Effect of hysteroscopic surgery on IVF/ICSI pregnancy outcomes for different cesarean scar diverticulum severity: A retrospective cohort study.

Objective: To investigate associations between hysteroscopic surgery for patients with varying cesarean scar diverticulum (CSD) severity and in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) embryo transfer (ET) pregnancy outcomes, focusing also on the correlation between the CSD size with its severity, and pregnancy outcomes. Methods: A retrospective study was conducted on patients with CSD who underwent IVF/ICSI‐ET at a university‐based hospital between January 2017 and July 2023. Patients were categorized into four groups based on CSD severity and whether they received hysteroscopic surgery: a mild surgical group (Group A, n = 86), a mild non‐surgical group (Group B, n = 30), a moderate‐to‐severe surgical group (Group C, n = 173), and a moderate‐to‐severe non‐surgical group (Group D, n = 96). Baseline characteristics and pregnancy outcomes were compared among these groups. Correlation assessments were conducted to explore relationships between CSD size with its severity, and pregnancy outcomes. Results: Compared with Group D, Group C exhibited significantly increased rates of biochemical pregnancy (odds ratio [OR] 1.90; 95% confidence interval [CI] 1.03–3.51, P = 0.041), clinical pregnancy (OR 2.30; 95% CI1.18–4.45; P = 0.014), and live birth (OR 2.77; 95% CI 1.10–7.00, P = 0.031). However, no differences in pregnancy outcomes were observed between Groups A and B. Correlation analyses revealed significant positive associations between CSD severity and its depth, length, width, and volume. Conclusions: Patients with moderate‐to‐severe CSD achieved favorable IVF/ICSI pregnancy outcomes following hysteroscopic surgery. The CSD size was significantly related to its severity. Synopsis: Our study explored the impact of hysteroscopic surgery on IVF/ICSI pregnancy outcomes for patients with different cesarean scar diverticulum severity. [ABSTRACT FROM AUTHOR]