Perinatal outcomes in singleton and twin ICSI pregnancies following hysteroscopic correction of partial intrauterine septa

Evidence-based diagnosis and treatment for uterine septum: a guideline

OBJECTIVE

To provide evidence-based recommendations regarding the diagnosis and effectiveness of surgical treatment of a uterine septum.

METHODS

This guideline provides evidence-based recommendations regarding the diagnosis and effectiveness of surgical treatment of a uterine septum. This replaces the last version of the same name (Fertil Steril. 2016 Sep 1;106(3):530-40).

MAIN OUTCOME MEASURE(S)

Outcomes of interest included the impact of a septum on underlying fertility, live birth, clinical pregnancy, and obstetrical outcomes.

RESULT(S)

The literature search identified relevant studies to inform the evidence for this guideline.

CONCLUSION(S)

The treatment of uterine septa and subsequent outcomes associated with infertility, recurrent pregnancy loss, and adverse obstetrical outcomes are summarized. Resection of a septum has been shown to improve outcomes in patients with recurrent pregnancy loss and to decrease the likelihood of malpresentation. In the setting of infertility, it is recommended to use a shared decision-making model after appropriate counseling to determine whether or not to proceed with septum resection.

Pregnancy and Adverse Obstetric Outcomes After Hysteroscopic Resection: A Systematic Review and Meta-Analysis

Objective

Although the randomized controlled trial (RCT) of the efficacy of hysteroscopic resection in women with uterine septum has not shown any significant correlation in recent research, motivation for deeper study remains insufficient. In this study, the objective was to determine pregnancy-related outcomes, along with adverse obstetric outcomes, following hysteroscopic resection and also to determine whether women with hysteroscopic resection bear the same outcomes as women with normal uterine cavities.

Search Methods

From January 1995 to February 2022, a systematic literature review was conducted to identify all studies published concerning the gestation outcomes of women with and without hysteroscopic resection while comparing the gestation outcomes of women after hysteroscopic resection and with a normal uterine cavity. Our primary outcome was the live birth rate (LBR). The secondary outcomes were term delivery, preterm delivery, spontaneous miscarriage, malpresentation, cesarean section, and other adverse obstetric outcomes.

Results

22 studies were included in this meta-analysis. The control groups of 14 studies were treated women, and the control groups of the other 8 studies were patients bearing a normal uterine cavity. Hysteroscopic resection was related to a higher rate of term delivery (OR = 2.26, 95% CI, 1.26–4.05), and a lower rate of spontaneous abortion (OR = 0.50, 95% CI, 0.27–0.93), and a lower rate of malpresentation (OR = 0.31, 95% CI, 0.19–0.50). Nevertheless, in comparison with the normal uterus group, the rates of preterm birth, cesarean section, and postpartum hemorrhage after resection did not return to normal levels.

Conclusion

Hysteroscopic resection can effectively reduce the risk of abortion and malpresentation in patients possessing a uterine septum while increasing the term delivery rate. Although well-designed RCTs should confirm our meta-analysis, it still bears recommending to patients

Effect of hysteroscopic septum resection on subsequent in vitro fertilization-intracytoplasmic sperm injection outcomes in cases of primary infertility

OBJECTIVE

Women with septate uteri are at risk for subfertility, recurrent miscarriage, and preterm birth. It is not clear if hysteroscopic septum resection is beneficial to subsequent in vitro fertilization-intracytoplasmic sperm injection o (IVF/ICSI) outcomes in women with primary infertility.

STUDY DESIGN

We analyzed all 278 women with uterine septum and primary infertility between January 2011 and January 2019. In this retrospective cohort study, the patients were divided into a surgery group and an expectant (non-surgery) group.

RESULTS

Among them, 87 had a complete and 191 a partial septate uterus. The IVF-ET characteristics of the two groups showed no significant differences in the patients' age, body mass index, or basal follicle-stimulating hormone, luteinizing hormone, and estradiol levels (P>0.05). The miscarriage rate in those who underwent hysteroscopic septum resection, however, was significantly reduced (5.1% vs. 12.9%, P = 0.035). In contrast, the live birth rate between the two groups revealed no significant difference (51.4% vs. 43.6%, P = 0.1771), nor did the obstetric and neonatal outcomes (P>0.05).

CONCLUSIONS

Hysteroscopic septum resection can be recommended prior to IVF/ICSI.

Is IVF/ICSI [corrected] an Independent Risk Factor for Spontaneous Preterm Birth in Singletons? A Population-Based Cohort Study

The aim of our study was to explore the risk factors for very preterm (gestation under 32 weeks) and moderate preterm birth (gestation weeks 32-36 6/7) in singleton pregnancies in a national retrospective cohort study. We also wanted to establish whether IVF/ICSI is an independent risk factor for preterm birth after adjusting for already known confounders. We used data for 267 718 singleton births from 2002-2015 from the National Perinatal Information System of Slovenia, containing data on woman, pregnancy, birth, the postpartum period, and the neonate for each mother-infant pair. Mode of conception, maternal age, education, BMI, parity, smoking, history of cervical excision procedure, history of hysteroscopic resection of uterine septum, presence of other congenital uterine malformations, bleeding in pregnancy, preeclampsia or HELLP and maternal heart, and pulmonary or renal illness were included in the analyses. Unadjusted OR for very preterm birth after IVF-ICSI [corrected] was 2.8 and for moderate preterm birth was 1.7. After adjusting for known confounders, the OR was still significantly elevated (1.6 and 1.3, respectively). Risk factors for very preterm birth with OR higher than 2.4 were history of cervical excision procedure, resection of uterine septum, operation or having other congenital uterine malformations, and bleeding in pregnancy. Risk factors for very preterm birth with OR between 1.4 and 2.1 were age >35 years, being underweight or obese, not having professional education, smoking, first birth, preeclampsia/HELLP, and IVF/ICSI. Risk factors for moderate preterm birth with OR higher than 2.4 were history of cold knife conization and other congenital uterine malformations. We found that even after adjustment, IVF/ICSI represents a single risk factor for early and late preterm birth even after adjustment with other risks such as maternal age, smoking, or a history of invasive procedures for either cervical intraepithelial neoplasia or infertility treatment.

Concurrent oocyte retrieval and hysteroscopy: a novel approach in assisted reproduction freeze-all cycles

In this matched-controlled study (n = 300), the effect of hysteroscopic surgery performed concurrently with oocyte retrieval on the reproductive outcomes of intracytoplasmic sperm injection (ICSI) freeze-all cycles was investigated in patients screened for intrauterine anomalies. Conventionally, hysterscopic surgery is performed in a different cycle from IVF, delaying treatment completion and increasing patient anxiety. One hundred and fifty patients who had hysteroscopic surgery concurrently with oocyte retrieval (hysteroscopy group) in ICSI freeze-all cycles were matched according to age and oocyte number with 150 ICSI freeze-all cycles, in which the patients required no hysteroscopy (control group). In the hysteroscopy group, hysteroscopy was performed for diagnostic (n = 5) and therapeutic (n = 145) purposes. Blastocyst culture and Cryotop vitrification was performed in both groups. Frozen embryo transfer (FET) was successfully performed in the hysteroscopy group from 35 days after oocyte retrieval. No significant differences were observed for implantation, pregnancy, clinical pregnancy and early pregnancy loss rates in the hysteroscopy and control groups (48.9%, 72.0%, 61.3% and 14.8% versus 48.3%, 75.3%, 64.7% and 14.3%, respectively). Performing hysteroscopic surgery concurrently with oocyte retrieval in a segmented-IVF programme has no negative impact on reproductive outcomes, increases efficiency, and provides patients with low-risk treatment.