Metroplasty for AFS Class V and VI septate uterus in patients with infertility or miscarriage: reproductive outcomes study

Abstract

Study objective: To assess reproductive outcomes in patients after surgical correction of septate uterus.

Design: Observational retrospective study (Canadian Task Force classification II-2).

Setting: Two university hospitals.

Patients: One hundred twenty-eight patients with primary infertility or recurrent miscarriage with partial (American Fertility Society [AFS] class Va), complete (AFS class Vb), or fundic (AFS class VI) septate uterus. Metroplasty is the current method of choice for surgically correcting septate uterus. The procedure and its indications are a matter of debate.

Interventions: Metroplasty via hysteroscopy.

Measurements and main results: Outcomes including the numbers of pregnancies, first live births (FLBs), and miscarriages were determined. After metroplasty, 78 women (60.9%) became pregnant, and 70 live neonates were delivered. The FLB rate in infertile women was 53.1%. Of the 25 pregnancies, 13 (52%) resulted from assisted reproductive technology. In women who experienced recurrent miscarriage, the miscarriage rate was significantly improved. Outcomes (miscarriages and FLBs) differed significantly according to anatomical type of septum after surgery.

Conclusion: Hysteroscopic septum resection is accompanied by safe improvement in reproductive performance in patients with symptoms of AFS class V/VI septate uterus.