Fertility success rates in patients with secondary infertility and symptomatic cesarean scar niche undergoing hysteroscopic niche resection

Abstract

Cesarean-induced niche can cause symptoms such as abnormal postmenstrual bleeding, pain, and associated infertility. Although hysteroscopic niche resection is generally considered an effective treatment to control abnormal uterine bleeding, the impact of surgical resection on fertility outcomes is still uncertain. In the present study, we aimed to evaluate the fertility outcomes of symptomatic patients following hysteroscopic niche resection. The design in this retrospective cohort study is Canadian Task Force classification II-2 and it is carried out in a tertiary medical center (Tel-Hashomer) and a private medical center (Herzliya), both in Israel. We included all patients who underwent a niche resection between 2011 and 2015 following at least one year of infertility. From 2011 to 2015, 39 patients with a symptomatic niche and secondary infertility were treated by hysteroscopic niche resection. The patients’ mean age was 37.2 (34–41) years, mean number of gestations was 7.04 (1–16), and mean parity 5.1 (1–14). The mean number of previous cesarean sections was 3.4 (1–6). Before the surgery, 32 patients attempted and failed to conceive spontaneously and seven patients underwent in vitro fertilization (IVF) treatment and failed. One year after the hysteroscopic resection, 18 patients conceived (14 spontaneously and four following IVF), leading to a cumulative pregnancy rate of 46.15%. Among the patients who failed to conceive after at least two IVF cycles prior to the hysteroscopic resection, 42.8% conceived following surgery (three patients out of seven). Hysteroscopic niche resection should be considered an effective treatment in patients suffering from secondary infertility.

Précis

Hysteroscopic niche resection is a safe option for patients with symptomatic secondary infertility, resulting in acceptable fertility rates.

Chinese abstract

剖宫产术后形成的憩室可能会导致异常的月经后出血、疼痛和相关的不孕症等症状。虽然宫腔镜下憩室切除术通常被认为是控制异常子宫出血的有效治疗方法, 但手术切除憩室后对生育结果的影响仍不确定。在这项研究中, 我们的目标是评估有症状的患者在宫腔镜下憩室切除术后的生育结果。这项回顾性队列研究的设计是加拿大特别工作组分类II-2, 在以色列的一个三级医疗中心(Tel-Hashmer)和一个私立医疗中心(Herzliya)进行。我们包括了所有在2011年至2015年期间在至少一年不孕后接受憩室切除术的患者。2011年至2015年, 对39例有症状性憩室的继发性不孕症患者行宫腔镜憩室切除术。患者平均年龄37.2(34∼41)岁, 平均妊娠7.04(1∼16)次, 平均产次5.1(1∼14)次。历次剖宫产平均3.4次(1∼6次)。手术前, 32名患者尝试自然受孕但失败, 7名患者接受体外受精(IVF)治疗失败。宫腔镜手术切除一年后, 18例受孕(14例自然受孕, 4例体外受精后受孕), 累计妊娠率为46.15%。在宫腔镜切除前至少两个体外受精周期未受孕的患者中, 42.8%的患者在手术后受孕(7名患者中有3名)。对于继发性不孕症患者, 宫腔镜憩室切除术应被认为是一种有效的治疗方法。

对于有症状的继发性不孕症患者, 宫腔镜憩室切除术是一种安全的选择, 可获得可接受的生育率。

Keywords:

• Cesarean niche
• infertility
• hysteroscopy

Disclosure statement

The authors declare that they have no competing interests.