Design: Retrospective case series.

Setting: Single large tertiary medical center in the United States

Patients or Participants: All women with an identified isthmocele who underwent RA-IR with or without hysteroscopic guidance between 9/2015 and 12/2022 were included in the study.

Interventions: All patients underwent RA-IR. Postoperatively, patients were sent a questionnaire regarding their postoperative obstetric outcomes, symptom profile, and satisfaction with the surgery.

Measurements and Main Results:

Our primary outcome was postoperative live births. Secondary outcomes included fertility rate, symptom improvement, and postoperative change in myometrial depth, width, and residual myometrial thickness. Of 13 patients who attempted pregnancy, 100% were able to conceive status post repair including six of the patients with a preoperative diagnosis of primary or secondary infertility. To date, 53.84% of patients who attempted conception after repair have had live births. Two patients are currently pregnant in their second or third trimesters without complication. Postoperative MRI was complete for the majority of patients. There was a statistically significant improvement in all three measurements postoperatively (p<0.1). The greatest difference was seen in the depth of the isthmocele. The residual myometrial thickness increased by an average of 3.61mm (SD 3.59) postoperatively. Twelve patients completed a questionnaire regarding symptoms and obstetric outcomes. Postoperatively, 100% had improvement in their symptoms with 66.67% reporting complete resolution.

100% of patients who attempted pregnancy following RA-IR were able to conceive, 53.84% of whom went on to have live births (and two currently pregnant).

There was a statistically significant improvement in postoperative width, depth, and residual myometrial thickness (p<0.1).

Conclusion:

RA-IR results in improved defect width and residual myometrial thickness with preservation of fertility and good obstetric outcomes with a 53.84%live birth rate.