ABSTRACT
Background@#Very few studies have been conducted regarding the optimal time interval between hysteroscopic adhesiolysis and the embryo transfer (ET). Investigation of this optimal time may be helpful for assisted reproductive technology. Therefore, we investigated effects of the interval between hysteroscopic adhesiolysis and ET upon in vitro fertilization (IVF) cycle outcomes.@*Methods@#Patients were recruited between January 2014 and September 2017 at the Reproductive Hospital Affiliated to Shandong University. Patients who were diagnosed with intra-uterine adhesion (IUA) and underwent hysteroscopic adhesiolysis before fresh IVF-ET or intra-cytoplasmic sperm injection cycles were classified into three groups according to the interval between hysteroscopic adhesiolysis and ET: less than 90 days (Group 1), 90 to 180 days (Group 2), and greater than 180 days (Group 3). Baseline characteristics, controlled ovarian stimulation (COS) response, and pregnancy outcomes after ET were compared. Analysis of variance or non-parametric tests were used to test numerical data. The Pearson’s Chi-squared test was used to test categorical data.@*Results@#A total of 312 patients were recruited as follows: 112 in Group 1, 137 in Group 2, and 63 in Group 3. There were no differences in baseline and COS characteristics among the three groups. The live-birth rate in Group 2 (40.1%) was significantly higher than that in Group 1 (17.9%; χ2 = 14.545, P < 0.001). There were no significant differences in the rates of biochemical, ongoing, and clinical pregnancy, and biochemical and clinical pregnancy abortion, as well as stillbirth among the groups. In the mild IUA patients, the live-birth rate was significantly higher in Group 2 (42.6%) compared with Group 1 (22%; χ2 = 8.413, P = 0.004). In the moderate IUA patients, Group 2 (35.7%) had a higher frequency of live births than Group 1 (6.7%; χ2 = 8.187, P = 0.004).@*Conclusions@#The optimal waiting period for fresh ET after hysteroscopic adhesiolysis was 90 to 180 days in the current study.
ABSTRACT
Objective To explore the effects of different intrauterine adhesion (IUA) classification systems on predicting the IUA prognosis.Methods One hundred cases were selected as the subjects in present study from those diagnosed with IUA and underwent surgery in Zhujiang Hospital of Southern Medical University from Jan.2010 to Jan.2017,and were followed up for two years.According to the actual situation,all patients were scored by March,AFS,ESGE and Chinese classification for comparing the effects of different IUA classification systems on predicting the pregnancy rate,live birth rate and effective rate within 2 years after surgery.Results ESGE classification had a good effect on predicting the postoperative live birth rate and effective rate,and a certain predictive effect on pregnant rate,with the area under curve (AUC) of 0.722,0.754 and 0.635,respectively.March classification had a certain effect on predicting the postoperative live birth rate and effective rate with AUC of 0.635,0.754,respectively,but had a poor effect on predicting pregnant rate.AFS classification and China classification had poor effect on predicting the IUA prognosis.Conclusion ESGE classification system is better than the other systems including March,AFS and Chinese classification,on predicting the IUA prognosis,but further verification in large sample size is still required.
ABSTRACT
Se presentan 3 casos clínicos de féminas con síndrome de Asherman, procedentes del Policlínico Docente "Ramón López Peña", tratadas con medicina natural y tradicional. Se aplicaron técnicas bioenergéticas (acupuntura y microsistema de oreja, hidroterapia, dietas hipotóxicas, reflexoterapia podal) y de respiración. Todas las pacientes mejoraron su cuadro clínico, pues se le restableció el flujo menstrual y la gestación, lo cual demostró la eficacia del tratamiento empleado.
Three case reports of females with Asherman syndrome, belonging to "Ramón López Peña" Teaching Polyclinic, treated with natural and traditional medicine are presented. Bioenergetic techniques (acupuncture and ear microsystem, hydrotherapy, hipotoxic diets, foot reflex therapy) and breathing techniques were applied. All the patients improved their clinical pattern, because the menstrual flow and pregnancy were reestablished, which demonstrated the effectiveness of the treatment.
Subject(s)
Gynatresia , Medicine, Traditional , Amenorrhea , HydrotherapyABSTRACT
Asherman syndrome is an acquired condition characterized by the formation of adhesions in the uterine cavity. This condition is often caused by trauma to the endometrium, which mostly happens after currettage or post-partum, and can produce several complications such as menstrual disturbances, infertility, or recurrent abortion. The management of Asherman syndrome requires complete actions which can be summarized with the acronym PRACTICE, consisting of prevention, anticipation, comprehensive therapy, timely surveillance of subsequent pregnancies, investigation and continuing education. The prevention and anticipation aspects can be performed through reduction of invasive methods of therapy such as currettage, prophylactic therapy for adhesions such as antibiotics and post-estrogen therapy for high risk patients, and the use of instruments that do less damage to the uterine walls. The comprehensive therapy that become the method of choice is operative lysis using hysteroscopy, which provides direct visualization of the adhesion. To prevent reccurrence, especially to patients planning to have subsequent pregnancies, timely surveillance of the next pregnancies for high risk patients should be performed at hospital, with complete work-ups. Lastly, evaluation of operative results and continuing education to explain prognoses to the patient should be also performed.