Efficacy of Dienogest in Thinning the Endometrium Before Hysteroscopic Metroplasty and Analysis of Postoperative Reproductive Outcomes

Shuichi Ono, Kenichiro Watanabe, Mirei Yonezawa, Tomoko Ichikawa, Yoshimitsu Kuwabara, Shigeo Akira, Toshiyuki Takeshita
In: Journal of Gynecologic Surgery · 2018 · vol. 34(5) , pp. 234–238 · doi:10.1089/gyn.2018.0015 · W2806490922
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Preoperative dienogest effectively thinned the endometrium before hysteroscopic metroplasty for septate uterus, reducing operative time and fluid infusion without negatively impacting reproductive outcomes.

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Abstract

Objective: This study was conducted to evaluate the efficacy of preoperative dienogest for thinning the endometrium in patients undergoing hysteroscopic metroplasty for septate uteri and to analyze postoperative reproductive outcomes. Materials and Methods: This retrospective cohort study involved 51 patients, each with a history of at least two miscarriages, who underwent hysteroscopic metroplasty. Of the total patients, 16 were treated with 2 mg/day of dienogest and 35 were not treated with dienogest. Primary outcome measures included: thickness of the endometrium on the day before surgery; operative time; hemoglobin and sodium levels on the day after hysteroscopic metroplasty; intraoperative amount of fluid infusion; and postoperative residual septum. Reproductive outcomes were analyzed by assessing pregnancy, miscarriage, and cumulative live birth rates. Dienogest, at 2 mg/day, was orally administered as an extended regimen from cycle day 3 until the preoperative day. Results: There were significant differences in endometrium thickness on the day prior to surgery (dienogest group versus non-dienogest group: 6.6 ± 2.0 mm versus 10.0 ± 2.3 mm; p ≤ 0.0001), operative time (47.8 ± 15.6 minutes versus 61.6 ± 23.6 minutes; p = 0.04), intraoperative amount of fluid infusion (2520.9 ± 771.0 mL versus 3254.1 ± 1259.2 mL; p = 0.02). There were no significant differences in pregnancy, miscarriage, and cumulative live birth rates. Conclusions: This analysis suggests that dienogest is effective for thinning the endometrium before hysteroscopic metroplasty for septate uterus without lowering reproductive outcomes.

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