Optimal waiting period for subsequent fertility treatment after various hysteroscopic surgeries.

Literature Review Article

Optimal waiting period for subsequent fertility treatment after various hysteroscopic surgeries. Yang JH, Chen MJ, Chen CD, Chen SU, Ho HN, Yang YS. Fertil Steril 2013; 99 (7): 2092-6. 

Review
Dr. John Preston Parry, M.D., M.P.H.
 

The authors address how endometrial healing after operative hysteroscopy depends on the procedure performed.  They evaluated 163 women through office hysteroscopy after hysteroscopic polypectomy, myomectomy, metroplasty, or adhesiolysis approximately 10-14 days after surgery, with repeat assessment every 10-14 days subsequently until healing was deemed complete. The authors did not report use of estrogen therapy or balloon placement during postoperative recovery. 86% of patients had endometrial normalization within 1 month of operative polypectomy, with a 0% rate of adhesion formation. For myomectomy, only 18% had healed by one month and 80% within two months. This accounts for 40% of hysteroscopic myomectomy patients having postoperative intrauterine adhesions (IUA) that were swept away during office hysteroscopy. For hysteroscopic metroplasty, 19% were healed by one month and 96% by two months, with 88% requiring adhesiolysis at follow up office hysteroscopy. For adhesiolysis, 67% were healed within one month and 96% within two months, though 76% required adhesiolysis during office hysteroscopy. (47% were IUA class II, 22% were IUA class III, 27% were IUA class IV, and 4% were IUA class V.) In summary, the type of operative hysteroscopy affects the interval for endometrial healing, as well as the potential for postoperative adhesions in the absence of estrogen or balloon therapy.

Comments
Dr. Steven Lindheim, M.D.
 

This is an interesting study to assess the optimal waiting time for infertility treatment after operative hysteroscopy for polypectomies, myoma and septum resection, and lysis of adhesions. The optimal waiting times for uterine healing appears to be different for each procedure with minimal adhesion formation after polyp resection, with a high likelihood in more advanced resection where 2nd look hysteroscopic resection may be warranted in these cases.  Using newer morcellation techniques may prevent the development of intra-uterine adhesion and alter these findings.

 

The above review and commentary on this article were written by SRS members. Publication of these summaries does not reflect endorsement of any particular procedure or treatment. Views expressed in these summaries do not necessarily reflect the views of SRS or ASRM.

 

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