June Murphy

Preterm Birth Rate Following Surgical Correction of Uterine Septum/Arcuate Uterus in Singleton Gestations [30E]

INTRODUCTION: This study compared preterm birth rate, gestational age at delivery and neonatal birth weights in singleton gestations, in a cohort of women with primary infertility and a surgically corrected uterine anomaly to those with normal uterine cavity. METHODS: This retrospective cohort study included 265 patients between 1992–2011. The study group (106 patients) had primary infertility patients with hysteroscopically corrected incomplete uterine septum or arcuate uterus. The control group (159 patients) had primary infertility with normal uterine cavity by hysteroscopic evaluation. All patients conceived a singleton gestation via spontaneous conception (SC), or intrauterine insemination after controlled ovarian stimulation (IUI+COS), or in vitro fertilization and embryo transfer (IVF-ET). RESULTS: There was no significant difference in patient age, BMI, day 3 FSH levels, the incidence of male factor infertility or ovulatory disorders between the two groups. There was significantly lower duration of infertility (P<.01), incidence of tubal factors (P<.001) and endometriosis (P<.001) in the study group compared to the control group. There was no statistically significant differences in the incidence of preterm birth (17.9% vs 22.6%), mean gestational age at delivery in weeks (37.6±5.3 vs 37.9±3.8) and birth weight in kg (3.2+0.6 vs 3.3±0.6) between the study group and the control group respectively. CONCLUSION: Our data suggest that in patients with primary infertility and hysteroscopically corrected incomplete uterine septum or arcuate uterus, the incidence of preterm birth, gestational age, and birth weight appear to be similar to those patients with normal uterine cavities.

Preterm Birth Rate in Twin Gestation After Hysteroscopic Septoplasty of Incomplete Uterine Septum/Arcuate Uterus [27G]

INTRODUCTION: The purpose of this study was to evaluate the risk of PTD in primary infertility patients who underwent hysteroscopic septoplasty and had a subsequent twin gestation. METHODS: This retrospective cohort study included 265 patients between 1992–2011. The study group (36 patients) were primary infertility patients who underwent hysteroscopic septoplasty for either an incomplete uterine septum or an arcuate uterine anomaly. The control group (50 patients) had primary infertility and a normal uterine cavity by hysteroscopic evaluation. All patients conceived twin gestations via spontaneous conception (SC), or intrauterine insemination after controlled ovarian stimulation (IUI+COS) or in vitro fertilization and embryo transfer (IVF-ET). RESULTS: There was no significant difference in age, duration of infertility, day 3 FSH levels, or incidence of male factor infertility between the two groups. There was a significantly higher BMI kg/m2 (30.1+6.9 vs 24.7+5.0; P<.03) and incidence of ovulatory disorders (P<.05). There was significantly lower incidence of tubal factors (P<.001) and endometriosis (P<.01) in the study group compared to the control group. The incidence of PTD in the study group (77.8%) was significantly higher compared to the control group (52.0%), P<.05. There were no differences in gestational ages or neonatal birth weights. CONCLUSION: This study suggests that the risk of PTD in patients with hysteroscopic correction of uterine anomalies may be compounded in twin gestations. Therefore, every effort should be made to achieve a singleton pregnancy in these patients. These patients may require increased surveillance, while future studies regarding possible interventions to reduce the incidence of PTD may be warranted.

Preterm Birth and IVF-ET in Singleton Pregnancy After Hysteroscopic Correction of Uterine Septum [27H]

INTRODUCTION: The purpose of this study is to compare preterm birth rate in a cohort of women with primary infertility, and hysteroscopically corrected incomplete uterine septum or arcuate uterine anomaly, who subsequently conceived singleton gestation via spontaneous conception (SC), or intrauterine insemination after controlled ovarian stimulation (IUI+COS) or IVF-ET. METHODS: This retrospective study included women with primary infertility and incomplete uterine septum or arcuate uterine anomaly. All patients underwent successful hysteroscopic septoplasty that resulted in a normal uterine cavity postoperatively between 1992–2011. Subsequently all patients conceived singleton gestation by SC, IUI+COS, or IVF-ET. The study included 106 patients, 45 conceived spontaneously, 11 with IUI+COS, and 50 with IVF-ET. The primary outcome was the preterm birth rate. Secondary outcomes were gestational age at delivery and neonatal birth weight. RESULTS: There was a significant difference in age, but no significant differences in duration of infertility, BMI, day 3 FSH levels or underlying etiology among the three groups. There was no statistical difference in preterm birth rates (17.8% vs 27.3% vs 16%), mean gestational age at delivery in weeks (38.6±2.5 vs 37.6±3.6 vs 36.6±7.0), and birth weight in Kg (3.3±0.6 vs 3.1±0.8 vs 3.2±0.7) between SC, IUI+COS, and IVF-ET groups respectively. CONCLUSION: Our data suggest that in patients with incomplete uterine septum or arcuate uterine anomaly, who underwent successful hysteroscopic correction, IVF-ET treatment per se is not associated with increased risk of preterm birth and/or low birth weight.