Impact of uterine cavity manipulation history on clinical and neonatal outcomes for in vitro fertilization-embryo transfers with donor sperm.

Objective: To evaluate the effect of prior uterine cavity procedures on clinical and neonatal outcomes in patients undergoing first-time in vitro fertilization-embryo transfer with donor sperm (IVF-ET with DS).

Methods: This retrospective cohort study included 599 infertility patients receiving their first IVF-ET with DS. Patients were categorized into two groups: those with a history of uterine cavity operation group (n=457) and the group with no history (n=142). The former was further subdivided into curettage (n=67), hysteroscopy (n=292), and complex uterine operations (n=98). Primary outcomes included clinical pregnancy outcomes (implantation rate, clinical pregnancy rate, miscarriage rate, and live birth rate) and neonatal outcomes (gestational age, birth weight and length, incidence of being small for gestational age [SGA], large for gestational age [LGA], and preterm birth).

Results: No significant differences were found in clinical pregnancy outcomes between the non-operative, curettage, and complex operation groups (all P > 0.05). However, the hysteroscopy group showed significantly lower miscarriage rates and higher implantation, clinical pregnancy, and live birth rates (all P < 0.05). Multivariate analysis confirmed that hysteroscopy history was independently associated with improved pregnancy outcomes and reduced miscarriage rates, particularly in both age groups (< 35 and ≥ 35 years). No significant differences in neonatal outcomes were observed across all groups (all P > 0.05).

Conclusion: A history of hysteroscopy is associated with improved implantation, clinical pregnancy, and live birth rates, and a lower miscarriage rate in patients undergoing first IVF-ET with DS, without affecting neonatal outcomes.