Hysteroscopic outpatient metroplasty to expand dysmorphic uteri (HOME-DU technique): a pilot study A. Di Spiezio Sardo, P. Florio, G. Nazzaro, M. Spinelli,

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Hysteroscopic outpatient metroplasty to expand dysmorphic uteri (HOME-DU technique): a pilot study A. Di Spiezio Sardo, P. Florio, G. Nazzaro, M. Spinelli, D. Paladini, C. Di Carlo, C. Nappi Reproductive BioMedicine Online Volume 30, Issue 2, Pages 166-174 (February 2015) DOI: 10.1016/j.rbmo.2014.10.016 Copyright © 2014 Reproductive Healthcare Ltd. Terms and Conditions

Figure 1 Dysmorphic uteri according to European Society of Human Reproduction and Embryology and the European Society for Gynaecological Endoscopy classification of female genital tract congenital anomalies (Grimbizis et al., 2013). (a) T-shaped uterus; (b) uterus infantalis. Reproductive BioMedicine Online 2015 30, 166-174DOI: (10.1016/j.rbmo.2014.10.016) Copyright © 2014 Reproductive Healthcare Ltd. Terms and Conditions

Figure 2 The enrollment process. Reproductive BioMedicine Online 2015 30, 166-174DOI: (10.1016/j.rbmo.2014.10.016) Copyright © 2014 Reproductive Healthcare Ltd. Terms and Conditions

Figure 3 Three-dimensional transvaginal ultrasound imaging referring to the landmarks of the HOME-DU technique: the distance between tubal ostia (IO, interostial distance); the transversal diameter at the isthmus (I, isthmic diameter), as well as the the depth of the healthy myometrium up to the serosa (of which sections are allowed). HOME-DU = Hysteroscopic Outpatient Metroplasty to Expand Dysmorphic Uteri. Reproductive BioMedicine Online 2015 30, 166-174DOI: (10.1016/j.rbmo.2014.10.016) Copyright © 2014 Reproductive Healthcare Ltd. Terms and Conditions

Figure 4 The HOME-DU technique on a frontal view of a T-shaped uterus. (1) incisions on the fibro-muscular constriction rings in the isthmic area of the uterine side walls; (2) incisions on the anterior walls. Note that incisions on posterior wall are symmetric pecular to anterior incisions. Home-DU = Hysteroscopic Outpatient Metroplasty to Expand Dysmorphic Uteri. Reproductive BioMedicine Online 2015 30, 166-174DOI: (10.1016/j.rbmo.2014.10.016) Copyright © 2014 Reproductive Healthcare Ltd. Terms and Conditions

Figure 5 Data on the volume of the uterine cavity measured at three-dimensional transvaginal ultrasound before and after the HOME-DU technique. Uterine volumes before and after surgery were significantly different (P < 0.001). HOME-DU = Hysteroscopic Outpatient Metroplasty to Expand Dysmorphic Uteri. Reproductive BioMedicine Online 2015 30, 166-174DOI: (10.1016/j.rbmo.2014.10.016) Copyright © 2014 Reproductive Healthcare Ltd. Terms and Conditions

Figure 6 Three-dimensional transvaginal sonography showing an improvement of the volume and morphology of T-shaped uteri before (A) and after (B) the HOME-DU technique. An increase of the I/IO ratio was detected. I = isthmic diameter; IO = interostial distance. Reproductive BioMedicine Online 2015 30, 166-174DOI: (10.1016/j.rbmo.2014.10.016) Copyright © 2014 Reproductive Healthcare Ltd. Terms and Conditions

Figure 7 Three-dimensional transvaginal ultrasound showing the improvement of the volume and morphology of tubular-shaped uteri before and after the HOME-DU technique. A significant I/IO ratio decrease was noted. HOME-DU = Hysteroscopic Outpatient Metroplasty to Expand Dysmorphic Uteri; I = isthmic diameter; IO = interostial distance. Reproductive BioMedicine Online 2015 30, 166-174DOI: (10.1016/j.rbmo.2014.10.016) Copyright © 2014 Reproductive Healthcare Ltd. Terms and Conditions