Predictive value of three-dimensional ultrasound evaluation of endometrium on pregnancy outcomes after hysteroscopic adhesiolysis for intrauterine adhesion

doi:10.3969/j.issn.1006-7795.2024.03.019

Abstract

Abstract: Objective To investigate the predictive value of endometrium-related indicators assessed by three-dimensional transvaginal ultrasound (3D-TVUS)on pregnancy outcome after hysteroscopic adhesiolysis(HA).Methods A total of 278 patients who underwent HA for fertility purposes at the Fuxing Hospital, Capital Medical University, from June 2020 to February 2022 were included in this study. In the mid-luteal phase, 3D-TVUS was performed to assess endometrial thickness, endometrial volume, and blood flow indices. Postoperative follow-up was conducted to evaluate uterine cavity and pregnancy outcomes. Based on the pregnancy outcome, patients were divided into a pregnancy group and a non-pregnancy group. Univariate analysis and multivariate Logistic regression analysis were performed to determine the factors influencing clinical pregnancy. The predictive value of these factors for clinical pregnancy was evaluated by using the area under the receiver operating characteristic curve. Results Among the 278 included patients, 8 cases were lost to follow-up. Clinical pregnancy was achieved in 143 cases, while 4 cases experienced ectopic pregnancy and 123 cases did not achieve pregnancy. Multivariate analysis revealed that postoperative American Fertility Society (AFS) score, endometrial thickness, and volume were independent factors influencing clinical pregnancy (P<0.05). The Logistic regression model for predicting pregnancy after HA had an area under the curve of 0.827, a Youden index of 58.5%, sensitivity of 74.8%, and specificity of 83.7%. The optimal cutoff values for postoperative endometrial thickness and endometrial volume were 6.22 mm and 1.42 mL, respectively. Conclusion Postoperative AFS score, endometrial thickness, and volume were found to be predictive factors for pregnancy outcomes following hysteroscopic adhesion separation. They can serve as reference indices for patients in their postoperative pregnancy planning and assistive treatment decisions.

Key words: three-dimensional transvaginal ultrasound, intrauterine adhesion, endometrial volume, pregnancy

CLC Number:

R713

hao Yuting, Huang Xiaowu, Xu Ruonan, Huang Rui, Xia Enlan. Predictive value of three-dimensional ultrasound evaluation of endometrium on pregnancy outcomes after hysteroscopic adhesiolysis for intrauterine adhesion[J]. Journal of Capital Medical University, 2024, 45(3): 501-507.

0
/ / Recommend

Add to citation manager EndNote|Reference Manager|ProCite|BibTeX|RefWorks

URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2024.03.019

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2024/V45/I3/501

References

［1］ Yu D, Wong Y M, Cheong Y, et al. Asherman syndrome—one century later［J］. Fertil Steril, 2008, 89(4): 759－779.
［2］ AAGL Elevating Gynecologic Surgery. AAGL practice report: practice guidelines on intrauterine adhesions developed in collaboration with the European Society of Gynaecological Endoscopy (ESGE)［J］. Gynecol Surg, 2017, 14(1): 6.
［3］ Burjoo A, Zhao X P, Zou L X, et al. The role of preoperative 3D-ultrasound in intraoperative judgement for hysteroscopic adhesiolysis［J］. Ann Transl Med, 2020, 8(4): 55.
［4］ Wamsteker K, De Block S. Diagnostic hysteroscopy: technique and documentation［M］//Sutton C, Diamond M. Endoscopic surgery for gynecologists. London: WB Saunders, 1998: 511－524.
［5］ The American fertility society. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, müllerian anomalies and intrauterine adhesions［J］. Fertil Steril, 1988, 49(6): 944－955.
［6］ Panayotidis C, Weyers S, Bosteels J, et al. Intrauterine adhesions (IUA): has there been progress in understanding and treatment over the last 20 years?［J］. Gynecol Surg, 2009, 6(3): 197－211.
［7］ Khan Z, Goldberg J M. Hysteroscopic management of asherman's syndrome［J］. J Minim Invasive Gynecol, 2018, 25(2): 218－228.
［8］ Guo E J, Chung J P W, Poon L C Y, et al. Reproductive outcomes after surgical treatment of asherman syndrome: a systematic review［J］. Best Pract Res Clin Obstet Gynaecol, 2019, 59: 98－114.
［9］ Xu J N, Zhang S D, Jin L, et al. The effects of endometrial thickness on pregnancy outcomes of fresh IVF/ICSI embryo transfer cycles: an analysis of over 40,000 cycles among five reproductive centers in China［J］. Front Endocrinol (Lausanne), 2021, 12: 788706.
［10］ Baradwan S, Shafi D, Baradwan A, et al. The effect of endometrial thickness on pregnancy outcome in patients with Asherman's syndrome post-hysteroscopic adhesiolysis［J］. Int J Womens Health, 2018, 10: 77－82.
［11］ Movilla P, Wang J, Chen T, et al. Endometrial thickness measurements among Asherman syndrome patients prior to embryo transfer［J］. Hum Reprod, 2020, 35(12): 2746－2754.
［12］ Fischer C, Copperman A. Use of three dimensional ultrasound imaging in evaluation of Asherman's syndrome［M］//Oleg M, Igor M. Ultrasound imaging － medical applications. Rijeka: Intech Open, 2011: 41－46.
［13］ Tetlow R L, Richmond I, Manton D J, et al. Histological analysis of the uterine junctional zone as seen by transvaginal ultrasound［J］. Ultrasound Obstet Gynecol, 1999, 14(3): 188－193.
［14］ Chien L W, Au H K, Chen P L, et al. Assessment of uterine receptivity by the endometrial-subendometrial blood flow distribution pattern in women undergoing in vitro fertilization-embryo transfer［J］. Fertil Steril, 2002, 78(2): 245－251.
［15］云兵, 田军, 杨小芳, 等. 经阴道三维能量多普勒超声在宫腔镜下重度宫腔粘连松解术后检查效果［J］. 中国计划生育学杂志, 2023, 31(1): 100－103.
［16］庞慧贤, 江宁珠, 黄翠平, 等. 阴道三维超声评估宫腔粘连患者的子宫内膜容受性及其对妊娠的影响［J］. 中国现代医学杂志, 2022, 32(6): 68－73.
［17］ Alcázar J L. Three-dimensional ultrasound assessment of endometrial receptivity: a review［J］. Reprod Biol Endocrinol, 2006, 4: 56.
［18］ Hanstede M M F, van der Meij E, Veersema S, et al. Live birthsafter Asherman syndrome treatet［J］. Fertil Steril, 2021,116(4): 1181-1187.
［19］ Chen L, Zhang H, Wang Q, et al. Reproductive outcomes in patients with intrauterine adhesion following hysteroscopic adhesiolysis: experience from the largest women's hospital in China［J］. J Minim Invasive Gynecol 2017,24(2):299-304.

[1]	Ma Jun, Ruan Xiangyan, Xu Zhongting, Gu Muqing, Alfred O.Mueck. Effect of Zi Gui Nv Zhen Capsules on pregnancy outcome in women with diminished ovarian reserve [J]. Journal of Capital Medical University, 2023, 44(4): 540-543.
[2]	Zhao Yue, Ruan Xiangyan, Gu Muqing, Cheng Jiaojiao, Wang Yuejiao, Jin Jing. Research progresses in fertility and pregnancy management in patients with Turner syndrome [J]. Journal of Capital Medical University, 2023, 44(4): 561-567.