UNVEILING THE IMPACT OF INTRAUTERINE ADHESIONS ON INFERTILITY: A COMPARATIVE JOURNEY THROUGH PRIMARY AND SECONDARY INFERTILITY PATIENTS
Abstract
Intrauterine adhesions (IUAs) represent an important cause of infertility, having various effect in patients with primary and secondary infertility. The objective of the study is to evaluates the clinical, demographic, and intraoperative characteristics of patients with IUAs, focusing the correlation between hysteroscopic and laparoscopic tubal patency assessment and infertility type. Materials and methods: A retrospective descriptive study was conducted between 2016 and 2024 at two hospitals in Iasi, Romania: Clinical Hospital of Obstetrics and Gynecology “Elena Doamna” and “Cuza-Vodă”. Medical records identified 134 patients with IUAs, of whom only 102 patients met the inclusion criteria and divided in two groups: primary and secondary cohorts. All patients underwent hysteroscopic adhesiolysis to restore the anatomy of uterine cavity, with perioperative tubal patency evaluation and confirmed laparoscopically in most cases. Results: Patients with IUAs and primary infertility were younger (31.66 vs. 34.13 years; p=0.023) and predominantly aged 25-34 years, whereas IUAs patients and secondary infertility was more common in those over 35 years. Secondary infertility subjects showed higher rates of repetitive dilation and curettage (77%, p=0.001), ectopic pregnancies (6.6%, p=0.04). Hysteroscopic and laparoscopic tubal patency revealed a higher patency rate in secondary infertility cases (90.2%) compared to primary infertility cases (73.2%, p=0.038). Bilateral positive patency through the laparoscopic Dye test was more common in primary infertility cases (61% vs. 41%, p=0.029). This study highlights distinct clinical and intraoperative characteristics between primary and secondary infertility in patients with AIUs. Secondary infertility was significantly associated with higher rates of previous D&Cs, increased hysteroscopic and laparoscopic tubal patency rates and ectopic pregnancies. Conclusions: This study emphasize the importance of tailored diagnostic and therapeutic approaches to optimize outcomes for patients with IUAs and infertility.
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