Speakers - 2026

Title: Isthmocele-associated secondary infertility: Impact of surgical correction on ART outcomes

Abstract

Objective: To evaluate whether  surgical correction of isthmocele improves assisted reproductive technology (ART) outcomes in women with secondary infertility.

Methods: This retrospective cohort study included 78 women with secondary infertility and ultrasound-confirmed isthmocele following caesarean section, treated between 2023 and 2025 at two tertiary referral reproductive medicine centres in Armenia (Erebouni Medical Center and Astghik Medical Center). Surgical approach was selected based on defect size, residual myometrial thickness, and reproductive plans, using hysteroscopic, laparoscopic, or combined techniques. ART cycles initiated after surgical correction were analysed and compared with pre-operative ART attempts when available. Primary outcomes were clinical pregnancy rate and live birth rate per initiated ART cycle. Secondary outcomes included implantation rate and miscarriage rate.

Results: Following surgical correction, ART outcomes significantly improved, with a clinical pregnancy rate of 41,9% and a live birth rate of 29,4% per initiated cycle. Implantation rates increased compared with pre-operative ART attempts (25,8% vs 35,5%, p<0.05), while miscarriage rates decreased (18% vs 9,7%). Laparoscopic and combined surgical approaches were associated with higher clinical pregnancy and live birth rates compared with hysteroscopic repair alone, particularly in women with larger defects and residual myometrial thickness <3mm.

Conclusions: Tailored surgical correction of isthmocele is associated with improved ART outcomes in women with secondary infertility. Selection of surgical approach according to defect characteristics may optimize implantation and live birth rates, supporting an individualized surgical strategy prior to ART.