Does surgery improve live birth rates in patients with recurrent miscarriage caused by uterine anomalies?

Abstract

We found that congenital uterine anomalies have a negative impact on reproductive outcome in recurrent-miscarriage couples, being associated with further miscarriage with a normal embryonic karyotype. There has been no study comparing live birth rates between patients with and without surgery. We conducted a prospective study to prove that surgery for a bicornuate or septate uterus might improve the live birth rate. A total of 170 patients with congenital uterine anomalies suffering two or more miscarriages were examined. The live birth rate after ascertainment of anomalies, cumulative live birth rate and infertility rate, were compared between patients with and without surgery. In patients with a septate uterus, the live birth rate (81.3%) at the first pregnancy after ascertainment of anomalies with surgery tended to be higher than that (61.5%) in those without surgery. The infertility rates were similar in both groups, while the cumulative live birth rate (76.1%) tended to be higher than without surgery (60.0%). Surgery showed no benefit in patients with a bicornuate uterus for having a baby, but tended to decrease the preterm birth rate and the low birth weight. The possibility that surgery has benefits for having a baby in patients with a septate uterus suffering recurrent miscarriage could not be excluded.

Keywords::

• Bicornuate uterus
• congenital uterine anomaly
• metroplasty
• recurrent pregnancy loss
• septate uterus

Acknowledgements

We thank Dr Shunsaku Fujii (Department of Obstetrics and Gynecology, Hirosaki University Hospital) and Dr Shigeru Saito (Department of Obstetrics and Gynecology, University of Toyama Hospital) for collecting clinical data.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

This study was supported by a grant-in-aid for Scientific Research from the Ministry of Health, Labour and Welfare of Japan.