P–748 Diode laser hysteroscopic metroplasty for dysmorphic uterus: a pilot study
Authors: Bilgory A , Shalo. Paz E , Atzmon Y , Aslih N , Estrada D , Shibli Y , Haimovich S 
Published: August 2021

Abstract

Study question
Whether diode laser hysteroscopic metroplasty for dysmorphic uterus is a safe and efficacious procedure and its effect on reproductive outcomes.

Summary answer
Diode laser hysteroscopic metroplasty is a safe and effective procedure for infertile women with dysmorphic uterus with comparable results to those reported in the literature.

What is known already
A T-shaped uterine anomaly is categorized by the ESHRE/ESGE consensus as dysmorphic uterus class U1a, characterized by an abnormal hypoplastic uterine cavity. A Y-shaped uterus is a dysmorphic uterus with a fundal subseptum. Dysmorphic uteri are associated with infertility, recurrent implantation failure (RIF), recurrent pregnancy loss (RPL), and adverse pregnancy outcomes. According to several studies, it seems that hysteroscopic metroplasty may improve the chances of conception and live birth. Previous studies described the procedure using bipolar systems, monopolar needle or scissors. The purpose is to achieve a uterine cavity of normal shape and volume by cutting the thickened lateral walls.

Study design, size, duration
This was a retrospective pilot study with a prospective follow-up. We retrospectively evaluated all cases operated between February 2018 to February 2020, at Hillel Yaffe Medical Center, Hadera, Israel. Reproductive outcomes for women who underwent the procedure were followed until September 2020. Pregnancies that were ongoing on September 2020 were followed until January 31st 2021.

Participants/materials, setting, methods
Nulliparous women with a diagnosis of infertility or RPL, who were diagnosed with dysmorphic uterus by three-dimensional ultrasound (3D-US) and underwent diode laser hysteroscopic metroplasty were included. All the metroplasties were done in one tertiary center by the same specialist. Reproductive outcomes were evaluated retrospectively and prospectively for a total follow-up time of 32 months. Reproductive performances before and after metroplasty were compared where possible.

Main results and the role of chance
Twenty-five women underwent diode laser hysteroscopic metroplasty for dysmorphic uterus in our institute. No perforations, excessive bleeding, or other complications were encountered during the procedures. Follow-up hysteroscopy and 3D-US were satisfactory in all cases 2 months after the metroplasty. A total of 15 nulliparous women returned to fertility treatments afterwards, among whom 9 conceived (60% pregnancy rate). Their infertility period before the procedure was 56.6 ± 36.1 months. The duration between the metroplasty to pregnancy was 5.2 ± 3.5 months. The rate of deliveries and ongoing pregnancies (pregnancies beyond 20 weeks of gestation) was 78% (7/9), with five successful liveborn deliveries and two ongoing pregnancies. All deliveries were between 36–37 weeks. The 10 women who were not treated by our infertility unit were contacted, among whom 6 discontinued their attempt to conceive. The other 4 conceived; three of them spontaneously. Among those 4 women,the rate of deliveries and ongoing pregnancies was 75%, with one term delivery and two ongoing pregnancies.

Limitations, reasons for caution
First, we included both T-shaped and Y-shaped uteri as both represent close versions of dysmorphic uteri, but in fact they differ. The subseptum might interfere with reproduction in a different mechanism. Second, the small and heterogeneous sample as well as the short duration of follow-up limit the conclusions.
Wider implications of the findings: We present the first application of diode laser in hysteroscopic metroplasty for dysmorphic uteri. This technique seems promising and our results are comparable with other series using different cutting devices. Only larger controlled trials with a longer follow-up can confirm the safety, efficacy, and impact on reproductive outcomes

Trial registration number
Not applicable