Simone Garzon1, Antonio Simone Laganà1, Attilio Di Spiezio Sardo2, Luis Alonso Pacheco3, Sergio Haimovich4, Jose Carugno5, Salvatore Giovanni Vitale6, Jvan Casarin7, Ricciarda Raffaelli8, Alessandra Andrisani9, Brunella Zizolfi10, Antonella Cromi11, Fabio Ghezzi12, Massimo Franchi13, Amerigo Vitagliano14. 1. Staff Physician, Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy. 2. Professor, Department of Public Health, University of Naples "Federico II," Naples, Italy. 3. Staff Physician, Endoscopy Unit, Centro Gutenberg, Málaga, Spain. 4. Associate Professor, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, The Rappaport Faculty of Medicine, Technion, Israel. 5. Associate Professor, Obstetrics, Gynecology and Reproductive Sciences Department, Minimally Invasive Gynecology Unit, University of Miami, Miller School of Medicine, Miami, FL. 6. Staff Physician, Unit of Obstetrics and Gynecology, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy. 7. Research Associate, Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy. 8. Associate Professor, Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy. 9. Research Associate, Department of Woman and Child Health, University of Padua, Padova. 10. Staff Physician, Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples "Federico II," Naples. 11. Associate Professor. 12. Professor and Chief, Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese. 13. Professor and Chief, Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona. 14. Staff Physician, Department of Woman and Child Health, University of Padua, Padova, Italy.
Abstract
IMPORTANCE: To date, a comprehensive review on the safety and effectiveness of hysteroscopic metroplasty for T-shaped uterus is still missing. OBJECTIVE: To provide a robust synthesis of the available studies investigating reproductive outcomes after hysteroscopic metroplasty for T-shaped uterus. EVIDENCE ACQUISITION: We performed a systematic review and meta-analysis (CRD42019143291), using the proportion method with 95% confidence interval (CI). Statistical heterogeneity was assessed by Higgins test (I2). RESULTS: We included 11 cohort studies embedding 937 women who underwent hysteroscopic metroplasty. After surgery, the pooled percentage of live birth was 44.54% (95% CI, 36.12%-53.12%; I2 = 46.22%) and 56.88% (95% CI, 46.48%-66.98%; I2 = 36.38%) in women with primary infertility and recurrent miscarriage, respectively. In women with recurrent miscarriage, the pooled proportion of miscarriage was 21.46% (95% CI, 15.09%-28.61%; I2 = 30.18%). The pooled clinical pregnancy proportion in women with primary infertility was 57.19% (95% CI, 43.83%-70.03%; I2 = 77.81%). The pooled rate of surgical complications was 0.65% (95% CI, 0.20%-1.33%; I2 = 11.44%). CONCLUSIONS: The hysteroscopic correction of T-shaped uteri was associated with high live birth rate and low miscarriage rate, both in case of primary infertility and recurrent miscarriage. RELEVANCE: Hysteroscopic metroplasty can be considered a safe and effective strategy to improve reproductive outcomes in case of T-shaped uterus.
IMPORTANCE: To date, a comprehensive review on the safety and effectiveness of hysteroscopic metroplasty for T-shaped uterus is still missing. OBJECTIVE: To provide a robust synthesis of the available studies investigating reproductive outcomes after hysteroscopic metroplasty for T-shaped uterus. EVIDENCE ACQUISITION: We performed a systematic review and meta-analysis (CRD42019143291), using the proportion method with 95% confidence interval (CI). Statistical heterogeneity was assessed by Higgins test (I2). RESULTS: We included 11 cohort studies embedding 937 women who underwent hysteroscopic metroplasty. After surgery, the pooled percentage of live birth was 44.54% (95% CI, 36.12%-53.12%; I2 = 46.22%) and 56.88% (95% CI, 46.48%-66.98%; I2 = 36.38%) in women with primary infertility and recurrent miscarriage, respectively. In women with recurrent miscarriage, the pooled proportion of miscarriage was 21.46% (95% CI, 15.09%-28.61%; I2 = 30.18%). The pooled clinical pregnancy proportion in women with primary infertility was 57.19% (95% CI, 43.83%-70.03%; I2 = 77.81%). The pooled rate of surgical complications was 0.65% (95% CI, 0.20%-1.33%; I2 = 11.44%). CONCLUSIONS: The hysteroscopic correction of T-shaped uteri was associated with high live birth rate and low miscarriage rate, both in case of primary infertility and recurrent miscarriage. RELEVANCE: Hysteroscopic metroplasty can be considered a safe and effective strategy to improve reproductive outcomes in case of T-shaped uterus.
Authors: Luis Alonso Pacheco; Carmina Bermejo López; José Carugno; Pedro Azumendi Gómez; Pilar Martinez-Ten; Antonio Simone Laganà; Simone Garzon Journal: Arch Gynecol Obstet Date: 2021-07-25 Impact factor: 2.344
Authors: Giovanni Buzzaccarini; Luis Alonso Pacheco; Amerigo Vitagliano; Sergio Haimovich; Vito Chiantera; Péter Török; Salvatore Giovanni Vitale; Antonio Simone Laganà; Jose Carugno Journal: Medicina (Kaunas) Date: 2022-08-20 Impact factor: 2.948