Effect of different surgical approaches for intrauterine adhesions patients on pregnancy outcomes.
10.11817/j.issn.1672-7347.2025.240529
- Author:
Ping GUO
1
,
2
,
3
;
Meiqin CHEN
1
;
Shan LIU
1
;
Wei PENG
1
;
Xingping ZHAO
4
;
Hualian CHEN
3
,
5
Author Information
1. Department of Gynecology, Yichun Maternal and Child Health Hospital of Jiangxi Province, Yichun
2. gping202@
3. com.
4. Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha
5. Department of Obstetrics and Gynecology, People's Hospital of Changsha County, Changsha 410100, China. ailianchen12@
- Publication Type:Journal Article
- Keywords:
cold knife surgery;
hysteroscopy;
intrauterine adhesions;
pregnancy outcome;
vascular endothelial growth factor
- MeSH:
Humans;
Female;
Pregnancy;
Tissue Adhesions/surgery*;
Retrospective Studies;
Adult;
Pregnancy Outcome;
Uterine Diseases/surgery*;
Hysteroscopy/methods*;
Infertility, Female/etiology*;
Electrosurgery/methods*;
Fertilization in Vitro;
Endometrium/surgery*;
Embryo Transfer;
Vascular Endothelial Growth Factor A/metabolism*
- From:
Journal of Central South University(Medical Sciences)
2025;50(3):482-491
- CountryChina
- Language:English
-
Abstract:
OBJECTIVES:Transcervical resection of adhesions (TCRA) under hysteroscopy is the mainstay treatment for intrauterine adhesions (IUA), but its effectiveness varies depending on the surgical approach. This study aims to investigate the impact of different surgical techniques on endometrial repair and pregnancy outcomes in patients with secondary infertility and moderate-to-severe IUA.
METHODS:A retrospective analysis was conducted on 225 patients who underwent TCRA followed by in vitro fertilization and embryo transfer between January 2021 and December 2022. Patients were grouped based on the surgical method: A cold knife group (n=127) and an electrosurgical group (n=98). Adhesions were separated using either cold knife or electrosurgical instruments. Postoperative visualization of uterine angle and tubal ostia, endometrial restoration, vascular endothelial growth factor (VEGF) expression in adhesion tissues, and clinical pregnancy outcomes were compared. Univariate and multivariate Logistic regression analyses were performed to identify factors influencing pregnancy outcomes. A LightGBM model was constructed to predict pregnancy outcomes.
RESULTS:Compared with the electrosurgical group, patients in the cold knife group had significantly greater postoperative endometrial thickness [(8.86±0.53) mm vs (8.10±0.87) mm, P<0.05], higher live birth rates (64.57% vs 30.61%, P<0.05), and lower VEGF expression (1.31±0.09 vs 1.53±0.16, P<0.05). Logistic regression analyses identified age, number of visible tubal ostia postoperatively, and surgical method as significant factors affecting pregnancy outcomes (P<0.05). The LightGBM model based on surgical method had an area under the curve (AUC) of 0.882 (0.838-0.926), with internal validation AUC of 0.817 (0.790-0.840).
CONCLUSIONS:Cold knife surgery promotes faster recovery of the endometrial microenvironment and earlier improvement of fertility in patients with secondary infertility and IUA Surgical method is a key factor influencing pregnancy outcomes, and the LightGBM model based on surgical approach shows good predictive performance for pregnancy outcomes in patients with moderate-to-severe IUA.
