Does metroplasty on dysmorphic uterus improve displaced and disrupted implantation window? A Case Report

ABSTRACT
Background. Different studies have shown that dysmorphic uterus may be associated with reproductive failure and adverse reproductive outcomes. Euploid embryos may fail to implant if the uterine environment is not appropriate.
Nevertheless, a causal relationship between dysmorphic uterus and impaired endometrial receptivity remains unproven.
Case presentation. Therapeutic management of T-shaped uterus is challenging while some authors advice expectant management others find encouraging results after enlargement of uterine cavity by hysteroscopic metroplasty.
Here we present a case of primary infertility in a 35 years-old woman, who presented a dysmorphic uterus on her fertility workup. She followed IVF cycle and had two failed embryo transfers besides personalized embryo transfer according to ERA test result and correction of mild dysbiosis according to EMMA test recommendations. She was offered hysteroscopic metroplasty and a sequential oestrogen-progestagen therapy for two months. The anatomical outcome was evaluated through second look hysteroscopy and 3D transvaginal ultrasound, and a new evaluation of endometrial receptivity was performed: her ERA test result before hysteroscopy was post-receptive and after the procedure showed receptive endometrium with 5 full days of progesterone administration, an optimal window of implantation, Alice test found no pathogens and no dysbiotic endometrial microenvironment. She had a spontaneous pregnancy afterwards.
Conclusions. This is first report to describe the impact of hysteroscopic metroplasty for U1a dysmorphic uterus on endometrial receptivity. This could shed some light for further research in order to explain improvement on reproductive outcome found by different authors after hysteroscopic metroplasty for correction of T-shaped uterus.