Effect of hysteroscopic metroplasty on IVF outcomes in women with T-shaped uterus: a retrospective cohort study.

BACKGROUND

T-shaped uterus is associated with impaired reproductive outcomes, and the role of hysteroscopic metroplasty remains unclear. This study aimed to evaluate the impact of hysteroscopic metroplasty on in vitro fertilisation (IVF) outcomes in women with T-shaped uterus and unexplained infertility.

METHODS

This retrospective cohort study included 105 women with unexplained infertility and hysteroscopically confirmed T-shaped uterus who underwent IVF between 2021 and 2024. The primary outcome was live birth rate (LBR). Unexplained infertility was defined as failure to conceive despite normal ovulation, tubal patency, and semen parameters. Fifty-six patients underwent hysteroscopic metroplasty prior to IVF, while 49 proceeded directly to IVF without surgical correction. All patients were treated using a standardised antagonist protocol with frozen embryo transfer. Implantation, biochemical pregnancy, clinical pregnancy, miscarriage, and live birth rates were compared between groups.

RESULTS

Baseline demographic characteristics, ovarian reserve parameters, and IVF cycle features were comparable between groups. Implantation rates did not differ significantly (46.4% vs. 42.8%, p = 0.122). The biochemical pregnancy rate was lower in the metroplasty group (5% vs. 16%, p = 0.012). However, clinical pregnancy rate (41% vs. 26.5%, p = 0.024) and live birth rate (33.9% vs. 18.3%, p = 0.016) were significantly higher in women who underwent metroplasty. Miscarriage rates were similar between groups.

CONCLUSIONS

Hysteroscopic metroplasty was associated with improved clinical pregnancy and live birth rates in women with T-shaped uterus undergoing IVF. Prospective randomised studies are warranted to confirm these findings. However, the observed improvement may reflect a combined effect of anatomical cavity restoration and endometrial injury associated with the surgical procedure.