Hysteroscopic Isthmocele repair on IVF outcome It aims to assesse the efficacy of Hysteroscopic CS scar defect repair on the clinical pregnancy rate after embryo transfer. Patients who were diagnosed with significant caesarean section scar defect and had a previous unsuccessful ongoing pregnancy after embryo transfer of one or more euploid embryo and planning for another trial of one euploid embryo transfer will be assed for study eligibility. Twenty five of them will be be randomized to hysteroscopic repair before having embryo transfer. and 25 will go directly for embryo transfer. Clinical pregnancy rate is the primary outcome.
Hysteroscopic Isthmocele repair on IVF outcome Background: Uterine niche is a very common finding in women with previous caesarean section. Subfertility can be associated finding and IVF outcome can be affected by its presence. It is not yet if its treatment before IVF trial could improve the outcome of IVF cycle. Objectives: assesse the efficacy of Hysteroscopic CS scar defect repair on the clinical pregnancy rate after embryo transfer. Methods This prospective randomized controled will be conducted at Healthplus fertility center. The population of the study will be Patients who was diagnosed with significant caesarean section scar defect and had a previous unsuccessful ongoing pregnancy after embryo transfer of one or more euploid embryo and planning for another trial of one euploid embryo transfer. Twenty five of them will be be randomized to hysteroscopic repair before having embryo transfer. and 25 will go directly for embryo transfer. Clinical pregnancy rate is the primary outcome. Seconday outcomes are Complications following hysteroscopic CS scar repair, the need of aspiration of intrauterine fluid before embryo transfer, early pregnancy complications, Caesarean section scar dehiscence or rupture and live birth rate.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
50
Dilatation of the cervix till 7 mm. Introduce the resctoscope through the cervix. The surgical correction of the isthmocele is done by resection of the inferior and superior edges or just the inferior edge of the defect with a resectoscopic loop, using pure cutting current, until reaching the muscular layer. Coagulation of fragile vessels at the base or even entire niche. At the end of procedure, flow and pressure of distending medium can be reduced to ensure adequate haemostasis.
Healthplus fertility center
Abu Dhabi, UAE, United Arab Emirates
RECRUITINGHealthplus fertility center
Abu Dhabi, United Arab Emirates
RECRUITINGRate of Clinical pregnancy
detection of intrauterine pregnancy with a detectable fetal heart pulsation by transvaginal ultrasound scan
Time frame: at 7 weeks of gestation or beyond
Rate of Complications following hysteroscopic CS scar repair
uterine perforation, fluid overload and endometritis
Time frame: up to 6 weeks
Rate of Need of aspiration of intrauterine fluid
Presence intrauterine fluid collection at the time of embryo transfer which should be aspirated before embryo transfer
Time frame: During the preparation of embryo transfer. Through study completion, an average of 1 year
Rate of Early pregnancy complications
Ectopic pregnancy or Miscarriage
Time frame: 12 weeks gestation
Rate of Caesarean section scar dehiscence or rupture
Rupture of CS scar during the antenatal period or presence of CS scar wound dehiscence at the time of delivery
Time frame: Within 40 weeks of pregnancy
Rate of delivery of a living baby
Delivery of a living baby after 24 weeks gestation
Time frame: Within 40 weeks of pregnancy
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