Effects of Septum Resection for Secondary Infertility on Subsequent Reproductive Outcomes of in vitro Fertilization-Intracytoplasmic Sperm Injection.

Huixiao Chen,Na Zhang,Ping Sun,Lei Yan,Yongzhi Cao,Shangge Lv

doi:10.3389/fmed.2022.765827

Abstract

ObjectiveTo assess the effect of uterine septum resection on reproductive outcomes of in vitro fertilization (IVF) / intracytoplasmic sperm injection (ICSI) in patients with secondary infertility complicated with uterine septum.MethodsA retrospective cohort study included 269 patients. Surgical group included 169 patients with secondary infertility complicated with uterine septum, who underwent 252 embryo-transfer (ET) cycles following septum resection. Control group consisted of 100 patients with secondary infertility and uterine septum, who underwent 178 ET cycles. Cumulative pregnancy rate and cumulative live birth rate after one complete assisted reproductive technology (ART) cycle were the primary outcomes.ResultsThe results showed that the cumulative pregnancy rate was higher in the surgery group, and statistically significant difference was observed in the cumulative pregnancy rate between the two groups (71.0 vs. 59%, P = 0.044). In fresh ET cycle, no statistically significant difference between the two groups was evident (54.9 vs. 40.6%, P = 0.061). Statistical analysis of other results of the fresh ET cycle did not differ significantly between the two groups. In terms of frozen embryo transfer (FET) cycle outcomes, the clinical pregnancy rate and delivery rate in surgery group were 52.7 and 38.2%, respectively, which were significantly higher than those in the control group (38.2 and 22.5%, respectively) (P = 0.028 and P = 0.011).ConclusionThe reproductive outcomes of IVF/ICSI after septum resection in patients with secondary infertility were better than that in the untreated group, suggesting that uterine septum resection can be performed in patients with uterine septum combined with infertility to improve their reproductive outcomes.

Highlights

Uterine malformations are the result of abnormal formation, differentiation, and fusion of müllerian or accessory renal ducts during the fetal period, and are believed to be one of the many causes of female infertility [1]
We collected the medical records of patients with secondary infertility as well as uterine septum, who were admitted to our hospital for in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment between 2009 and 2019, and performed further screening according to the inclusion and exclusion criteria
About 100 patients preferred to undergo transplantation of embryo rather than surgical treatment of the uterine septum, and we defined them as control group, who underwent a total of 178 cycles of embryo transfer (ET)

Summary

Introduction

Uterine malformations are the result of abnormal formation, differentiation, and fusion of müllerian or accessory renal ducts during the fetal period, and are believed to be one of the many causes of female infertility [1]. A guideline suggests that imaging with hysteroscopy should be used to diagnose uterine septa, which is better than laparoscopy combined with hysteroscopy, because it is less invasive (Grade B). In the AFS classification, uterine septum is represented as simple drawings (class Va: Complete uterine septum and class Vb: Partial uterine septum), without providing strict parameters to define septate configurations [7]. In 2021, Samanth et al published a new paper on müllerian anomalies, partially updating the uterine septum classification, and specific numerical values were given. They defined septate uterus as having an endometrial septum length of >1 cm, as measured from the bicornual line, with the leading edge of the septum having an angle of

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