Factors Affecting Reproductive Outcomes of Hysteroscopic Septum Incision: A Retrospective Cohort Study

Area of Science:

• Reproductive Medicine
• Minimally Invasive Gynecologic Surgery

Background:

• Uterine septum is a common congenital uterine anomaly that can impact reproductive outcomes.
• Hysteroscopic septum incision is a standard surgical procedure to correct uterine septa.

Purpose of the Study:

• To identify factors influencing reproductive success after hysteroscopic septum incision.
• To evaluate the impact of preoperative history and postoperative findings on pregnancy and live birth rates.

Main Methods:

• Retrospective cohort study of 1426 women undergoing hysteroscopic septum incision at a tertiary university hospital.
• Analysis of pregnancy rates, live birth rates (LBR), and miscarriage risks.
• Subgroup analysis based on preoperative history (mid-trimester loss) and postoperative fundal indentation (3D ultrasound).

Main Results:

• High conception (90.5%) and live birth rates (83.9%) were observed post-surgery.
• Prior mid-trimester loss increased miscarriage risk (OR=4.08).
• Multiple surgical indications correlated with lower term birth rates (OR=0.54).
• Postoperative fundal indentation ≤ 5 mm was associated with higher pregnancy rates (95.7% vs 76.0%).

Conclusions:

• Reproductive outcomes are influenced by preoperative patient history and postoperative uterine cavity morphology.
• Septum type (incomplete vs. complete) did not significantly affect outcomes.
• Individualized patient counseling and postoperative assessment are crucial for optimizing management.