Reproductive outcomes after surgical resection of isthmocele in secondary infertility.

Objectives: To evaluate the reproductive outcomes after different approaches of surgical isthmocele excision in women with secondary infertility.

Methods: The present study was conducted between November 2017 and February 2023 in the Department of Gynecological Endocrinology and Gynecology at Jagiellonian University Medical College, Krakow, Poland. Women with large isthmocele with residual myometrial thickness (RMT) <3 mm and secondary infertility were included in this retrospective study. Surgical removal of the uterine defect was performed either by the laparoscopic or laparotomic approach. Pregnancy outcomes were measured.

Results: Fifty-eight women aged 32.3 ± 3.5 years with a body mass index 22.9 ± 3.4 kg/m were included. Pregnancy was confirmed in 62.1% of women after surgical repair of isthmocele either via laparoscopy (n = 19) or laparotomy (n = 17) and 36 women (44.8%) women delivered healthy babies. There were no differences in the type of surgical approach used for isthmocele removal regarding pregnancy outcomes. Women in the laparotomic group had a higher number of abdominal surgeries (2.8 times) and longer postsurgical hospitalization (+85.7%). There were no differences between the laparoscopy and laparotomy groups regarding the duration of infertility, number of pregnancies, performed cesarean sections, and the type of cesarean sections (urgent vs planned).

Conclusion: Surgical treatment should be offered to symptomatic women with isthmocele and secondary infertility. Given the absence of comparative studies, laparoscopic niche resection is the method of choice for a large uterine niche with an RMT <3 mm. Nonetheless, it offers comparable pregnancy outcomes to the laparotomic approach.