Congenital complex uterine anomalies carry complex complications: an evaluation of ART outcomes

To examine assisted reproductive technology (ART) outcomes in patients with congenital complex uterine anomalies (CUA) as well as the impact of surgical repair on these outcomes.

This retrospective cohort study analyzed 46 patients with CUA who underwent 130 embryo transfer cycles at a large academic fertility center from 2000 to 2024. Outcomes were compared between patients who underwent surgical repair and those who did not.

The overall live birth and ongoing pregnancy rate after fresh or frozen embryo transfer was 36.9% (48/130). Cesarean section was the most common mode of delivery (61.7%). Pregnancy complications occurred in 38.3% of live births. Live birth and ongoing pregnancy rates did not differ significantly between patients with and without surgical repair (32.6% vs. 39.2%, p = 0.57).

Patients with complex uterine anomalies experience lower live birth rates compared to the center's average and face a high risk of pregnancy complications. Surgical repair of CUA does not significantly improve ART outcomes. Personalized counseling regarding goals and risks is crucial for CUA patients undergoing ART.