The Factors Affecting the Fertility of Women Undergoing Transcervical Resection of Intrauterine Adhesions: A Retrospective Study

Background: Hysteroscopic adhesiolysis effectively restores the anatomical integrity of the uterine cavity in cases of intrauterine adhesions (IUA). However, there is ongoing debate regarding the factors influencing the reproductive outcomes of hysteroscopic adhesiolysis in women with IUA. Methods: One-hundred and thirty-seven patients with IUAs who wanted to become pregnant were enrolled. All patients underwent hysteroscopic adhesiolysis performed by a single experienced surgeon at a tertiary University-affiliated hospital between February 2019 and July 2021. Subsequently, these patients attempted to conceive within the following two years. Patients with concurrent intrauterine diseases such as polyps, submucosal myoma, or IUAs attributed to tuberculosis were excluded from the study. General clinical data were collected and analyzed using univariate and multivariable logistic regression analyses. Results: The clinical pregnancy rate for patients with IUA was 60.6% (83/137), and the live birth rate was 51.8% (71/137). The clinical pregnancy and live birth rates were similar between the in vitro fertilization (IVF) group and the spontaneous conception group. Multivariable logistic regression analysis revealed that patients aged 37 years or older (Odds ratio (OR) 3.928, 95% confidence interval (CI) 1.214-12.710, p = 0.022) or with severe IUA (OR 4.579, 95% CI 1.811-11.578, p = 0.002) were significantly more likely to have a lower clinical pregnancy rate. Similarly, patients aged 37 years or older (OR 3.919, 95% CI 1.147-13.388, p = 0.029) or with severe IUA (OR 5.8, 95% CI 2.129-15.806, p = 0.001) were more likely to have a lower birth rate. Conclusions: Patients' age and severity of IUA can potentially predict the reproductive outcomes of IUA treatment.