(intrauterine adhesion IUA) (Asherman syndrome) (transcervical resection of adhesions TCRA) 1988 (American Fertility Society

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1 Med J Chin PLA, Vol. 42, No. 5, May 1, [ ] (IUA) IUA March AFS ESGE IUA 2 ESGE IUA (AUC) MarchAUC AFS IUA IUA ESGE March AFS [ ] Asherman [ ] R711.5 [ ] A [ ] (2017) [DOI] /j.issn Predictive efficacy of different intrauterine adhesion (IUA) classification systems on the prognosis of patients with IUA SUN Dong-hua, HE Yuan-li *, ZHANG Dong-mei, HUANG Xiao-bin, CAI Hui-hua, ZENG Li-ying Department of Obstetrics and Gynecology, Zhujiang Hospital, Southern Medical University, Guangzhou , China * Corresponding author, heyuanli310@163.com This work was supported by the National Natural Science Foundation of China ( ) [Abstract] Objective To explore the effects of different intrauterine adhesion (IUA) classification systems on predicting the IUA prognosis. Methods One hundred cases were selected as the subjects in present study from those diagnosed with IUA and underwent surgery in Zhujiang Hospital of Southern Medical University from Jan to Jan. 2017, and were followed up for two years. According to the actual situation, all patients were scored by March, AFS, ESGE and Chinese classification for comparing the effects of different IUA classification systems on predicting the pregnancy rate, live birth rate and effective rate within 2 years after surgery. Results ESGE classification had a good effect on predicting the postoperative live birth rate and effective rate, and a certain predictive effect on pregnant rate, with the area under curve (AUC) of 0.722, and 0.635, respectively. March classification had a certain effect on predicting the postoperative live birth rate and effective rate with AUC of 0.635, 0.754, respectively, but had a poor effect on predicting pregnant rate. AFS classification and China classification had poor effect on predicting the IUA prognosis. Conclusion ESGE classification system is better than the other systems including March, AFS and Chinese classification, on predicting the IUA prognosis, but further verification in large sample size is still required. [Key words] intrauterine adhesion; Asherman syndrome; classification systems; prognosis (intrauterine adhesion IUA) (Asherman syndrome) ( ) ( ) [ ] ( ) [ ] [ ] ( ) [ ] heyuanli310@163.com [1-2] [3] IUA (transcervical resection of adhesions TCRA) IUA [1,4] IUA 1978 March [5] 1988 (American Fertility Society AFS) [6] 1998 (European Society for Gynaecological Endoscopy ESGE) [1]

2 IUA IUA [7] IUA IUA (20~46) IUA 2 - (IVF-ET) IUA March AFS ESGE [1,5-7] Hegar 10 B 2~ SPSS 19.0 x±s One-Way ANOVA SNK-q χ 2 Spearman Logistic ROC P< IUA 100 IUA IUA (BMI) Spearman IUA IUA (P<0.05) IUA (P>0.05) 2.2 IUA IUA Spearman March AFS ESGE ( 1) IUA Spearman March

3 Med J Chin PLA, Vol. 42, No. 5, May 1, Variable Preoperative menstruation 1 IUA Tab.1 Correlation of different variables to postoperative IUA prognosis Endometrial thickness Gestational history Curettage history Adhesion range Adhesion properties opening of oviduct Pregnancy rate * Live birth rate * * * Effective rate * * * * Presents P<0.05 AFS ESGE ( 2) 2 IUA Tab.2 Correlation of different types of score criteria to the prognosis of postoperative IUA Variable Parameter March AFS ESGE Chinese Pregnancy rate Live birth rate γ P γ P γ Effective rate P AFS. American Fertility Society; ESGE. European Society for Gynaecological Endoscopy 2.3 IUA logistic Logistic March AFS ( P=0.124 OR= %CI 0.406~1.115 P =0.338 OR= %CI 0.482~1.328 P=0.082 OR= %CI 0.285~1.079) ESGE (P=0.023 OR= %CI 0.524~0.954) AFS (P=0.081 OR= %CI 0.337~1.064) March ESGE ( P=0.017 OR= %CI 0.274~0.881 P =0.001 OR= %CI 0.379~0.786 P=0.030 OR= %CI 0.203~0.923) AFS ( P=0.061 OR= %CI 0.254~1.030 P=0.085 OR= %CI 0.200~1.109) March ESGE ( P=0.004 OR= %CI 0.136~0.690 P=0.002 OR= %CI 0.286~ ) 2.3 ROC ROC 4 IUA 3 IUA logistic Tab.3 Univariate logistic regression analysis of different score criteria to IUA prognosis Variable Classification β P OR 95%CI March Pregnancy rate AFS ESGE Chinese March Live birth rate AFS ESGE Chinese March Effective rate AFS ESGE Chinese B=ln(OR); OR. Odds ratio; 95%CI. 95% confidence interval ESGE (AUC) March AFS 4 ESGE AUC ( 4 1) 4 IUA ROC Tab.4 The parameters of ROC curve of different score criteria to IUA prognosis Variable Classification AUC SE P 95%CI March Pregnancy rate AFS ESGE Chinese March Live birth rate AFS ESGE Chinese March Effective rate AFS ESGE Chinese AUC. Area under curve; SE. Standard error

442 2017 5 1 42 5 1.0 1.0 0.8 0.8 Sensitivity 0.6 0.4 Sensitivity 0.6 0.4 0.2 0.2 0.0 0.0 0.2 0.4 0.6 0.8 1.0 1-Specificity A 0.0 0.0 0.2 0.4 0.6 0.8 1.0 1-Specificity B 1.0 0.8 Sensitivity 0.6 0.4 0.2 March AFS ESGE Chinese Line of reference 0.

4 Sensitivity Sensitivity Specificity A Specificity B Sensitivity March AFS ESGE Chinese Line of reference Specificity C 1 IUA ROC Fig.1 ROC curve of different classification and prognosis of IUA A. Pregnancy rate; B. Live birth rate; C. Effective rate 3 IUA IUA IUA 25%~30% [8] IUA [7] IUA [1] IUA 3 March AFS ESGE 3 (AFS) (ESGE) IUA IUA [7] IUA [9] 148 IUA March AFS ESGE Nasr March March AFS ESGE 100 IUA TCRA 4 ESGE IUA (AUC>0.7) (AUC<0.7) March ESGE ESGE March AFS AFS ESGE IUA

5 Med J Chin PLA, Vol. 42, No. 5, May 1, [3] IUA IUA HPO [10] Yu [4] Roy [11] Kasius [12] Zhao [13] Meta IVF IUA [3,14] IUA IUA (P<0.05) IUA (P>0.05) AFS IUA [15] IUA IUA IUA [16-20] ESGE March AFS ESGE IUA IUA ESGE March AFS IUA IUA IUA [1] Yu D, Wong YM, Cheong Y, et al. Asherman syndrome--one century later[ J]. Fertil Steril, 2008, 89(4): [2] Deans R, Abbott J. Review of intrauterine adhesions[ J]. J Minim Invasive Gynecol, 2010, 17(5): [3] Huang SM, Gao JF, Shi LJ, et al. A preliminary study of the relationship between the uterine junctional zone and outcome of intrauterine adhesions[ J]. Med J Chin PLA, 2016, 41(4): [,,,. [ J]., 2016, 41(4): ] [4] Yu D, Li TC, Xia E, et al. Factors affecting reproductive outcome of hysteroscopic adhesiolysis for Asherman's syndrome[ J]. Fertil Steril, 2008, 89(3): [5] March CM, Israel R, March AD. Hysteroscopic management of intrauterine adhesions[ J]. Am J Obstet Gynecol, 1978, 130(6): [6] [No authors listed]. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, müllerian anomalies and intrauterine adhesions[ J]. Fertil Steril, 1988, 49(6): [7] Society of Gynaecology and Obstetrics of the Chinese Medical Association. Chinese experts consensus of clinical diagnosis and treatment of intrauterine adhesions[ J]. Chin J Obstet Gynecol, 2015, 50(12): [. [J]., 2015, 50(12): ] [8] Rein DT, Schmidt T, Hess AP, et al. Hysteroscopic management of residual trophoblastic tissue is superior to ultrasound-guided curettage[ J]. J Minim Invasive Gynecol, 2011, 18(6): [9] Wu JN. The comparison of value of different IUA classification systems in indicating pregnancy outcomes[d]. Hangzhou: Zhejiang University, [. [D]. :, 2015.] [10] March CM. Asherman's syndrome[ J]. Semin Reprod Med, 2011, 29(2): [11] Roy KK, Baruah J, Sharma JB, et al. Reproductive outcome following hysteroscopic adhesiolysis in patients with infertility due to Asherman's syndrome[ J]. Arch Gynecol Obstet, 2010, 281(2): [12] Kasius A, Smit JG, Torrance HL, et al. Endometrial thickness and pregnancy rates after IVF: a systematic review and metaanalysis[ J]. Hum Reprod Update, 2014, 20(4): [13] Zhao J, Zhang Q, Wang Y, et al. Endometrial pattern, thickness and growth in predicting pregnancy outcome following 3319 IVF cycle[ J]. Reprod Biomed Online, 2014, 29(3): [14] Takai IU, Kwayabura AS, Ugwa EA, et al. A 10-year review of the clinical presentation and treatment outcome of Asherman's syndrome at a center with limited resources[ J]. Ann Med Health Sci Res, 2015, 5(6): [15] Wang XL, Cai PF, Zhang WJ, et al. Relationship of telomere length in cumulus cells with oocytes maturation and outcome of IVF-ET in patients with different ages[ J]. J Zhengzhou Univ (Med Sci), 2016, 51(2): [,,,. IVF-ET [ J]. ( ), 2016, 51(2): ] [16] Sun YH, Lin Y, Sun WJ, et al. Analysis on influence factors of postoperative pregnancy in 132 cases of intrauterine adhersion separation operation[ J]. Chongqing Med, 2017, 46(2):

6 [,,,. 132 [ J]., 2017, 46(2): ] [17] Ru XL, Duan H, Wang YJ, et al. Study on influencing factors of occurrence of intrauterine adhesion and prognosis[ J]. Matern Child Health Care China, 2014, 29(24): [,,,. [J]., 2014, 29(24): ] [18] Qin Y, Wang AM, Wang MK, et al. Analysis of influence factors for pregnancy outcomes of hysteroscopic adhesiolysis[ J]. J Reprod Med, 2014, 23(9): [,,,. [J]., 2014, 23(9): ] [19] Zhou L. The factors which influence hysteroscopic effects in treatment of intrauterine adhesions[ J]. Chin J Endosc, 2013, 19(5): [. [ J]., 2013, 19(5): ] [20] Chang CY, Chang YT, Chien SC, et al. Factors associated with operative hysteroscopy outcome in patients with uterine adhesions or submucosal myomas[ J]. Int J Gynaecol Obstet, 2010, 109(2): ( ) ( )

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