Uterine Septum with or without Hysteroscopic Metroplasty: Impact on Fertility and Obstetrical Outcomes—A Systematic Review and Meta-Analysis of Observational Research

Abstract

Objective: we performed a systematic review/meta-analysis to evaluate the impact of septate uterus and hysteroscopic metroplasty on pregnancy rate-(PR), live birth rate-(LBR), spontaneous abortion-(SA) and preterm labor (PL) in infertile/recurrent miscarriage-(RM) patients. Data sources: a literature search of relevant papers was conducted using electronic bibliographic databases (Medline, Scopus, Embase, Science direct). Study eligibility criteria: we included in this meta-analysis all types of observational studies that evaluated the clinical impact of the uterine septum and its resection (hysteroscopic metroplasty) on reproductive and obstetrics outcomes. The population included were patients with a diagnosis of infertility or recurrent pregnancy loss. Study appraisal and synthesis methods: outcomes were evaluated according to three subgroups: (i) Women with untreated uterine septum versus women without septum (controls); (ii) Women with treated uterine septum versus women with untreated septum (controls); (iii) Women before and after septum removal. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for the outcome measures. A p-value < 0.05 was considered statistically significant. Subgroup analysis was performed according to the depth of the septum. Sources of heterogeneity were explored by meta-regression analysis according to specific features: assisted reproductive technology/spontaneous conception, study design and quality of papers included Results: data from 38 studies were extracted. (i) septum versus no septum: a lower PR and LBR were associated with septate uterus vs. controls (OR 0.45, 95% CI 0.27–0.76; p < 0.0001; and OR 0.21, 95% CI 0.12–0.39; p < 0.0001); a higher proportion of SA and PL was associated with septate uterus vs. controls (OR 4.29, 95% CI 2.90–6.36; p < 0.0001; OR 2.56, 95% CI 1.52–4.31; p = 0.0004). (ii) treated versus untreated septum: PR and PL were not different in removed vs. unremoved septum(OR 1.10, 95% CI 0.49–2.49; p = 0.82 and OR 0.81, 95% CI 0.35–1.86; p = 0.62); a lower proportion of SA was associated with removed vs. unremoved septum (OR 0.47, 95% CI 0.21–1.04; p = 0.001); (iii) before-after septum removal: the proportion of LBR was higher after the removal of septum (OR 49.58, 95% CI 29.93–82.13; p < 0.0001) and the proportion of SA and PL was lower after the removal of the septum (OR 0.02, 95% CI 0.02–0.04; p < 0.000 and OR 0.05, 95% CI 0.03–0.08; p < 0.0001) Conclusions: the results show the detrimental effect of the uterine septum on PR, LBR, SA and PL. Its treatment reduces the rate of SA.

Fertility-enhancing hysteroscopic surgery; multi-center retrospective cohort study of reproductive outcome

“…The reduction in miscarriage rate and preterm birth rate in our study was consistent with those found in a systematic review and meta-analysis [ 21 ]. Our findings regarding hysteroscopic septoplasty were also consistent with those found in a Systematic Review and Meta-Analysis of Observational Research [ 22 ]; a detrimental effect of the uterine septum was found on pregnancy rate, low birth rate, spontaneous abortion and preterm labor. Its treatment reduced the rate of spontaneous abortion [ 22 ].…”

Spontaneous Pregnancy After Surgical Repair of Subseptate Uterus: A Case Report and Review of the Available Literature

“…Another meta-analysis by Noventa et al produced similar results with regard to recurrent miscarriage (OR 0.02, 95%CI 0.02-0.04), preterm labor (OR 0.05, 95%CI 0.03-0.08), with pregnancy rate still demonstrating no statistically significant difference [ 15 ]. An additional finding of this study was the statistically significant improvement in live birth rate (OR 3.07, 95%CI 1.22-7.73) in the hysteroscopic metroplasty group.…”

Diagnostic and surgical approaches to congenital uterine anomalies for the minimally invasive gynecologic surgeon

“…The current recommendation is to wait two months before conceiving postoperatively, and trial of labor is acceptable. A recent meta-analysis showed that metroplasty remains useful in infertile patients or in patients with a history of repeated spontaneous abortion, as treatment reduces the rate of spontaneous abortion, and increases live birth rate [26,27 ▪ ,28].…”