Retrospective cohort study of the risk factors for secondary infertility following hysteroscopic metroplasty of the uterine septum in women with recurrent pregnancy loss

Abstract

PurposeA hysteroscopic metroplasty was performed for women with recurrent pregnancy loss owing to a uterine septum, following which some women became infertile. The aim of this study was to elucidate the risk factors of secondary infertility 1 year after hysteroscopic metroplasty for a uterine septum.MethodsA retrospective, single‐center, cohort study included women with a history of at least two miscarriages that had been attributed to a uterine septum who underwent a hysteroscopic metroplasty. The patients’ background data were compared between the patients who conceived and those who remained infertile at 1 year postoperatively. The data were analyzed by using the Mann–Whitney U‐test and multivariate analyses.ResultsThe postoperative live birth rate was 83.9% (n = 26), with persistent infertility in five women at 1 year. When comparing the pregnancy group with the infertile group, the women in the postoperative infertility group were significantly older than those in the postoperative pregnancy group. The multivariate analysis showed that age was an independent risk factor for persistent infertility.ConclusionAge was identified as an independent risk factor for postoperative secondary infertility. Therefore, surgery as early as possible is recommended.

Fertility and pregnancy outcomes following hysteroscopic metroplasty of different sized uterine septa

“…However, at present, there is no evidence to support the use of this surgical procedure in these women, and randomized controlled trials are urgently needed. [14] Several studies [7,11,15,16] reported an increase in pregnancy rate after metroplasty in groups of infertile patients, ranging from 23% to 80.6%. Unfortunately, low numbers of patient, heterogeneity, and retrospective design, as well as the absence of a control group make the results of these studies hard to interpret.…”

“…More recently, Ono et al [7] published a retrospective, single-center, cohort study including 31 patients with a history of at least 2 miscarriages due to a uterine septum who underwent a hysteroscopic resection. In this study, the postoperative pregnancy rate was 83.9%, and at 1 year postoperatively, 5 women remained persistent infertile.…”

“…Some studies have indicated that hysteroscopic metroplasty of uterine abnormalities can improve pregnancy outcomes in women with a history of recurrent pregnancy loss. [7,8] A retrospective matched-control study evaluated the effect of uterine anomalies on pregnancy rates after 2481 embryo transfers in conventionally stimulated in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles. The study groups of 289 embryo transfers before and 538 transfers following metroplasty were compared with 2 consecutive embryo transfers in the control group.…”

Uterine factors in recurrent pregnancy losses

“…It is generally accepted that RPL occurs in 1%-3% of couples who try to conceive (3). The prevalence of anatomical uterine anomalies in women experiencing RPL varies from 15% to 42% according to different studies (6)(7)(8)(9)(10). Congenital uterine anomalies are associated with 7%-28% of RPL (6)(7)(8)(9)(10).…”

“…These mainly include septate uteri and more rarely arcuate or bicorporeal uteri. Acquired uterine anomalies are associated with 6%-15% of RPL (6)(7)(8)(9)(10). These include submucosal myomas, intrauterine adhesions (IUAs), and endometrial polyps.…”