Metroplasty before IVF in women with a T-shaped uterus: A clinical challenge

A T-shaped uterus is a uterine malformation, which can be either congenital or acquired, potentially impairing fertility and increasing the risk of miscarriage. Diagnosis primarily relies on three-dimensional ultrasound and hysteroscopy. Hysteroscopic metroplasty is the standard surgical intervention aimed at restoring normal uterine anatomy and potentially improving reproductive outcomes. This narrative review, conducted in accordance with SANRA (Scale for the Assessment of Narrative Review Articles) guidelines, is based on a comprehensive database search and critically evaluates observational and interventional studies on the definition, diagnosis, and management of T-shaped uterus in the context of in vitro fertilization. Recent studies indicate that correction of this anomaly might not only improve spontaneous conception rates but also enhance the outcomes of IVF. However, the precise role of metroplasty in patients undergoing IVF outcomes remains controversial. Some evidence indicates that surgical correction might improve embryo implantation and endometrial perfusion. Despite these promising observations, randomized controlled trials are necessary to define optimal patient selection criteria and to confirm the true benefit of metroplasty in the context of IVF. Future research should also address the potential risks associated with the procedure. A standardized diagnostic and therapeutic approach might contribute to improved reproductive outcomes in affected patients.