Analysis Of The Efficacy Of Estradiol Valerate After Transcervical Resection Of Adhesions

Objectives:This study compared the differences of reconstruction of intrauterine cavity, the restoration of menstruation and reproductive outcomes after oral administration of estradiol valerate in mild, moderate and severe IUA patients who underwent Transcervical Rescection of Intrauterine Adhesion(TCRA), Trying to provide more evidences for clinical application of post-op estradiol valerate.Methods:A retrospective analysis was carried out to explore the clinical datas of210cases of intrauterine adhesion patients who were treated in the third Xiangya hospital of Central South University from January2008to May2011. According to the March classification, the severity of IUA is scaled from mild to severe. All patients were administered oral estrogen(estradiol valerate) after TCRA. According to the dosage of estrogen patients taken per day, four groups are devided:2mg group,4mg group,6mg group,8mg group. All patients were followed up of their drug side-effects, menstrual condition, reconstruction of uterine cavity, and reproductive outcomes. All datas were analysed by statistical software SPSS20.0.Results:1. Among210cases of IUA patients, estrogen’s side-effects such as breast distension, gastrointestinal reactions, weight gain, VVC or irregular vaginal bleeding happened in some patients, but no statistically signifigant difference were found among different dosage groups(P>0.05).2. There was no statistically significant difference both in the reconstruction of uterine cavity and restoration of menstruation among different dose groups in mild IUA patients(P=0.794,0.555).3. Statistically significant difference was found in the reconstruction of cavity among different dose groups in moderate IUA patients (P=0.021).8mg group’s restoration of cavity rate compared to2mg and4mg group was significantly high (P=0.007,0.003). There was no statistically significant difference in the restoration of menstruation among different dose groups in mild IUA patients(P=0.978).4. There was no statistically significant difference both in the reconstruction of uterine cavity and restoration of menstruation among different dose groups in severe IUA patients(P=0.712,0.352).5. There was statistically significant difference in the reconstruction of cavity among different severity group of IUA(P=0.000), mild and moderate IUA’s cavity restoration rate was higher than that of severe IUA. Statistically difference was found in the restoration of menstruation among different dose groups (P=0.000), mild IUA had higher restoration rate than moderate and severe IUA.6. There was no statistically significant difference in the live birth rate among different severity goups of IUA(P=0.753). But statistically significant difference was found in the pregnancy rate (P=0.041) and obstetric complications(P=0.041) of different IUA severity group.7. The unconditional logistic regression shows that in moderate IUA, the unadjusted OR value of6mg%8mg EV and reconstruction of cavity are2.024and2.971, and their value become1.901and2.620after mixed factors included.Conclusions:1. There is no statistically difference in the efficacy of EV in mild IUA patient, low-dose estrogen is sufficient for mild IUA patients’recovery.2. Large dose of post-op EV seems to have significant efficacy in treating moderate IUA patients, it functions well in mild IUA patient. 3. There is no statistically difference in the efficacy of different doses of EV in severe IUA patient, the efficacy of estrogen is not satisfied in severe IUA patients.4. There is no difference in the live birth rate among different severity groups, but pregnancy rate of mild IUA patients is significantly higher than moderate and severe patients and obstetric complication rate is significantly high in severe IUA patients than in mild and moderate IUA patients.