Study question Does laparoscopic repair of cesarean scar defect improve in-vitro fertilization (IVF) outcomes? Summary answer Laparoscopic (LSC) repair of cesarean scar defect (CSD) should selectively indicated to patients experiencing repetitive pregnancy failure or having an increased depth of niche What is known already Cesarean section (CS) rate has markedly from 7% in 1990 to an estimated 29% of all births by 2030. CSD, also known as isthmocele or uterine niche, has emerged as a cause of secondary infertility, frequently encountered with recurrent implantation failures and cycle cancellations because of the endometrial fluid collection both in endometrium and uterine lower segment of cesarean scar. Study design, size, duration This is a retrospective study encompassing total of 62 patients. With 50 patients undergoing expectant management, 12 undergoing LSC repair of CSD at a single IVF center from 2019 to 2023. Primary outcomes included the clinical pregnancy rate and time to pregnancy, while secondary outcomes were the depth of CSD and residual myometrial thickness. Of the 72 patients, 68 patients underwent frozen embryo transfer. Participants/materials, setting, methods Patients with secondary infertility who had experienced more than two instances of implantation failure or cycle cancellation due to endometrial fluid collection were included. Laparoscopic repair of CSD was performed by a single gynecologic oncologist in accordance with the physician’s preference and patient consent. For patients in expectant management, diagnostic hysteroscopy and endometrial fluid suction were conducted prior to embryo transfer. Main results and the role of chance The age, BMI, gravidity, parity, or the number of previous cesarean section showed no statistical differences between the expectant management and the LSC repair group. The uterine position, either anteflexion was similar across groups. (all p value >0.05). Both the clinical pregnancy rate and live birth rate did not significantly differ between the expectant management group and the LSC repair group (26.0% vs 50.0%, p = 0.149, and 32.0% vs 60.0%, p = 0.149, respectively). The mean time to pregnancy was 7.38 months in the expectant management group and 9.80 months in LSC repair group, showed no significant difference (p = 0.240). Correlation analysis revealed a significantly moderate correlation between the initial depth of CSD and the depth of CSD at embryo transfer with clinical pregnancy (r = -0.424, P = 0.001). Furthermore, our data indicated that the CSD depth at embryo transfer was significantly impacted on clinical pregnancy outcomes from the multivariate regression logistic analysis (OR = 0.522, 95% CI [0.332 – 0.823]). Limitations, reasons for caution This study is retrospectively designed and including small sample size, caution is required in interpreting the findings. Wider implications of the findings This study suggests that the depth of niche influences clinical pregnancy outcomes. Laparoscopic repair may offer a viable treatment option who have experienced multiple failed cycles and increased depth of niche. Future studies with larger population studies may further indicate the LSC repair based on the depth of CSD. Trial registration number not applicable

中文翻译：

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P-742 腹腔镜剖宫产疤痕修复术后体外受精的结果


研究问题 腹腔镜修复剖宫产疤痕缺损是否可以改善体外受精 (IVF) 的结果？摘要答案 剖宫产疤痕缺损 (CSD) 的腹腔镜 (LSC) 修复术应选择性地适用于经历重复妊娠失败或利基深度增加的患者 已知剖宫产 (CS) 率已从 1990 年的 7% 显着下降到估计值到 2030 年，占所有出生人口的 29%。CSD，也称为峡部膨出或子宫龛，已成为继发性不孕的原因，由于子宫内膜和子宫下段的子宫内膜液积聚，经常会遇到反复着床失败和周期取消的情况。剖腹产疤痕。研究设计、规模、持续时间 这是一项回顾性研究，共有 62 名患者参与。 2019 年至 2023 年间，50 名患者接受期待治疗，其中 12 名患者在单个 IVF 中心接受 LSC 修复 CSD。主要结局包括临床妊娠率和妊娠时间，次要结局是 CSD 深度和残余子宫肌层厚度。在这 72 名患者中，68 名患者接受了冷冻胚胎移植。参与者/材料、背景、方法 因子宫内膜积液而经历过两次以上植入失败或周期取消的继发性不孕患者被纳入其中。 CSD 的腹腔镜修复由一名妇科肿瘤科医生根据医生的偏好和患者的同意进行。对于期待治疗的患者，在胚胎移植前进行诊断性宫腔镜检查和子宫内膜吸液。 主要结果和机会的作用期待治疗组和 LSC 修复组之间的年龄、BMI、妊娠情况、产次或既往剖宫产次数没有统计学差异。各组的子宫位置、前屈情况相似。 （所有 p 值 >0.05）。期待治疗组和 LSC 修复组之间的临床妊娠率和活产率没有显着差异（分别为 26.0% vs 50.0%，p = 0.149 和 32.0% vs 60.0%，p = 0.149）。期待治疗组的平均妊娠时间为 7.38 个月，LSC 修复组为 9.80 个月，没有显着差异 (p = 0.240)。相关分析显示初始CSD深度和胚胎移植时CSD深度与临床妊娠之间存在显着中度相关性（r = -0.424，P = 0.001）。此外，我们的数据表明，多变量回归逻辑分析显示，胚胎移植时的 CSD 深度对临床妊娠结局有显着影响（OR = 0.522，95% CI [0.332 – 0.823]）。局限性、谨慎原因本研究是回顾性设计的，样本量较小，在解释研究结果时需要谨慎。研究结果的更广泛影响这项研究表明，生态位的深度影响临床妊娠结局。腹腔镜修复可能为经历过多次失败周期和增加龛深度的患者提供可行的治疗选择。未来针对更大人群的研究可能会进一步表明基于 CSD 深度的 LSC 修复。 试用注册号不适用