Reproductive outcomes after hysteroscopic myoma resection and septal surgery in infertile women – a retrospective study

Background To evaluate reproductive outcomes after hysteroscopic myoma resection and septal surgery in women with primary or secondary infertility.Methods This monocentric retrospective cohort study included women with infertility who underwent hysteroscopic myoma resection or septal surgery between 2014 and 2021. Patients with uterine septa were divided into three groups, depending on the extent of the septa (mild, moderate and sub-/total). All procedures were performed by a single experienced surgeon. Pregnancy rates and live birth rates before and after surgery were compared.Results Of 85 women who underwent hysteroscopic surgery, 65 were available for follow-up. After surgery, 55.4% achieved pregnancy and 44.6% had a live birth (p = .001). Live birth rates increased after both septal surgery (14.7 vs. 50%; p = .002; n = 34) and myoma resection (16.1 vs. 38.7%; p = .092; n = 31). In women with uterine septa, live birth rates improved significantly after surgery, independent of septum extent (mild: 16.67% vs. 50%; moderate: 13.64% vs. 50%; sub-/total: 16.67% vs. 50%). Postoperative reproductive treatment increased pregnancy rates (44.44% vs. 63.16%) but did not affect live birth rates (44.44% vs. 44.74%).Conclusion Hysteroscopic treatment of uterine septa and submucosal fibroids was associated with improved live birth outcomes in women with infertility. These findings suggest that, in suitable cases of infertility, hysteroscopic surgery should be considered.