- Is Hysteroscopic Lysis Necessary in Mild Uterine Synechia for Increasing Pregnancy Rate?

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Is Hysteroscopic Lysis Necessary in Mild Uterine Synechia for Increasing Pregnancy Rate?

S.-T. Oh. Dept of OB/GYN, Chonnam University Medical School, Kwangju, KOREA.

Objectives: Traditionally hysteroscopic lysis has been performed for uterine synechia even in mild case. However patients with mild synechia often conceived spontaneously without any treatment, so benefit of lysis in mild synechia for pregnancy improvement is doubtful. This study was performed to determine whether hysteroscopic lysis is necessary or not in mild uterine synechia when fertility is only goal of treatment.

Design: Follow-up check of pregnancy was performed for 3 years after completion of hysteroscopic treatment in treatment group and after diagnosis of uterine synechia in no-treatment group. Comparison of pregnancy rates between treatment group and no-treatment group was analyzed by c2 test with Yate’s correction and Fisher’s exact test.

Material and Methods: One hundred eighty-two patients, who diagnosed to mild uterine synechia by hysterosalpingogram (HSG), were studied retrospectively. One hundred sixteen patients were treated by operative hysteroscopy and the other 66 patients did’nt received any treatment for synechia. If recurrence was found after hysteroscopic lysis, hysteroscopic lysis was repeated until normal uterine cavity on HSG. Pregnancy was checked for 3 years after complete treatment in treatment group and 3 years after diagnosis of synechia in no-treatment group. One hundred fifty-nine patients, who had moderate uterine synechia and received the hysteroscopic lysis, were also compared with 20 patients who refused the hysteroscopic treatment.

Results: Ninety-five of 116 (81.9%) patients in treatment group conceived, but term pregnancies were in 84 (72.4%) patients and ten (8.6%) patients had a spontaneous abortion and one (0.1%) patients had ectopic pregnancy. Fifty-five of 66 (83.3%) patients in no-treatment group achieved pregnancy, but 49 (74.2%) patients achieved term pregnancy and 6 (9.1%) patients had a spontaneous abortion. Conception rates between treatment group and no-treatment group in mild synechia were not statistically different. In moderate synechia, no-treatment group conceived in 2 (1.0%) patients but all of them was abortion. However in treatment group of moderate synechia, 127 (79.9%) of 159 patients conceived; of those, 105 (66.0%) achieved a term pregnancy, 20 (12.6%) had abortion and 2 (1.3%) had ectopic pregnancy (pá0.01).

Conclusions: Although but treatment is necessary in moderate uterine synechia, hysteroscopic lysis in mild uterine synechia is not necessary when fertility is only purpose of treatment for mild uterine synechia.