Does the Depth of Hysteroscopic Endometrial Fundal Incision Influence Reproductive Outcomes in Oocyte Recipients? A Prospective Study

Background: Hysteroscopic endometrial fundal incision (HEFI) is a novel addition to the standard IVF procedure. This study aimed to evaluate whether different depths of incision during HEFI could affect reproductive outcomes in oocyte recipients. Methods: A prospective analysis was conducted on women who underwent HEFI 1–2 months prior to embryo transfer with donor oocytes. Patients were categorized into three groups based on the depth of incision: U2a (superficial level) U2aa (intermediate level), and U2aaa (deep level). Pregnancy and live birth rates were assessed. Results: A total of 212 women without intrauterine pathology were included. Positive pregnancy rates were 78% in U2a, 76.9% in U2aa, and 77.1% in U2aaa (p = 0.95). Live birth rates were 58.5%, 57.1%, and 56.4%, respectively (p = 0.97). Early and late miscarriage rates and biochemical pregnancies showed no significant differences between the groups. Conclusions: Based on the results obtained, we could speculate that the depth of infiltration during HEFI does not significantly influence reproductive outcomes in oocyte recipients without intrauterine pathology. However, these findings should be interpreted with caution, given the limitations of the study, including its non-randomized design and differences among groups, such as variations in the number of embryos transferred and intraoperative group allocation. Therefore, further randomized clinical trials should be performed to more comprehensively understand the impact of incision depth on reproductive outcomes.