Patients with known uterine septum or arcuate uterine anomaly who had a successful live birth with placental location not on the septum and subsequently present with reproductive failure pose a difficult management decision. The aim of this study is to compare pregnancy outcomes in patients who had hysteroscopic correction of the uterine anomaly to those who did not in such group of patients.METHODS:
This retrospective study included 67 patients who had a live birth and a diagnosis of uterine septum (complete [2.4%], incomplete [61.9%]), or arcuate uterine anomaly (35.7%), between 2005 and 2015. Subsequently 30 patients (44.8%) presented with secondary infertility, 6 patients (9%) presented with recurrent pregnancy loss (RPL), 3 patients (4.5%) presented with history of miscarriage, and 28 (41.8%) presented with secondary infertility and miscarriage or RPL. Forty-eight patients (71.6%) underwent hysteroscopic correction and 19 patients (28.4%) elected not to have surgery.RESULTS:
Mean age was 32.4+4.3 years. Mean gestational age was 37.1+3.9 weeks. Of the 48 patients who underwent hysteroscopic correction, 34 conceived (70.8%). Of those, 31 delivered/ongoing (64.6%), and 3 miscarried (8.8%). Of the 19 patients who elected not to have surgery, 1 patient conceived (5.3%), and her pregnancy is ongoing (P<.001).CONCLUSION:
Hysteroscopic correction of uterine septum or arcuate uterine anomaly significantly improves reproductive outcomes in patients who present with reproductive failure even after a previous successful live birth.