***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To determine if sectioning of the cervical septum in hysteroscopic metroplasty of the complete uterine septum is associated with intraoperative bleeding , cervical incompetence , and secondary infertility . DESIGN Multicenter , r and omized , controlled clinical trial . SETTING University hospitals . PATIENT(S ) Twenty-eight women with a diagnosis of complete uterine septum who had a history of pregnancy wastage or infertility . They were r and omized into two groups : group A underwent metroplasty including section of the cervical septum ; group B underwent the same procedure with preservation of the cervical septum . INTERVENTION(S ) Hysteroscopic metroplasty was performed for all patients in the two groups . MAIN OUTCOME MEASURE(S ) Operating time , distending media deficit , total distending media used , intraoperative bleeding , complications , and reproductive outcome . RESULT ( S ) Operating times were 36.40 + /- 10.67 minutes and 73 + /- 14.40 minutes in group A and group B , respectively . Distending media deficit was 456.66 + /- 165.68 mL in group A , while in group B it was 673.84 + /- 220.36 . Two cases of pulmonary edema and three cases of significant bleeding ( > 150 mL ) were seen in group B. The cesarean section rate was significantly higher in group B. There were no significant differences in the reproductive outcome in the two groups . CONCLUSION ( S ) Resection of the cervical septum during hysteroscopic metroplasty of complete uterine septum makes the procedure safer , easier , and less complicated than the procedure with preservation of the cervical septum . This procedure is recommended for all cases of complete uterine septum Background The success rate of IVF treatment is low . A recent systematic review and meta- analysis found that the outcome of IVF treatment could be improved in patients who have experienced recurrent implantation failure if an outpatient hysteroscopy ( OH ) is performed before starting the new treatment cycle . However , the trials were of variable quality , leading to a call for a large and high- quality r and omised trial . This protocol describes a multi-centre r and omised controlled trial to test the hypothesis that performing an OH prior to starting an IVF cycle improves the live birth rate of the subsequent IVF cycle in women who have experienced two to four failed IVF cycles . Methods and design Eligible and consenting women will be r and omised to either OH or no OH  using an internet based trial management programme that ensures allocation concealment and employs minimisation for important stratification variables including age , body mass index , basal follicle stimulating hormone level and number of previous failed IVF cycles . The primary outcome is live birth rate per IVF cycle started . Other outcomes include implantation , clinical pregnancy and miscarriage rates .  The sample size for this study has been estimated as 758 participants with 379 participants in each arm . Interim analysis will be conducted by an independent Data Monitoring Committee ( DMC ) , and final analysis will be by intention to treat . A favourable ethical opinion has been obtained ( REC reference : 09/H0804/32).Trail Registration The trial has been assigned the following IS RCT N number : IS RCT OBJECTIVE To highlight the efficiency of intrauterine device ( IUD ) guidance during hysteroscopic adhesiolysis for severe intrauterine adhesions . DESIGN A prospect i ve , r and omized trial . SETTING Private tertiary and referral infertility clinic . PATIENT(S ) Seventy-one subfertile patients who underwent hysteroscopic treatment of intrauterine synechiae or adhesions . INTERVENTION(S ) Thirty-six women in group 1 were initially examined by laparoscopy-hysteroscopy at first look , and an IUD was inserted during hysteroscopic adhesiolysis . The adhesions were further lysed by the guidance of IUD during the second-look office hysteroscopy , 1 week later . Patients were prescribed 2 months of estrogen as well as P therapy , and the IUD was removed by the end of this period . The uterine cavity was evaluated , and adhesions were further lysed by a third-look office hysteroscopy , 1 week after the removal of IUD . Thirty-five women in group 2 were similarly examined by first-look office hysteroscopy , and an IUD was inserted during hysteroscopic adhesiolysis . These patients did not undergo early intervention of office hysteroscopy , 1 week after the first procedure . They also used 2 months of estrogen and P therapy . The IUD was removed by the end of this period , and the uterine cavity was evaluated and adhesions were further lysed during a second-look office hysteroscopy . MAIN OUTCOME MEASURE(S ) Pregnancy rate and live birth rate . RESULT ( S ) Spontaneous pregnancy rates after treatment were 17/36 ( 47.2 % ) and 11/35 ( 30 % ) , and live birth rates were 10/36 ( 28 % ) and 7/35 ( 20 % ) in groups 1 and 2 , respectively . These differences between the two groups were not statistically significant . CONCLUSION ( S ) The method described especially for early intervention may prevent complications during the treatment of severe intrauterine adhesions and may present a secure and effective alternative for constructive clinical outcomes OBJECTIVE To evaluate the efficacy and safety of auto-crosslinked hyaluronic acid ( HA ) gel for preventing intrauterine adhesion ( IUA ) after hysteroscopic adhesiolysis . METHODS A prospect i ve , r and omized , double blinded and controlled clinical trial ( level I ) was performed . According to American Fertility Society ( AFS ) scoring system , 120 patients ( treatment group : 60 cases , control group : 60 cases ) with moderate to severe IUA were enrolled . Upon completion of adhesiolysis , a Foley balloon catheter was first introduced into the uterine cavity and then 3 ml of auto-crosslinked HA gel for patients in the treatment group ; patients in the control group , however , only received Foley balloon catheter . Second-look hysteroscopic examination was performed to all patients at 3 months postoperatively for evaluation of IUA . Primary endpoint was the reduction rate of IUA at 3 months after surgery . The secondary endpoints include total AFS score , score of each individual AFS category . RESULTS At 3 months after surgery , auto-crosslinked HA gel result ed in significantly higher effective rate for reduction of adhesion , the effective rate were 76 % ( 42/55 ) and 48 % ( 27/56 ) respectively ( P = 0.000 9 ) ; the total AFS score of treatment group was 2.1 ± 1.1 , and significantly lower than that of control group ( 3.7 ± 2.5 , P = 0.000 8) . Application of auto-crosslinked HA gel after surgery significantly enhanced the improvement for each individual patient with regard to their adhesive type and menstrual pattern ( P = 0.037 8 , P = 0.000 4 ) . The treatment group had significantly lower proportion of patients with moderate to severe adhesive stages than that of control group [ 13 % ( 7/55 ) versus 38 % ( 21/56 ) , P = 0.000 6 ] . No adverse events and complications were observed . CONCLUSIONS Auto-crosslinked HA gel coule be able to reduce IUA , decrease adhesion severity , and improve menopause postoperatively . This absorbable auto-crosslinked HA gel is proposed as a barrier for preventing IUA after intrauterine procedures OBJECTIVE To evaluate prospect ively the effect of hysteroscopic septoplasty as therapy for  unexplained primary infertility in women with uterine septum as a sole cause for reproductive failure and to define the factors influencing reproductive success . STUDY DESIGN In a prospect i ve comparative study , we enrolled 103 infertile women with uterine septum as a sole cause for reproductive failure . They had had unexplained primary infertility > 2 years and a follow-up > 12 months . Uterine anomalies were diagnosed by means of hysterosalpingography ( HSG ) and 2D-transvaginal sonography ( TVS ) with intrauterine saline infusion . Hysteroscopic septoplasty was performed in the early follicular phase . Pregnancy rates ( PR ) according to patient and septum characteristics ( septum size ) were the main outcome measures . RESULTS Follow-up was complete for 88 patients . The mean ( ±SD ) age of the patients was 36.1±2.1 years . Forty-two patients became pregnant ( 40.7 % ) . The mean ( ±SD ) delay in conception was 7.5±2.6 months . Nearly 80 % of the pregnant women conceived spontaneously . Of 44 pregnancies in 42 women , 36 live newborns were delivered . The PR was significantly higher in women < 35 years of age or with <3 years of unexplained primary infertility . Moreover , in women with a septum size larger than one-half of their uterine length the PR was significantly higher than those with septum size < 1/2 of their uterus ( P=.12 ) . CONCLUSION Fertility and pregnancy after hysteroscopic septoplasty in women with unexplained primary infertility and uterine septum as a sole cause for reproductive failure seems to depend on patient age , duration of infertility before septoplasty , and septum size . Women with a septum size larger than one-half of their uterine length have a higher chance of successful pregnancy after hysteroscopic septoplasty STUDY QUESTION Does the use of diagnostic criteria in the hysteroscopic diagnosis of a septate uterus improve inter-observer agreement ? SUMMARY ANSWER Pre-set diagnostic criteria slightly improve the inter-observer reproducibility of hysteroscopy in diagnosing a uterine septum , although agreement remains moderate . WHAT IS KNOWN ALREADY The inter-observer agreement on the hysteroscopic diagnosis of the septate uterus has been reported to be poor . STUDY DESIGN , SIZE , DURATION From April 2013 until May 2014 , a r and omized controlled comparative inter-observer study was performed . A total of 191 gynecologists from 43 countries took part . PARTICIPANTS / MATERIAL S , SETTING S , METHODS Each gynecologist was asked to assess 10 video recordings of hysteroscopy procedures  with a specific focus on the internal uterine shape . The hysteroscopies had been performed in subfertile women and women with recurrent miscarriage . The recordings contained images of uterine cavities primarily diagnosed as septate , arcuate or normal . Participating gynecologists were r and omized into two groups : one group received diagnostic criteria for a septate uterus before assessment of the videos ( DC group ) , whereas the other group assessed the recordings without instruction ( no DC group ) . The inter-observer agreement , expressed as the intra-class correlation coefficient ( ICC ) , was compared between groups . Main outcomes were the inter-observer agreement on the uterine shape and the necessity of surgical correction . MAIN RESULTS AND THE ROLE OF CHANCE Eighty-six observers were r and omized to the DC group and 105 to the no DC group . The ICCs in the diagnosis of a septum were 0.59 versus 0.52 , in the DC group and the non-DC group , respectively ( P-value : 0.002 ) . The overall agreement on the need for surgical correction was found to be moderate ( DC ICC 0.43 versus no DC 0.39 , P-value : 0.70 ) . Most importantly , once a septate uterus had been diagnosed , the agreement on the need for surgery was poor in both groups ( DC ICC 0.05 versus no DC ICC 0.02 , P-value : 0.78 ) . LIMITATIONS , REASONS FOR CAUTION We used video recordings rather than study ing real-time hysteroscopic procedures , which may have influenced the accuracy of the assessment s. WIDER IMPLICATION S OF THE FINDINGS The reproducibility of hysteroscopy for the diagnosis of a septate uterus is moderate , even with the use of st and ardized criteria . The fact that the agreement among physicians on both the diagnosis of a uterine septum , as well as the decision to resect such septum after hysteroscopy is moderate , may imply that hysteroscopy is insufficient as single tool to diagnose and decide on treatment of a septate uterus . STUDY FUNDING /COMPETING INTERESTS No study funding was received and no competing interests are present BACKGROUND Hysteroscopy is often done in infertile women starting in-vitro fertilisation ( IVF ) to improve their chance of having a baby . However , no data are available from r and omised controlled trials to support this practice . We aim ed to assess whether routine hysteroscopy before the first IVF treatment cycle increases the rate of livebirths . METHODS We did a pragmatic , multicentre , r and omised controlled trial in seven university hospitals and 15 large general hospitals in the Netherl and s. Women with a normal transvaginal ultrasound of the uterine cavity and no previous hysteroscopy who were scheduled for their first IVF treatment were r and omly assigned ( 1:1 ) to either hysteroscopy with treatment of detected intracavitary abnormalities before starting IVF ( hysteroscopy group ) or immediate start of the IVF treatment ( immediate IVF group ) . R 
    Output:
    
A large benefit with the hysteroscopic removal of submucous fibroids for improving the chance of clinical pregnancy in women with otherwise unexplained subfertility can not be excluded .
The hysteroscopic removal of endometrial polyps suspected on ultrasound in women prior to IUI may increase the clinical pregnancy rate .