Factors Affecting Reproductive Outcomes of Hysteroscopic Septum Incision: A Retrospective Cohort Study.

STUDY

OBJECTIVE

To investigate what factors affect reproductive outcomes after hysteroscopic septum incision.

DESIGN

A single-center retrospective cohort study.

SETTING

A tertiary university hospital.

PATIENTS: A total of 1426 women with uterine septum who underwent hysteroscopic septum incision.

INTERVENTIONS: Hysteroscopic septum incision.

MEASUREMENTS AND MAIN

RESULTS

Of 1426 women undergoing hysteroscopic septum incision, 1238 cases attempted to conceive after surgery. The primary outcome measures were the outcome of the first pregnancy following septum surgery and factors affecting these outcomes. The secondary outcome measures included (1) pregnancy rate and (2) cumulative live birth rate (LBR) by 12, 24, 36 months after surgery. Overall, 1121 of 1238 women (90.5%) conceived, resulting in a LBR of 932/1111 (83.9%). Women with prior mid-trimester loss showed a significantly higher risk of mid-trimester miscarriage postoperatively compared to other groups (odds ratio = 4.08, 95% confidence interval: 1.86-8.97). Women with multiple indications demonstrated significantly lower term birth rate vs those with a single indication (odds ratio = 0.54, 95% confidence interval: 0.39, 0.75). No significant outcome differences were observed between incomplete and complete septa. In the subgroup with postoperative three-dimensional ultrasound fundal assessment, women with fundal indentation ≤5 mm showed a significantly higher pregnancy rate than those with >5 mm (95.7% vs 76.0%; p = .035), though with comparable LBRs (90.9% vs 89.5%; p > .05).

CONCLUSION

Women with uterine septa represent a heterogeneous population. Clinical outcomes depend on both preoperative reproductive history and postoperative fundal indentation depth, but are unaffected by initial septum type (incomplete vs complete). Careful postoperative assessment and individualized counseling may help optimize patient management.