OBJECTIVE
The aim of this systematic review and meta-analysis was to analyze the reproductive
outcomes of natural pregnancy after hysteroscopic septum resection in patients with
recurrent miscarriage, primary infertility, or secondary infertility.
DATA SOURCES
The PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure
(CNKI), Wanfang Data Knowledge Service Platform, VIP Database, and Chinese Biomedical
Literature Database (CBM) databases were electronically searched. The search time
frame was from inception up to July 2021. The English search terms were (arcuate*
and uter*), (sept* and uter*), (subseptate* and uter*), metroplast*, septoplast*,
and resect*.
STUDY ELIGIBILITY CRITERIA
Selection criteria included randomized controlled trials, cohort studies, and case
series that explored reproductive outcomes after hysteroscopic septum resection in
patients with recurrent miscarriage, primary infertility, or secondary infertility
with or without a control group.
METHODS
The primary outcomes were the live birth rate and eventual postoperative live birth
rate after hysteroscopic septum resection. The secondary outcomes were the clinical
pregnancy rate, preterm birth rate, and miscarriage rate. Study-level proportions
of outcomes were transformed using the Freeman–Tukey double-arcsine transformation
to calculate pooled values for the postoperative rates; the counted data were analyzed
using relative risk as the effect analysis statistic, and each effect size was provided
with its 95% confidence interval. Heterogeneity between the results of the included
studies was analyzed using the I2 test.
RESULTS
Overall, 5 cohort studies and 22 case series involving 1506 patients were included.
In patients with a septate uterus and recurrent miscarriage, hysteroscopic septum
resection was associated with an increased live birth rate (relative risk, 1.77; 95%
confidence interval, 1.26–2.49; P=.001; I2=0%), resulting in a postoperative live birth rate of 66% (95% confidence interval,
59–72), and septum resection was associated with a reduced preterm birth rate (relative
risk, 0.15; 95% confidence interval, 0.04–0.53; P=.003; I2=0%) and miscarriage rate (relative risk, 0.36; 95% confidence interval, 0.20–0.66;
P=.0009; I2=0%). In patients with a septate uterus and primary infertility, hysteroscopic septum
resection was associated with an increased live birth rate (relative risk, 4.12; 95%
confidence interval, 1.19–14.29; P=.03; I2=0%) and clinical pregnancy rate (relative risk, 2.28; 95% confidence interval, 1.04–4.98;
P=.04; I2=0%). The postoperative live birth rate was 37% (95% confidence interval, 30–44),
and the miscarriage rate of patients with primary infertility was reduced (relative
risk, 0.19; 95% confidence interval, 0.06–0.56; P=.003). The efficacy of hysteroscopic septum resection in patients with secondary
infertility was unclear. However, their postoperative live birth rate was found to
be 41% (95% confidence interval, 2–88).
CONCLUSION
Hysteroscopic septum resection is associated with an increased live birth rate and
a reduced miscarriage rate in patients with recurrent miscarriage or primary infertility,
indicating that septum resection may improve the reproductive outcomes of these patients.
The effectiveness of septum resection was unclear for patients with secondary infertility.
These findings are limited by the quality of the included studies, warranting further
randomized controlled trials, including only patients with recurrent miscarriage or
primary infertility.
Key words
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Article info
Publication history
Published online: October 07, 2022
Accepted:
October 3,
2022
Received in revised form:
September 29,
2022
Received:
June 8,
2022
Footnotes
Y.J. and L.W. share first authorship.
The authors report no conflict of interest.
This study received no financial support.
This study was registered with the International Prospective Register of Systematic Reviews on October 20, 2021 (registration number: CRD42021279715).
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