Remodeling of the endometrial cavity in patients experiencing infertility and pregnancy loss

Relevance: Uterine abnormalities occur in 35% of infertile patients and in approximately 63% of cases of pregnancy loss. Early detection of congenital uterine abnormalities and timely surgical correction are crucial.

Objective: To evaluate the effectiveness of surgical remodeling of the endometrial cavity in patients with reproductive dysfunction and various types of intrauterine septa.

Materials and methods: Between 2024 and 2025, 325 patients with various types of intrauterine septa underwent surgery at the Department of Operative Gynecology at V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia. All patients underwent pelvic examination using three-dimensional ultrasound scanning. The extent of surgical treatment was determined by the anatomical form of the intrauterine septum and the presence of concomitant gynecological pathologies. Reproductive outcomes were studied in 135 patients over two years following the recovery phase.

Results: The mean age of the patients was 33.6±3.5 years. Based on the anatomical characteristics of the uterus, we classified the intrauterine septa into three categories: complete intrauterine septum (n=22), incomplete intrauterine septum (n=183), and T-shaped narrowing of the uterine cavity (n=120). Hysteroresectoscopy was performed in 245 cases, whereas laparoscopy was combined with hysteroresectoscopy in 80 cases. Three-dimensional surgical remodeling of the endometrial cavity was performed by making a transverse incision in the subendometrial layer of the myometrium using a monopolar hysteroscopic loop at the fundus of the uterine cavity between the openings of the fallopian tubes. Areas of fibrous myometrium at the fundus were excised to a depth of 4–6 mm and a length of 25–30 mm in the transverse direction. Subsequently, a longitudinal excision of the subendometrial layer of the fibrous myometrium was performed along the lateral walls of the uterus from the openings of the fallopian tubes to the internal os, measuring 30–35 mm in length, 4–5 mm deep, and 6–8 mm wide. Pregnancy occurred in 34.8% of patients: 27 achieved pregnancy in a natural cycle, and 20 through IVF and embryo transfer. Thirty-six (26.7%) patients participated in the oocyte donation and pre-pregnancy preparation programs.

Conclusion: Three-dimensional surgical remodeling of the endometrial cavity is recommended for patients with congenital (intrauterine septum) or acquired narrowing (synechiae) of the uterine cavity. It also aims to enhance reproductive outcomes in cases of ineffective embryo transfer attempts during IVF and in older reproductive age groups as part of preimplantation preparation.