Reproductive outcomes following hysteroscopic metroplasty in T-shaped uterus

Does hysteroscopic metroplasty for a T-shaped uterus impact reproductive outcomes?

This retrospective study was carried out between January 2012 and March 2022 using data from Teba Centre, a tertiary centre in Iraq. In total, of 16,570 females with infertility, 216 (aged 14-46 years) with a diagnosis of congenital T-shaped uterus were analysed. Of these, 83 chose not to undergo surgery (uncorrected group), and 133 underwent hysteroscopic metroplasty. Patients' demographics, gynaecological history, reproductive outcomes and diagnostic imaging findings were analysed. The diagnosis was made following three-dimensional ultrasound imaging, and was verified by outpatient hysteroscopy in accordance with the European Society for Gynaecological Endoscopy/European Society of Human Reproduction and Embryology classification.

In the metroplasty group, the pregnancy rate was significantly higher than in the uncorrected group [77/133 (57.9%) versus 27/83 (32.5%); P < 0.001]. Following surgery, recurrent implantation failure decreased from 21/133 (15.8%) to 4/133 (3.0%) (P < 0.001), and recurrent pregnancy loss decreased from 32/133 (24.1%) to 9/133 (6.8%) (P < 0.001). Following metroplasty, there was a higher live birth rate [68/77 (88.3%) versus 11/27 (40.7%); P = 0.002], more term deliveries [65/77 (84.4%) versus 0/27 (0%); P < 0.001], and a lower miscarriage rate [9/77 (11.7%) versus 10/27 (37.1%); P < 0.001].

Females with a T-shaped uterus who underwent metroplasty experienced significant improvements in reproductive and obstetric outcomes compared with those who did not undergo surgery. It is recommended that hysteroscopic metroplasty should be performed in women with a T-shaped uterus who wish to conceive.