The impact of operative hysteroscopy on pregnancy outcomes in patients with suspected uterine cavity lesions prior to the first frozen-thawed embryo transfer: a retrospective propensity-score matching cohort study.

BACKGROUND

Hysteroscopy is a common procedure in assisted reproductive technology (ART) and serves as the gold standard for diagnosing and treating uterine cavity lesions. However, there is currently a lack of research on the impact of operative hysteroscopy prior to the first frozen-thawed embryo transfer (FET) on subsequent pregnancy outcomes in patients with suspected uterine cavity lesions. This study aimed to investigate whether performing operative hysteroscopy before the first FET improved pregnancy outcomes within this patient population.

METHODS

A retrospective propensity-score matching (PSM) Cohort Study. A cohort comprised of 879 patients (879 cycles) who underwent their first FET at the Reproductive Medicine Center of the Second Affiliated Hospital of the Naval Medical University between July 1, 2021, and May 31, 2024. The follow-up period extended until December 31, 2024. Participants were categorized into two groups: those with suspected uterine cavity lesions who underwent operative hysteroscopy (hysteroscopy group, 526 cycles), and those without suspected lesions who did not receive hysteroscopy (control group, 353 cycles). Compared the pregnancy outcomes between the two groups and performed binary logistic regression analysis to assess the impact of operative hysteroscopy on clinical pregnancy rate (CPR) and live birth rate (LPR).

RESULTS

Both before and after PSM, the hysteroscopy group exhibited higher CPR (pre-PSM: 68.06% vs. 53.54%; post-PSM: 65.03% vs. 54.90%, P < 0.05) and LBR (pre-PSM: 53.80% vs. 43.34%; post-PSM: 52.79% vs. 44.40%, P < 0.05) compared to the control group. Binary logistic regression analyses of all three models consistently demonstrated that operative hysteroscopy was significantly associated with improved clinical pregnancy and live birth rates. After adjusting for confounding factors, including age, body mass index, delivery mode, number of miscarriages, fertilization method, FET protocol, embryo attributes, number of embryos transferred, and endometrial thickness, operative hysteroscopy still increased CPR by 54.3% (OR 1.543, 95% CI 1.070-2.227) and LBR by 44.2% (OR 1.442, 95% CI 1.011-2.056).

CONCLUSIONS

This study confirmed that in patients with suspected uterine cavity lesions, performing hysteroscopic surgery before the first frozen-thawed embryo transfer can improve both CPR and LBR.

TRIAL REGISTRATION: This is a retrospective cohort study.