The effect of uterine septum resection on fertility and live birth rates

Splinter, Karen (2023) The effect of uterine septum resection on fertility and live birth rates. Masters thesis, Memorial University of Newfoundland.

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Abstract

Objectives: To determine if patients who undergo a hysteroscopic uterine septum resection have higher live birth rates than patients with a normal hysteroscopy and unexplained infertility. Study Methods: Using surgical billing records from Newfoundland and Labrador Fertility Services, a cohort of patients undergoing hysteroscopic uterine septum resection from October 2003 to June 2011 were identified. The study patients were matched with the next four patients from Newfoundland and Labrador Fertility Services undergoing a diagnostic hysteroscopy who had otherwise unexplained infertility. The patients were followed from surgery for at least one year to determine if they had a pregnancy and the outcome of that pregnancy. Both groups included patients with primary infertility, secondary infertility, and recurrent pregnancy loss. The primary outcome was live birth rate, with a p value <0.05 defining statistical significance. Secondary outcomes included pregnancy rate, preterm birth rate, and markers of obstetric and neonatal morbidity; with p value <0.01 defining statistical significance. Results: A total of 50 eligible patients underwent hysteroscopic uterine septum resection (SR) during the specified timeline and were matched with 189 patients who had a diagnostic hysteroscopy (DH) for unexplained infertility. The groups were similar in age, BMI, years trying to conceive and surgeon. Univariate analysis demonstrated a significant difference in live birth rates between the groups (52.0% (SR) compared with 33.3% (DH), RR 1.56 [1.12-2.18], p=0.015). Subgroup analysis demonstrated a significant different in live birth rates between the secondary infertility group (66.7% (SR) compared with 32.4% (DH), RR 2.06 [1.22-3.47], p=0.023). Logistic regression analysis also found a higher live birth rate in the SR group (OR 2.35 [1.17-4.74], p=0.016). Postoperative pregnancy rates were higher in the SR group (72.0% compared with 41.2%, RR 1.74 (1.38-2.21), p<0.001), and this finding was confirmed by logistic regression (OR 3.78 [1.80-7.93], p<0.001). The SR group had a higher proportion of patients with risk factors for preterm delivery (29.6% compared with 10.8%, p=0.035) and composite neonatal morbidity (11.5% compared with 6.5%, p=0.029); but these differences did not meet statistical significance for secondary outcomes. Of live births, there was no significant difference in rate of preterm birth between the two groups (10.8% compared with 6.1%, p=0.37) or gestational age at delivery (268 days compared with 274 days, p=0.10). Conclusions: Hysteroscopic uterine septum resection may result in higher pregnancy rates and live births in patients with infertility, compared to patients undergoing a diagnostic hysteroscopy for unexplained infertility.

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