Optimal Waiting Period for Fresh Embryo Transfer after Hysteroscopic Adhesiolysis: A Retrospective Cohort Study
Intrauterine adhesions (IUAs), also known as Asherman syndrome, are a significant cause of infertility and recurrent pregnancy loss. These adhesions are composed of fibrotic tissue that can lead to partial or complete closure of the uterine cavity, resulting in menstrual abnormalities, infertility, and repeated failure of embryo implantation. Hysteroscopic adhesiolysis is the primary treatment for IUAs, but the optimal time interval between this procedure and fresh embryo transfer (ET) in assisted reproductive technology (ART) cycles remains unclear. This study aims to determine the optimal waiting period for fresh ET after hysteroscopic adhesiolysis to improve IVF/ICSI cycle outcomes.
The study was conducted at the Reproductive Hospital Affiliated to Shandong University between January 2014 and September 2017. A total of 312 patients diagnosed with IUAs and undergoing hysteroscopic adhesiolysis before fresh IVF-ET or ICSI cycles were included. Patients were classified into three groups based on the interval between hysteroscopic adhesiolysis and ET: less than 90 days (Group 1), 90 to 180 days (Group 2), and greater than 180 days (Group 3). Baseline characteristics, controlled ovarian stimulation (COS) response, and pregnancy outcomes after ET were compared among the groups.
The baseline characteristics of the patients, including age, body mass index (BMI), hormone levels, pre-operative endometrial thickness, indication for IVF, and type of infertility, showed no significant differences among the three groups. The COS characteristics, such as total dosage and startup dosage of gonadotropin (Gn), protocol type, total number of mature oocytes, peak endometrial thickness, number of embryos transferred, and days to ET, also did not differ significantly among the groups.
The primary outcome of the study was the live-birth rate, which was significantly higher in Group 2 (40.1%) compared to Group 1 (17.9%). There were no significant differences in the rates of biochemical, ongoing, and clinical pregnancy, as well as biochemical and clinical pregnancy abortion and stillbirth among the groups. In patients with mild IUAs, the live-birth rate was significantly higher in Group 2 (42.6%) compared to Group 1 (22.0%). Similarly, in patients with moderate IUAs, Group 2 (35.7%) had a higher frequency of live births than Group 1 (6.7%).
The study also analyzed the severity classification of IUAs using the American Fertility Society (AFS), European Society for Gynecologic Endoscopy (ESGE), and Chinese IUA scoring systems. There were no significant differences in the severity classification among the three groups. Additionally, the surgical procedures, including hysteroscopic electrotomy and cold knife surgery, did not show significant differences in outcomes among the groups.
The findings suggest that the optimal waiting period for fresh ET after hysteroscopic adhesiolysis is 90 to 180 days. This interval allows sufficient time for endometrial recovery and reduces the risk of adhesion recurrence, thereby improving ART outcomes. The study also highlights the importance of considering the severity of IUAs when determining the optimal waiting period for ET.
In conclusion, the time interval between hysteroscopic adhesiolysis and fresh ET significantly affects the outcomes of IVF/ICSI cycles. An interval of 90 to 180 days is optimal for improving live-birth rates and overall pregnancy outcomes. This study provides valuable insights for clinicians in managing patients with IUAs and optimizing ART protocols.
doi.org/10.1097/CM9.0000000000000456
Was this helpful?
0 / 0