases a complete restoration of the integrity of the uterine cavity, improving the reproductive potential of these patients.(AU)

A case report: Metroplasty of a noncommunicated uterine body and cervix due to unknown etiology / 대한산부인과학회지

Congenital anomalies of the female reproductive tract may involve the uterus, cervix, fallopian tubes, or vagian. Depending on the specific defect, a women's obstetric and gynecologic health may be adversely affected. We have experienced a case of rudimentary uterine horn with noncommunicated uterus complicated by pelvic endometriosis in a 25 years old woman with primary amenorrhea and monthly periodic pelvic pain. We observed noncommunicating uterus with blind pouch, cervix disconnected to uterus with normal appearance, and left ovarian endometrial cyst. For treatment, the metroplastic surgery with end-to end anastomosis connecting cervix and noncommunicated uterus and removal of endometrial cyst were done. Many cases of uterine anomalies have been documented but, there have been few reported cases of noncommunicated uterus with disconnected cervix and successful performance of the metroplasty. Thus hereby we report this case with a review of literatures.

Reproductive Outcomes after Metroplasty in Patients with Congenital Uterine Anomalies / 대한산부인과학회잡지

OBJECTIVE: Metroplasty has been shown to improve the reproductive outcomes in patients with congenital uterine anomalies, especially for those suffering from multiple fetal losses. This study was performed to evaluate the impact of abdominal metroplasty on the reproductive outcomes in patients with infertility or recurrent abortions. METHODS: Among fifty cases diagnosed as Mullerian anornalies at SNUH from Oct. 1988 to Dec. 1996, only 26 cases were included in this retrospective study. Inclusion criteria was the patients with primary infertility(n=7) or recurrent spontaneous abortions(n 19) who underwent abdominal metroplasty for the correction of uterine anomalies. Statistical analysis was carried out by chi-square test using SPSS ver 7.0. RESULTS: Bicornuate uterus was the most common uterine anomaly as 53.9%(14/26). After metroplaty, the overall live birth rate was increased from 0% to 57.7%(15/26), and the live birth rate in patients with recurrent abortions, 68.4%(13/19), was significantly higher than that in patients with primary infertility, 28.6%(2/7). The rate of fetal wastage was dropped from 96.0%(48/50) to 41.7%(10/24) after metroplasty in 19 patients with recurrent abortions. Pelvic pathologic lesions associated with uterine anomalies were diagnosed in 11(42.3%) patients, and 45.5%(5/11) of them succeeded in live births postoperatively. CONCLUSION: These data showed that metroplasty may improve the reproductive outcomes definitely in patients with recurrent abortions. Although the impact of metroplasty on the fertility in infertile patients was not definite, it seems better to perform metroplasty in infertile patients with uterine anomaly, which offers the opportunity to correct the combined pelvic lesions such as myoma, ovarian cyst or endometriosis, and to avoid the chance of abortion after ART(assisted reproductive technology) such as 1VF-ET.