Work

11656 Reproductive Outcome After Metroplasty of T-Shaped Uterus in Infertile Patients

Year: 2024

Type: article

Abstract: Study Objective To determine reproductive outcome after hysteroscopic metroplasty in infertile patients with T-shaped uterus. Design Retrospective study. Setting Fertility Center - Teaching Hospital. Patients or Participants The study included 35 consecutive patients (2020-2023) who presented with reproductive failure and were found to have T-shaped uterus. 35 patients had infertility with 12 also having recurrent pregnancy loss (RPL). All patients underwent hysteroscopic metroplasty (unilateral or bilateral) for T-shaped uterus; 26 also underwent septoplasty for additional partial septate uterus (PSU) [ESHRE-ESGE classification of Müllerian anomalies, 2013]. Postoperative transvaginal 3D ultrasound scan (TV 3D US) with saline infusion hysterosonogram (SIH) were performed for evaluation of the uterine cavity. Depending on the underling etiology, couples were offered to try to conceive naturally, with fertility medication (Letrozole), intrauterine insemination after controlled ovarian stimulation, or in vitro fertilization. Pregnancy outcome and any intra or postoperative complications were documented. Interventions Hysteroscopic metroplasty for T-shaped uterus in all patients and hysteroscopic septoplasty in 26 patients. Measurements and Main Results Mean age (years), BMI (kg/m 2 ), duration of infertility (years) and AMH (ng/mL) were 33.6 + 4.7, 26.2 + 5.5, 3.5 + 4.2 and 4.0 + 4.3 respectively. Metroplasty for T-shaped was unilateral in 74.3% and bilateral in 25.7%. In 26 patients PSU was also present. The mean mid-fundal protrusion length (mm) was 12.1 + 3.0 and 92.3% had an indentation apex angle that was >90 degrees. Septoplasty was performed in the 26 patients who underwent unilateral metroplasty. Postoperative SIH with TV 3D US revealed minimal filmy synechia in 22.9%, requiring a second hysteroscopy and lysis of adhesions. No other intra or postoperative complications were reported. Postoperative pregnancy, miscarriage and best outcome delivery/ongoing rates were 77.1%, 25.9% and 62.9 % respectively. Conclusion This pilot study suggests that hysteroscopic metroplasty of T-shaped uterus with septoplasty, if PSU is found, may improve reproductive outcome in infertile patients and those with infertility and RPL.

Source: Journal of Minimally Invasive Gynecology

DOI: 10.1016/j.jmig.2024.09.801

Authors: MI Abuzeid, SK Joseph, J Hitaj, B Rizk

Institutions: Henry Ford Health, Mohammed Bin Rashid University of Medicine and Health Sciences

Language: English

Topic: Gynecological conditions and treatments

Subfield: Obstetrics and Gynecology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,000