Comparative analysis of intrauterine device placement or estrogen therapy to patients after hysteroscopic uterine septum resection

Abstract

Whether the implement of Intrauterine Device (IUD) and/or Estrogen Replacement Therapy (ERT) is required for preventing intrauterine adhesion after transcervical hysteroscopic resection of uterine septum (TCRS) remains unclear, here, we report a retrospective cohort analysis of the outcomes of patients who had received different treatments after TCRS. Among the 223 cases received TCRS and/or postoperative treatments, the group A, B and C received TCRS at periods 2002-2007, 2007-2009 and 2009-2011 respectively. The group A of 74 patients was placed IUD for 2~3 months after operation. Group B of 63 patients was given ERT treatment for 2~3 cycles. Group C of 86 patients received neither IUD nor ERT. All of the patients were checked hysteroscopically for uterine cavity adhesions during the period of the third to the seventh days after the second menstruation. All pregnancies occurring during the observation period were recorded. The TCRS succeeded for all patients. None of them needed a two-stage operation. Cavity membrane adhesion of uterine cavity formed in 3 cases, 2 cases and 2 cases in the groups A, B, C respectively. 194 of 223 patients got pregnant within one year after TCRS. 160 children had been delivered successfully. The live birth rate was 71.7% (160/223). The abortion rates after operation were 10 cases, 7 cases and 9 cases in A, B, C group respectively. Statistical analysis showed no significant differences in uterine adhesion, pregnancy rate, abortion frequency, live birth rate and the rate of cesarean section among the three groups. However, the postoperational cost of group C was significantly lower than that of groups A and B. In short, neither postoperational IUD placement, nor estrogen therapy, nor the combination of IUD and ERT demonstrated any discernible clinical benefits to the patients in preventing intrauterine adhesions and facilitating pregnancy after TCRS.