Uterine synechiae after bipolar hysteroscopic resection of submucosal myomas in patients with infertility

Abstract

Objective: To determine the rate of uterine synechiae after bipolar hysteroscopic myomectomy in patients suffering from infertility.

Design: Retrospective case series study.

Setting: University obstetrics gynecologic and assisted reproduction center.

Patient(s): A group of 53 patients with primary (n = 30) and secondary (n = 23) infertility.

Intervention(s): Patients underwent bipolar hysteroscopic resection of myomas between 2001 and 2006, and an outpatient hysteroscopy was performed 2 months after the fibroid resection.

Main outcome measure(s): The formation of uterine synechiae and pregnancy rates were collected from the patients' clinical notes.

Result(s): The submucosal myomas were intracavitary class 0 (n = 12), intramural class 1 (n = 19), and intramural class 2 (n = 22). The mean age of the women was 35.0 +/- 4.8 years. The mean myoma size was 25 +/- 11 mm. Postoperative office hysteroscopies revealed synechiae in four (7.5%) of 53 patients. Sixteen (32.7%) of the 49 patients not lost to follow-up conceived, and 12 (24.5%) of them delivered at term. Myoma size >or=3.5 cm and age <35 years were associated with a significantly higher pregnancy rate in univariate and multivariate analysis.

Conclusion(s): The incidence of uterine synechiae after bipolar hysteroscopic resection of fibroids was 7.5%. This appears to be lower than that reported in previous studies using monopolar energy. Bipolar hysteroscopic myomectomy may be a better option for infertile women.