Design: Retrospective study

Setting: Fertility Center - Teaching Hospital

Patients or Participants:

The study included 35 consecutive patients (2020-2023) who presented with reproductive failure and were found to have T-shaped uterus. 35 patients had infertility with 12 also having recurrent pregnancy loss (RPL). All patients underwent hysteroscopic metroplasty (unilateral or bilateral) for T-shaped uterus; 26 also underwent septoplasty for additional partial septate uterus (PSU) [ESHRE-ESGE classification of Müllerian anomalies, 2013]. Postoperative transvaginal 3D ultrasound scan (TV 3D US) with saline infusion hysterosonogram (SIH) were performed for evaluation of the uterine cavity. Depending on the underling etiology, couples were offered to try to conceive naturally, with fertility medication (Letrozole), intrauterine insemination after controlled ovarian stimulation, or in vitro fertilization. Pregnancy outcome and any intra or postoperative complications were documented.

Interventions:

Hysteroscopic metroplasty for T-shaped uterus in all patients and hysteroscopic septoplasty in 26 patients

Measurements and Main Results:

Mean age (years), BMI (kg/m²), duration of infertility (years) and AMH (ng/mL) were 33.6 + 4.7, 26.2 + 5.5, 3.5 + 4.2 and 4.0 + 4.3 respectively. Metroplasty for T-shaped was unilateral in 74.3% and bilateral in 25.7%. In 26 patients PSU was also present. The mean mid-fundal protrusion length (mm) was 12.1 + 3.0 and 92.3% had an indentation apex angle that was >90 degrees. Septoplasty was performed in the 26 patients who underwent unilateral metroplasty. Postoperative SIH with TV 3D US revealed minimal filmy synechia in 22.9%, requiring a second hysteroscopy and lysis of adhesions. No other intra or postoperative complications were reported. Postoperative pregnancy, miscarriage and best outcome delivery/ongoing rates were 77.1%, 25.9% and 62.9 % respectively.

Conclusion:

This pilot study suggests that hysteroscopic metroplasty of T-shaped uterus with septoplasty, if PSU is found, may improve reproductive outcome in infertile patients and those with infertility and RPL.