Hysteroscopic Metroplasty may Improve Fertility Performance in Patients with Dysmorphic Uterus

Abstract

Study Objective The new ESHRE/ESGE classification system of female genital anomalies defines class U1 or dysmorphic uterus as anomalies that have been associated with poor reproductive performance. Hysteroscopic metroplasty may improve reproductive performance in these patients. Design Retrospective cohort study. Setting A tertiary medical center. Patients or Participants A cohort of 40 women who have a dysmorphic uterus (non DES) and infertility or repeated IVF failures (RIF). Interventions These patients underwent hysteroscopic metroplasty between the years 2014 and 2016. The patients from the study group served as their own control, comparing fertility performance before and after the hysteroscopy, respectively. Measurements and Main Results Average follow-up time lasted three years. All women were identified as having U1 type dysmorphic uterus according to ESHRE-ESGE classification by diagnostic hysteroscopy. The average time to conception was 3.028±2.756 years, compared to 1.003±0.91 years post procedure (P=0.001). A total of 27 women (67.5%) conceived during the three years after the hysteroscopy. Six (15%) conceived only after the intervention. Abortion rate declined from 1.45±1.276 prior to hysteroscopy to 0.45±0.510 post hysteroscopy (P=0.006). The cumulative pregnancy rate during the first three years post hysteroscopy increased significantly. Studying time intervals of six months, a year and three years: cumulative pregnancy rate increased from 1.042%, 15.63% and 52.1%, respectively, prior to hysteroscopy to 45%, 53.182% and 67.5% post hysteroscopy (P=0.038). The cumulative live birth rate also increased significantly during the study period, from 0, 5% and 15%, respectively, prior to hysteroscopy to 27.5%, 30% and 30% post hysteroscopy (P=0.001). Conclusion Remodeling dysmorphic uterus by hysteroscopic metroplasty is a new approach to treat infertile patients, especially those with RIF. This new and promising approach may assist in shortening the time to pregnancy, increasing both cumulative pregnancy rates and cumulative live birth rates, and decreasing abortion rates in these patients. A larger study cohort is needed.