Hysteroscopic metroplasty of a uterine septum for primary infertility

4.1 A case series of 246 women with a septate uterus and a history of recurrent miscarriage or infertility reported that 57% (61/108) of women with unexplained fertility became pregnant after hysteroscopic metroplasty, with a live birth rate of 75% (44/71) of pregnancies; there were 12 ongoing pregnancies at the close of the study. The preterm delivery rate was 10% (7/71). A case series of 263 women with a septate uterus and a history of primary or secondary infertility or a history of recurrent miscarriage reported that 38% (57/149) of women with primary infertility became pregnant after hysteroscopic metroplasty, with a term delivery rate of 88% (50/57). A case series of 181 women with a septate uterus and a history of unexplained infertility or more than 1 miscarriage reported that 44% (43/98) of women with unexplained infertility became pregnant after hysteroscopic metroplasty; there were 51 pregnancies, 36 of which were spontaneous and the live birth rate was 80% (41/51). Of the 36 spontaneous pregnancies, 22% (8/36) had a preterm delivery.

4.2 A review of 2528 women (37 studies) with a septate uterus and a history of recurrent miscarriage, infertility, spontaneous abortion or preterm delivery that included a meta‑analysis of 2074 women (29 studies) reported a live birth rate of 50% after hysteroscopic metroplasty (95% confidence interval [CI] 43 to 57; 19 studies, n=1525) (follow‑up period not reported).

4.3 The specialist advisers listed key efficacy outcomes as a normal‑sized uterine cavity, improved pregnancy outcome, improved fertility, malpresentation rate, and reduction in difficulty in labour and delivery.