Reproductive outcomes of different management strategies after hysteroscopic resection of the uterine septum with endometrial polyps: a retrospective study

Background The presence of a septate uterus combined with endometrial polyps significantly impacts women’s fertility. There is currently no study on whether medication is needed after surgery and which postoperative regimen is more beneficial for uterine recovery and pregnancy outcomes. This study aims to compare the reproductive outcomes and complications of artificial cycle therapy with those of short-acting contraceptives or no hormonal treatment after hysteroscopic resection of the uterine septum with coexisting endometrial polyps. Methods A retrospective study was conducted on 189 women with a history of infertility or adverse pregnancy who underwent hysteroscopic resection of uterine septum with endometrial polyps between December 2017 and February 2023 . According to the postoperative medication regimens, patients were divided into three groups: artificial cycle (Group A), short-acting contraceptive (Group B), and no hormonal treatment (Group C). The primary outcome was pregnancy rates leading to live birth within 12 months post-surgery. Results There were 92 patients in Group A, 52 in Group B, and 45 in Group C. The live birth rates were 40.2% in Group A, 34.6% in Group B, and 31.1% in Group C ( χ 2 = 1.192, P = 0.547). A multivariate logistic regression analysis was performed incorporating confounding variables including age, body mass index (BMI), types of fertility problems, and types of uterine septum. The results showed that only age (adjusted odds ratio (OR) = 0.892, 95%CI [0.822–0.968], P = 0.006) was significantly associated with live birth after surgery. The mean time to pregnancy resulting in live birth was 9.6 months in Group A, 10.2 months in Group B, and 10.4 months in Group C (log-rank P = 0.468). There were no significant differences in clinical pregnancy rate, pregnancy loss rate, preterm birth rate, placental abnormality rate, postoperative intrauterine adhesion rate, and endometrial polyp recurrence rate among the three groups ( P > 0.05). Conclusions Hormonal therapy, including artificial cycles and short-acting contraceptives, may not be necessary after hysteroscopic septum resection with polypectomy for patients with short-term fertility requirements.