Design: Retrospective cohort study

Setting: Private practice at large tertiary care hospital

Patients or Participants: Women with secondary infertility desiring pregnancy who underwent robotic assisted laparoscopic isthmocele repair from January 1, 2015 until December 31, 2021. Patients were selected for robotic assisted laparoscopic repair if remaining myometrial thickness in the isthmocele was equal or less than 3mm, or if there was fluid in isthmocele cavity.

Interventions: Robotic assisted laparoscopic resection and repair of uterine isthmocele in patients with secondary infertility

Measurements and Main Results: The study sample included 67 patients with a mean age at time of surgery of 36± 3.3 years old. 61% of the patients were white with an average BMI of 24.3 (range: 17.4-48.3). During isthmocele repair, additional pathology was identified in nearly two-thirds (64%) of patients, most commonly being adhesions (31%) and endometriosis (24%). In the 46 patients with available imaging and remaining myometrial thickness measurements pre and post operatively, the median increase in remaining myometrial thickness was 3.9mm (range 0-11mm). Pregnancy was achieved in 52 patients (78%), with 5 of those patients having a spontaneous abortion (9.6%) and 45 (67%) delivering a viable infant.

Conclusion: There is no consensus in the literature as to the optimal treatment for patients with secondary infertility and uterine isthmocele who desire subsequent pregnancy. Our study is the largest to date looking specifically at secondary infertility and subsequent pregnancy rates after robotic assisted laparoscopic repair of isthmocele. We demonstrate significantly improved pregnancy rates and live birth outcomes in patients with secondary infertility after repair of isthmocele and therefore should be considered as primary treatment in women with isthmocele measuring 3mm or less, or found to have fluid in the isthmocele