Long term reproductive outcomes after hysteroscopic treatment of dysmorphic uteri in women with reproductive failure: an European multicenter study

ABSTRACT OBJECTIVE To evaluate the long term reproductive outcomes in patients with dysmorphic uterus treated by hysteroscopic metroplasty with miniaturized instruments. DESIGN Retrospective multicenter cohort study SETTING Tertiary Care University Hospitals PATIENTS The study was conducted on 214 women with a dysmorphic uterus (T-shaped, infantilis or other dysmorphic uteri according to the ESHRE/ESGE classification system) with history of primary unexplained infertility (GROUP 1) or repeated (>2) early miscarriages (GROUP 2). Dysmorphic uteri were diagnosed by office hysteroscopy and 3D-transvaginal ultrasound (3D-TVS). INTERVENTIONS All patients underwent in office hysteroscopic metroplasty using continuous-flow hysteroscope with a 5 Fr operating channel introduced into the uterine cavity using the vaginoscopic approach. Longitudinal incisions were performed on the fibro-muscular constriction rings in the isthmic area and in some cases on the other uterine walls with a 5 Fr bipolar electrode or scissors. At the end of the procedure, an anti-adhesive gel was applied into the uterine cavity to minimize adhesion formation. Post-surgical assessment of the uterine cavity was carried out through office hysteroscopy and 3D-TVS. All patients were followed for at least 24 months. MEASUREMENTS AND MAIN RESULTS The metroplasty was completed in all cases, resulting in a significant increase of uterine cavity volume (100%) and optimization of uterine morphology in 211 of 214 women (98.6%). After 60 months, the overall clinical pregnancy rate was 72.9% (n=156/214) and the live birth rate was 80.1% (n=125/156). Specifically, 74 among 156 women (47.4%) conceived spontaneously (with median time to pregnancy of 5.5 months), of whom the 32.4% had previously failed one or more IVF/ICSI attempts. CONCLUSIONS Our long-term follow-up data demonstrated that the hysteroscopic correction of dysmorphic uterus may result in high live birth rate in women suffering from unexplained infertility or repeated miscarriages.