Role of Diagnostic Hysterolaparoscopy in the Evaluation of Infertility - A Prospective Study from Telangana, India

BACKGROUND Infertility is a multidimensional health problem with social and economic consequences. Infertility affects about 10 - 15 % of reproductive age couples. 1 Hysterolaparoscopy is safe and effective method to diagnose infertility. The purpose of this study was to determine the role of diagnostic hysterolaparoscopy in the evaluation of infertility in Chalmeda Anand Rao Institute of Medical Sciences. METHODS A prospective hospital-based study was carried out in Chalmeda Anand Rao Institute of Medical Sciences over a period of 1 year from August 2019 to July 2020. Hysterolaparoscopy was done in 100 patients. Women aged 20 - 40 years with normal hormone profile without male factor infertility were included. RESULTS 100 patients with infertility were undertaken, 70 (70 %) women had primary infertility and the remaining 30 (30 %) had secondary infertility. Ovarian pathology (30 %), endometriosis (23 %), tubal pathology (14 %) and pelvic adhesion (14 %) were the most well-known anomalies recognized in laparoscopy in both primary and secondary infertility. Uterine septum was major intrauterine pathology seen in two gatherings. Out of 12 patients having uterine malformations, most regular uterine malformation in both the gatherings was 9 uterine septum and 2 unicornuate and 1 was hypoplastic uterus. CONCLUSIONS Combined hysterolaparoscopy is a safe, effective, and reliable method in comprehensive evaluation of infertility. It helps in the diagnosis of pelvic pathology which is missed by routine pelvic examinations and basic investigations done for evaluation of infertility. Hysterolaparoscopy gives the added advantage of doing a therapeutic procedure in the same sitting. Thus, hysterolaparoscopy may be considered as gold standard and definitive investigative day-care procedure for evaluation of female infertility. KEY WORDS Hysteroscopy, Infertility, Laparoscopy

FERTILITY AND ABORTION RATES FOLLOWINGHYSTEROSCOPIC RESECTION OF UTERINE SEPTA

Objectives: the presented work studied the effect of uterine septum resection in patients with short and long septa on obstetric outcomes specially the abortion rates and preterm deliveries Subjects and methods: 100 hundred patients known to have uterine septum had been recruited to a private clinic in Benha city –Egypt and classified into two groups according to the length of septum, group A with short septum<2.5cmand groupB with long septum >2.5 cm, all patients subjected to hysterosopic resection of septa after counseling and signed informed consent. Results: The infertility rate was significantly lower in group b after surgery (39.47% vs 10.53%, P = .006). However, no significant difference was observed in the infertility rate between groups A and B. There were no significant differences in pregnancy rate, and preterm live births rate among the 2 groups (P >.05 for all). In Group A the change is only in the rate of term and preterm which was significant but abortion rate didnt differ, this was the group of the smalls septum <2.5cm.Significant change occurred in the rate of abortion in group b (25 before resection dropped to 10 after with p value of 0.001 a high significant difference also there were a significant change in all other items including the pregnancy rate and term pregnancy (pregnancy rate elevated from 35 cases to 40 cases with p value 0.01 also the rate of term pregnancy highly increased from25 cases before septum resection to 38 cases after resection with p value 0.007 Conclusion: large uterine septum >2.5cm resection associated with increase in fertility and decreased rates of abortions.

O-140 Uterine septum: clinical implications on fertility and obstterics outcomes. A systematic review and meta-analysis

Study question How does the septate uterus and his metroplasty influence pregnancy rate (PR), live birth rate (LBR), spontaneous abortion rates (SA) and preterm labour rates (PL)? Summary answer Uterine septum is associated with a poor reproductive outcome. Metroplasty reduce the rate of SA but non-conclusive evidence can be extrapolated about PR and PL. What is known already Different studies evaluated the correlation between uterine septum and reproductive outcomes. On one hand, studies reported its association with poor obstetrics outcomes. On the other hand, recent studies raised doubts about the effectiveness of septum metroplasty to improve reproductive outcomes, although recent position papers continue to propose metroplasty in patients with a septate uterus and a history of infertility or miscarriages. Debate is still ongoing on reproductive outcomes of uterine septum on infertile patients and especially on patients with recurrent miscarriage, leading to an unanswered question whether or not these women should be treated. Study design, size, duration Systematic review and meta-analysis of published studies that evaluated the clinical impact of uterine septum and its metroplasty on reproductive and obstetrics outcomes. The meta-analysis included study with infertile patients or patients with a history of recurrent miscarriage. Searches were conducted using the following search terms: uterine septum, septate uterus, metroplasty, pregnancy rate, live birth rate, spontaneous miscarriage, infertility, preterm delivery. Primary outcomes were PR and LBR. Secondary outcomes were SA and PL. Participants/materials, setting, methods The meta-analysis was written following the PRISMA guidelines. Fifty-nine full-text articles were preselected based on title and abstract. Endpoints were evaluated in three subgroups: 1) infertile/recurrent miscarriage patients with septum versus no septum 2) infertile/recurrent miscarriage patients with treated versus untreated septum 3) infertile/recurrent miscarriage patients before-after septum removal. Odds-ratios (OR) with 95% confidence intervals (CI) were calculated for outcome measures. Random-effect meta-analysis was performed and a p-value less than 0.05 was considered statistically significant. Main results and the role of chance Data from 37 articles were extracted. In the first subgroup (10 studies), a lower PR and LBR were associated with septate uterus vs. controls, respectively (OR 0.39, 95% CI 0.26 to 0.58; p &lt; 0.000; low-heterogeneity and OR 0.21, 95% CI 0.12 to 0.39; p &lt; 0.0001; small-heterogeneity) and a higher proportion of SA and PL was associated with septate uterus vs. controls, respectively (OR 4.17, 95% CI 2.83 to 6.15; p &lt; 0.000; moderate-heterogeneity and OR 2.18, 95% CI 1.27 to 3.76; p = 0.005; low-heterogeneity). In the second subgroup (8 studies), PR and PL were not different in removed vs. unremoved septum, respectively (OR 1.10, 95% CI 0.49 to 2.49; p = 0.82; moderate heterogeneity and OR 0.44, 95% CI 0.18 to 1.08; p = 0.08;low-heterogeneity) and a lower proportion of SA was associated with removed vs. unremoved septum (OR 0.40, 95% CI 0.17 to 0.95; p = 0.001; substantial-heterogeneity). In the third subgroup (19 studies), the proportion of LBR was higher after the removal of septum (OR 49.58, 95% CI 29.93 to 82.13; p &lt; 0.0001; moderate-heterogeneity) and the proportion of SA and PL was lower after the removal of septum, respectively (OR 0.02, 95% CI 0.02 to 0.04; p &lt; 0.000; moderate-heterogeneity and OR 0.05, 95% CI 0.03 to 0.08; p = &lt;0.000; low-heterogeneity). Limitations, reasons for caution The present meta-analysis is limited by the observational design of included studies because, in literature, there are no prospective randomized controlled trials (RCTs). In the second and third subgroup of analysis clinical heterogeneity within and between studies represents another limitation. Wider implications of the findings The results of this meta-analysis confirm the detrimental effect of uterine septum on PR, LBR, SA and PL. Its treatment seems to reduce the rate of SA. Metroplasty should still be considered as good clinical practice in patients with a history of infertility and recurrent abortion. Trial registration number Not applicable © The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please e-mail: [email protected].