Dysmorphic Uteri: Obstetric Results after Hysteroscopic Office Metroplasty in Infertile and Recurrent Pregnancy Loss Patients. A Prospective Observational Study

Abstract

To compare the obstetric results achieved after hysteroscopic office metroplasty (HOME-DU) in infertile and recurrent pregnancy loss (RPL) patients diagnosed with dysmorphic uterus, women hysteroscopically diagnosed with dysmorphic uterus who underwent uterine-enlargement metroplasty were prospectively enrolled from June 2016 until April 2020. Patients were followed up and obstetric outcomes were recorded (pregnancy and live birth rate). Sixty-three women (30 infertile; 33 RPL) were enrolled, of which 48 became pregnant post-HOME-DU, with an overall pregnancy rate of 76.2% (66.7% among infertile participants; 84.9% among those with RPL). Overall, 64.3% (n = 36/63) achieved live birth. Among infertile women, 62.07% (n = 18/29) achieved live birth, as well as 66.7% of women with RPL (n = 18/27). The difference in live birth rates between both cohorts was 4.6% (p > 0.05). The rate of miscarriage amongst infertile patients was 3.3% (n = 1/30) and 12.1% amongst women with RPL (n = 4/33). Office metroplasty via the HOME-DU technique improves obstetric results (namely increasing live birth rate) in patients with dysmorphic uterus and a history of reproductive failure. No significant difference was found in the clinical efficacy of HOME-DU in infertile and RPL patients.

Uterine factors in recurrent pregnancy losses

“…However, no evidence of a benefit of surgical treatment for arcuate, bicornuate, or unicornuate uterus has been shown (25). Data about uterine enlargement metroplasty for dysmorphic uteri (class U1) are controversial in the case of RPL (38)(39)(40). No RCT and case control studies are available.…”

Hysteroscopic metroplasty for the treatment of the dysmorphic uterus: A SWOT analysis

“…DU U1a uterine malformation is characterized by a uterus with normal external contour with thickened lateral walls giving the characteristic appearance to the uterine cavity of T–shaped. This myometrium excess gives rise to a subcornual constriction ring which causes the hypoplasia of the uterine cavity ( 9 – 11 ).…”

“…The pathophysiology explaining the poor obstetrical outcomes of patients diagnosed with dysmorphic uterus is not clear, although it might be related to a modified endometrial lining which would be responsible for lower implantation rates ( 12 ). Recently, an increasing number of studies evaluating the effect of hysteroscopic metroplasty in patients with dysmorphic uterus Alonso et al ( 19 ), Adriaensen et al ( 20 ), Boza et al ( 6 ), Di Spiezio et al ( 21 ), Ferro et al ( 22 ), Giacomucci et al ( 23 ), Haydardedeoglu et al ( 24 ), Mounir et al ( 25 ), Sanchez-Santiuste et al ( 11 ), Sukur et al ( 7 ) and Uyar et al ( 26 ), have described an improvement of the reproductive outcomes after restoring the normal anatomy of the uterine cavity.…”

T-shaped Uterus, Other Studies are Needed But What Can We Do in The Meantime?

“…Dysmorphic uterus is a condition that can affect fertility differently depending on the type of malformation [1][2][3]. The underlying etiopathogenetic processes can be vary and they can involve fusion or resorption defects [4,5].…”

“…Exact etiopathogenetic mechanisms are not known but endocrine disruptors, that may mimic or interfere with body's hormones, can have a role and they may act as DES during Mullerian organogenesis [4]. There is no agreement on the diagnosis [2,6,7] and management [5,8] of the t-shaped uterus and also on the effect of this malformation on fertility and obstetric outcomes [3,9,10]. T-shaped uterus can be suspected through different types of examinations as 2D vaginal ultrasound, hysteroscopy, hysterosalpingography, magnetic resonance imaging and the 3D-vaginal ultrasound [4].…”