Optimal waiting period for subsequent fertility treatment after various hysteroscopic surgeries

The duration of endometrial wound healing is different after various hysteroscopic surgeries. It can be clearly observed with postoperative monthly office hysteroscopic examinations.

Jehn-Hsiahn Yang, M.D., Mei-Jou Chen, M.D., Ph.D., Chin-Der Chen, M.D., Shee-Uan Chen, M.D., Hong-Nerng Ho, M.D., Yu-Shih Yang, M.D., Ph.D.

Volume 99, Issue 7, Pages 2092-2096.e3, June 2013


To investigate the endometrial wound healing duration after a hysteroscopic surgery.

Prospective study.

Tertiary university hospital.

One hundred sixty-three women who underwent hysteroscopic surgeries for endometrial polyp (n=37), submucous myoma (n=65), uterine septum (n=16), and intrauterine adhesion (IUA, n=45).

Postoperative office hysteroscopy was consecutively done till complete endometrial wound healing. If there was newly formed IUA occurring at the endometrial wounds, adhesiolysis was immediately done with the tip of the office hysteroscope.

Main Outcome Measure(s):
Office hysteroscopic inspection of endometrial wound healing, and the presence of newly formed IUA.

Thirty-two out of 37 women (86%) achieved a fully healed endometrium one month after polypectomy, higher than those after myomectomy (18%), septal incision (19%), and adhesiolysis (67%). Postoperative office hysteroscopy revealed that 88% and 76% of the women had new IUA formation after septal incision and adhesiolysis, more than those after myomectomy (40%) and polypectomy (0%). Women with postoperative new IUA formation were less likely to achieve endometrial wound healing within one month, as compared with those who had no new IUA formation (31% vs. 61%).

The duration of endometrial wound healing is different after various hysteroscopic surgeries. Postoperative new IUA formation is an important factor influencing endometrial wound healing.

  • Lauren Johnson

    Thanks to the authors for an interesting study! This data will be helpful when counseling patients and planning fertility treatments after hysteroscopic surgery.

    I have a couple questions about this study. Were there specific criteria or cut-offs that you used to assess endometrial healing? Also, I noticed that you requested that women in the study use contraception prior to endometrial healing. In general, did these women use hormonal contraception? If so, were you able to observe any differences in the rates of endometrial healing based on contraceptive regimen? Did anyone receive estrogen or balloon therapy?

  • Micah Hill

    Congratulations and thank you for your study! I felt your data was very practical and potentially could change some practices. I have a few questions:

    1. Is this frequency of repeat follow-up hysteroscopy (q10-14 days) your normal practice or was it unique to this study?

    2. Were these patients consented for the study?

    3. Are you able to do a secondary analysis examining the use of electrocuting and new adhesion formation? From your methods it seems that not all adhesion cases required this and it could be a significant potential confounder to time to healing.

    4. I saw you did not use estrogen or ballon therapy for adhesion takedown. Was this the same then for septums and large myoma? Im curious if there are ever cases where you use these therapies, especially after several repeat adhesion takedown procedures? If not, why your practice is not to use these modalities for healing?

    I appreciate your expertise on these questions!

Translate »