The study hopes to learn the best way to prevent internal scar tissue after septum removal. The use of an intrauterine foley catheter balloon may prevent the formation of adhesions following surgery.
This is an open label randomized controlled clinical trial of post-operative interventions to prevent intrauterine adhesion formation following hysteroscopic septoplasty. Individuals undergoing planned hysteroscopic resection of a known uterine septum with a length of ≥50% of the uterine cavity, as measured from the lower uterine segment to the inter-cornual line on 3D ultrasound or MRI will be randomized to either placement of an intrauterine foley catheter balloon for 7-10 days with hormonal supplementation or hormonal supplementation only. Individuals unwilling or unable to consent, those with a history of prior transmural uterine surgery, those with a history of a prior septum resection, history of prior surgery for intrauterine adhesions, or individuals in whom complete septum resection is unable to be performed in a single procedure will be excluded. Patients will be screened by study investigators for eligibility. Patients will be identified if they are found to have a uterine septum during their evaluation for infertility or recurrent pregnancy loss or if previously identified by a referring provider. Investigators will obtain written informed consent in the patient's preferred language by person-to-person contact. Patients choosing to enroll will be randomized in a 1:1 allocation to one of two interventions: Surgical technique in the form of electrocautery versus sharp resection will be at the surgeon's discretion. All patients will undergo a post-operative in-clinic 3D saline sonogram to assess adhesion formation within the first two menstrual cycles following the intervention, to be performed no later than 12 weeks following surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
320
Intraoperative placement of an inflated intrauterine pediatric foley catheter balloon to remain in place for 7-10 days following surgery.
No Intraoperative placement of an inflated intrauterine pediatric foley catheter balloon
2 weeks of oral estradiol (2 mg daily) or transdermal (two 0.1 mg patches changed twice weekly) estradiol supplementation followed by 1 week of oral or transdermal estradiol (same dosing as above) with oral medroxyprogesterone acetate (10 mg daily)
Arkansas Fertility & Gynecology
Little Rock, Arkansas, United States
Weill Cornell Medicine
New York, New York, United States
University Hospitals
Cleveland, Ohio, United States
The rate of intrauterine adhesion formation following hysteroscopic septoplasty
Time frame: 12 weeks
Number of participants with Intraoperative complications
Time frame: 12 weeks
Number of participants with postoperative complications
Time frame: 12 weeks
Number of subjects completing postop intervention-hormone use
Time frame: 12 weeks
Patient compliance - Post Operative - #subject with balloon remaining in place to post op visit
Time frame: 12 weeks
Long Term Reproductive Outcome
Number of subjects achieving pregnancy
Time frame: 3 years
Surgeon assessment of intervention modality
Surgeon assessment of whether intrauterine adhesions were prevented
Time frame: 12 weeks
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100 mg of oral doxycycline twice daily or other appropriate antibiotic in allergic patients to be given while the intrauterine stent is in place