Effect of Hysteroscopic Metroplasty on Reproductive Outcomes in Women with Septate Uterus: Systematic Review and Meta-Analysis

Carrera, M; Millan, Federico Pérez; Alcázar, Juan Luis; Alonso, Luis; Caballero, Miguel; Carugno, Josè; Domínguez, José; Moratalla, Enrique

doi:10.1016/j.jmig.2021.10.001

Cited by 39 publications

(15 citation statements)

References 29 publications

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“…More recently, a systematic review and meta-analysis comparing reproductive outcomes between women undergoing hysteroscopic resection of the uterine septum and those with expectant management supported that hysteroscopic metroplasty was effective in reducing the risk of miscarriage in patients with complete or partial uterine septum. This study was similar with our results, but they only considered treated uterine septum versus untreated septum without evaluating the uterine septum versus controls (no septum) [ 76 ].…”

Section: Main Findings and Implicationssupporting

confidence: 87%

Uterine Septum with or without Hysteroscopic Metroplasty: Impact on Fertility and Obstetrical Outcomes—A Systematic Review and Meta-Analysis of Observational Research

Noventa

Spagnol

Marchetti

et al. 2022

JCM

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Objective: we performed a systematic review/meta-analysis to evaluate the impact of septate uterus and hysteroscopic metroplasty on pregnancy rate-(PR), live birth rate-(LBR), spontaneous abortion-(SA) and preterm labor (PL) in infertile/recurrent miscarriage-(RM) patients. Data sources: a literature search of relevant papers was conducted using electronic bibliographic databases (Medline, Scopus, Embase, Science direct). Study eligibility criteria: we included in this meta-analysis all types of observational studies that evaluated the clinical impact of the uterine septum and its resection (hysteroscopic metroplasty) on reproductive and obstetrics outcomes. The population included were patients with a diagnosis of infertility or recurrent pregnancy loss. Study appraisal and synthesis methods: outcomes were evaluated according to three subgroups: (i) Women with untreated uterine septum versus women without septum (controls); (ii) Women with treated uterine septum versus women with untreated septum (controls); (iii) Women before and after septum removal. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for the outcome measures. A p-value < 0.05 was considered statistically significant. Subgroup analysis was performed according to the depth of the septum. Sources of heterogeneity were explored by meta-regression analysis according to specific features: assisted reproductive technology/spontaneous conception, study design and quality of papers included Results: data from 38 studies were extracted. (i) septum versus no septum: a lower PR and LBR were associated with septate uterus vs. controls (OR 0.45, 95% CI 0.27–0.76; p < 0.0001; and OR 0.21, 95% CI 0.12–0.39; p < 0.0001); a higher proportion of SA and PL was associated with septate uterus vs. controls (OR 4.29, 95% CI 2.90–6.36; p < 0.0001; OR 2.56, 95% CI 1.52–4.31; p = 0.0004). (ii) treated versus untreated septum: PR and PL were not different in removed vs. unremoved septum(OR 1.10, 95% CI 0.49–2.49; p = 0.82 and OR 0.81, 95% CI 0.35–1.86; p = 0.62); a lower proportion of SA was associated with removed vs. unremoved septum (OR 0.47, 95% CI 0.21–1.04; p = 0.001); (iii) before-after septum removal: the proportion of LBR was higher after the removal of septum (OR 49.58, 95% CI 29.93–82.13; p < 0.0001) and the proportion of SA and PL was lower after the removal of the septum (OR 0.02, 95% CI 0.02–0.04; p < 0.000 and OR 0.05, 95% CI 0.03–0.08; p < 0.0001) Conclusions: the results show the detrimental effect of the uterine septum on PR, LBR, SA and PL. Its treatment reduces the rate of SA.

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Section: Main Findings and Implicationssupporting

confidence: 87%

Uterine Septum with or without Hysteroscopic Metroplasty: Impact on Fertility and Obstetrical Outcomes—A Systematic Review and Meta-Analysis of Observational Research

Noventa

Spagnol

Marchetti

et al. 2022

JCM

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“…Septum resection is generally recommended for women wishing to conceive, based on reported bene t including higher pregnancy rate and live birth rate, as well as decreased preterm delivery rate and spontaneous abortion rate post-surgical removal of the septum [15,16,19,20]. Although opposite data had been published, the general opinion in the eld remains that "evidence is not adequate to change clinical practices based on decades of scienti c literature" [17].…”

Section: Discussionmentioning

confidence: 99%

Septum resection did not improve reproductive outcomes in a group of Han Chinese women with septate uterus undergoing in vitro fertilization/ intracytoplasmic sperm injection embryo transfer (IVF/ICSI-ET)

Liu,

et al. 2024

Preprint

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Background The septate uterus is a common anomaly affecting about 5% of infertile patients. Septum resection is recommended to improve pregnancy outcomes. However, several recent studies challenged the necessity of surgical removal of septum based on lack of benefit, increased risk to the patients, and avoidable economic burden to the health care system.Methods This retrospective study aimed to evaluate the impact of septum resection on reproductive outcomes in a group of infertile patients with septate uterus. All patients underwent in vitro fertilization-embryo transfer or intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET). Reproductive outcomes were compared between patients with septum resection and patients without septum resection.Results A total of 91 patients, with half of them received septum resection, were included in this analysis. For the 45 patients with septum resection, 25 pregnancy (56%) were achieved with 20 live births (44%), 7 were preterm delivery (35%). Similarly, out of the 46 patients without septum resection, 24 pregnancy (52%) were achieved with 19 live births (41%), 6 were preterm delivery (32%).Conclusions This study demonstrated that Han Chinese women with septate uterus did not benefit significantly from septum resection, in the context of undertaking IVF/ICSI-ET assisted pregnancy. However, although it did not reach statistical significance, a trend was noticed that primary infertile women might derive more benefit from septum resection compared to women with a history of recurrent abortion.

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“…A meta-analysis recently published by Carrera M demonstrated that hysteroscopic resection could effectively reduce the risk of abortion in patients with a complete or partial uterine septum. Further, patients with complete hysterectomy bore a lower risk of abortion, indicating a dose-response gradient in terms of the impact of hysterectomy on reproductive outcomes ( 52 ). In the previous meta-analysis, no significant effect of surgery on preterm birth was unearthed, and full-term birth was not analyzed as a reproductive outcome.…”

Section: Discussionmentioning

confidence: 99%

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

Zhang

Sun

et al. 2022

Front. Surg.

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ObjectiveAlthough 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 MethodsFrom 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.Results22 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.ConclusionHysteroscopic 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

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Effect of Hysteroscopic Metroplasty on Reproductive Outcomes in Women with Septate Uterus: Systematic Review and Meta-Analysis

Cited by 39 publications

References 29 publications

Uterine Septum with or without Hysteroscopic Metroplasty: Impact on Fertility and Obstetrical Outcomes—A Systematic Review and Meta-Analysis of Observational Research

Uterine Septum with or without Hysteroscopic Metroplasty: Impact on Fertility and Obstetrical Outcomes—A Systematic Review and Meta-Analysis of Observational Research

Septum resection did not improve reproductive outcomes in a group of Han Chinese women with septate uterus undergoing in vitro fertilization/ intracytoplasmic sperm injection embryo transfer (IVF/ICSI-ET)

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

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