Comparison of hysteroscopic adhesiolysis with electrosurgery instrument or hysteroscopic scissors in the treatment of intrauterine adhesions of infertile or recurrent pregnancy loss women.

Abstract

Objective: To investigate pregnancy outcomes following hysteroscopic adhesiolysis (HA) in patients with recurrent pregnancy loss (RPL) or infertility.

Design: Retrospective cohort study.

Setting: University-affiliated hospital.

Subjects: According to the inclusion and exclusion criteria of this study, finally, a total of 461 subjects were included.

Interventions: HA performed using either an electrosurgical instrument or hysteroscopic scissors.

Main outcome measures: Pregnancy outcomes post-HA.

Results: A total of 461 patients were included in the study, with follow-up periods ranging from 1 to 6 years. The mean age was 29.48 ± 3.25 years. Hysteroscopic scissors demonstrated greater efficiency in restoring the uterine cavity compared to electrosurgical instruments (88.1% vs. 80.0%, p = 0.025). Post-HA, the pregnancy rate was approximately 75.3% (347/461), with a live birth rate of 55.9% (251/449). No significant differences were found between the electrosurgical instrument and hysteroscopic scissors groups regarding improvements in menstrual flow or fertility outcomes (all p > 0.05). Kaplan-Meier time-dependent cumulative curves for pregnancy and live birth rates after HA indicated that over 50% of patients achieved pregnancy within one year, with the pregnancy rate plateauing at 2 years and the live birth rate at 3 years.

Conclusion: Our findings suggest that HA can improve fertility outcomes for patients with RPL or infertility within 2 to 3 years following surgery. Hysteroscopic scissors proved more effective than electrosurgical instruments in restoring the uterine cavity, although no differences were observed between the techniques in terms of menstrual flow or fertility improvements. All in all, our study suggests that standardized HA procedures, the implementation of proactive intraoperative and postoperative measures to prevent the recurrence of intrauterine adhesions (IUA), and an active conception plan following HA are key factors in improving reproductive outcomes for these patients with RPL or infertility.