Effectiveness of Hysteroscopic Surgery for Intrauterine Lesions on Pregnancy Rates in Patients With Primary Infertility in Bahrain

Background Infertility poses a substantial challenge in the realm of reproductive health, impacting numerous couples globally. Intrauterine abnormalities like polyps, submucosal fibroids, and uterine septa can impede the process of successful implantation and placentation, thereby contributing to infertility issues and miscarriages. Hysteroscopy has emerged as a promising therapeutic approach for addressing these intrauterine lesions. Our objective is to assess the efficacy of hysteroscopic surgery in treating intrauterine lesions and its impact on pregnancy rates among individuals experiencing primary infertility. Objectives Our primary objective is to assess the association between operative hysteroscopy for defined intrauterine lesions (polyps, submucous fibroids, septa) and subsequent pregnancy and live-birth rates in women with primary infertility. Secondary objectives: (i) quantify the proportion of previously undiagnosed lesions detected at hysteroscopy; (ii) explore predictors of pregnancy (age, BMI, infertility duration, and lesion type); and (iii) report outcomes stratified by conception method (spontaneous vs. assisted reproductive technology (ART)). Material and methods This retrospective cohort study was conducted in the Obstetrics and Gynaecology department at Salmaniya Medical Complex (SMC), Bahrain. The study included 113 patients with primary infertility due to intrauterine lesions, such as polyps, submucosal fibroids, and uterine septa, who underwent hysteroscopic surgery at SMC between September 2018 and February 2023. The primary outcome of interest was the achievement of pregnancy following hysteroscopic surgery. Secondary outcomes included the mode of conception (spontaneous or assisted). Pregnancy outcomes were confirmed through registry follow-up to ensure accuracy and reproducibility of the data. Results After operative hysteroscopy, 72 out of 113 patients (64%) achieved pregnancy. Among those who became pregnant, 73.6% had singleton pregnancies, while 26.4% had twin pregnancies. Of the patients who achieved pregnancy, 18.1% experienced miscarriage, 1.4% had an ectopic pregnancy, 62.2% carried to term, and 18.1% had preterm deliveries. The overall live birth rate was 80.6% (58 live births). The highest live birth rate was observed in the polypectomy group (37.9%), followed by the uterine septum resection group (31%), the diagnostic hysteroscopy and endometrial scratching group (15.5%), the hysteroscopic myomectomy group (8.6%), and the hysteroscopic polypectomy and myomectomy group (6.9%). Conclusions Hysteroscopic surgery for intrauterine lesions significantly improved pregnancy rates in patients with primary infertility, proving particularly effective for treating polyps, uterine septa, and submucosal fibroids. These findings underscore the importance of hysteroscopy as a valuable treatment option for patients with primary infertility and intrauterine abnormalities.