Uterine synechiae after bipolar hysteroscopic resection of submucosal myomas in patients with infertility

ObjectiveTo determine the rate of uterine synechiae after bipolar hysteroscopic myomectomy in patients suffering from infertility.DesignRetrospective case series study.SettingUniversity obstetrics gynecologic and assisted reproduction center.Patient(s)A group of 53 patients with primary (n = 30) and secondary (n = 23) infertility.Intervention(s)Patients underwent bipolar hysteroscopic resection of myomas between 2001 and 2006, and an outpatient hysteroscopy was performed 2 months after the fibroid resection.Main Outcome Measure(s)The formation of uterine synechiae and pregnancy rates were collected from the patients' clinical notes.Result(s)The submucosal myomas were intracavitary class 0 (n = 12), intramural class 1 (n = 19), and intramural class 2 (n = 22). The mean age of the women was 35.0 ± 4.8 years. The mean myoma size was 25 ± 11 mm. Postoperative office hysteroscopies revealed synechiae in four (7.5%) of 53 patients. Sixteen (32.7%) of the 49 patients not lost to follow-up conceived, and 12 (24.5%) of them delivered at term. Myoma size ≥3.5 cm and age <35 years were associated with a significantly higher pregnancy rate in univariate and multivariate analysis.Conclusion(s)The incidence of uterine synechiae after bipolar hysteroscopic resection of fibroids was 7.5%. This appears to be lower than that reported in previous studies using monopolar energy. Bipolar hysteroscopic myomectomy may be a better option for infertile women.