Reproductive outcome of hysteroscopic metroplasty for women with T-shaped uterus: a retrospective study

Abstract

Background T-shaped uterus is a Müllerian malformation with unapparent clinical manifestations. Intrauterine adhesion and tuberculosis may lead to T-shaped uterus, too. Hysteroscopic metroplasty is a treatment option for T-shaped uterus, while the postoperative reproductive outcomes have not been thoroughly investigated. The aim of this study was to determine the reproductive outcome in Chinese women with T-shaped uterus who had hysteroscopic metroplasty with cold scissors. Methods This retrospective cohort study was conducted in the reproductive surgery unit of a university-affiliated hospital. One hundred and eleven patients with T-shaped uterus who underwent hysteroscopic metroplasty from Jan. 2017 to Sept. 2019 were followed-up by telephone in Apr. 2021. All patients received hysteroscopic metroplasty using microcissors, followed by estrogen-progesterone sequential treatment, with or without intrauterine device (IUD) implantation. According to whether they had had history of intrauterine operation, patients were divided into congenital group and acquired group. The main outcome measure was postoperative live birth rate. χ2 test and t test were used for comparison between groups. Cochran-Mantel–Haenszel test were used for stratified analysis. P < 0.05 was considered statistically significant. Results One hundred and eleven patients were included in total, with 46 in congenital group and 65 in acquired group. After hysteroscopic metroplasty, in the congenital group, the pregnancy rate increased from 28.3% to 87.0% (P < 0.001) and the live birth rate increased from 23.1% to 79.5% (P = 0.001); in the acquired group, the pregnancy rate slightly dropped from 98.5% to 72.3% (P < 0.001) while the live birth rate increased from 20.8% to 74.5% (P < 0.001). No statistically significant difference was observed in postoperative reproductive outcome indicators between the two subgroups except mode of conception. Conclusions For both groups, hysteroscopic metroplasty may improve reproductive outcomes for patients with T-shaped uterus.

T-shaped Uterus, Other Studies are Needed But What Can We Do in The Meantime?

“…Exact etiopathogenetic mechanisms are not known but endocrine disruptors, that may mimic or interfere with body's hormones, can have a role and they may act as DES during Mullerian organogenesis [4]. There is no agreement on the diagnosis [2,6,7] and management [5,8] of the t-shaped uterus and also on the effect of this malformation on fertility and obstetric outcomes [3,9,10]. T-shaped uterus can be suspected through different types of examinations as 2D vaginal ultrasound, hysteroscopy, hysterosalpingography, magnetic resonance imaging and the 3D-vaginal ultrasound [4].…”

“…Finally, management is also controversial due to the use of non-standardized diagnostic criteria [6,11] and subjectivity in treatment [4,8]. Some authors suggest an expectant management, others recommend surgery as first step, others only for women undergoing assisted reproductive technology (ART) [2,5,9]. The common conclusion of many studies is the need for RCT studies to evaluate the real benefit of surgical treatment for T-shaped uterus [4,5].…”