Table 4 Surgical approaches and their success rates in restoring fertility through uterine niche repair

Cohen 2017 [20]

Retrospective cohort study

Four women with secondary infertility

Repeated hysteroscopic niche resection following failure of first hysteroscopy or recurrence of niche.

There were no significant differences regarding fertility and obstetric outcomes between the first and second surgeries.

Enderle 2020 [34]

Retrospective cohort study

Ten women with secondary infertility

Isthmocele surgery by hysteroscopy, vaginal way, or laparotomy.

Six conceived (6/10,60%), resulting in five miscarriages and three live births. Isthmocele surgery is effective for infertility regardless of the surgical route.

Bingqing 2018 [43]

Retrospective cohort study

N/D

Laparoscopic combined with hysteroscopic repair

The surgery improved pregnancy rates, but no statistically significant difference was observed between the two surgical techniques.

Gubbini 2008

[44]

Prospective cohort study

Nine women with secondary infertility

Resectoscopic correction of the Isthmocele.

Seven of 9 women with secondary infertility became pregnant.

Gubbini 2011

[33]

Prospective cohort study

41 women with secondary infertility

Operative hysteroscopy

All 41 women became pregnant spontaneously between 12 and 24 months after surgery.

Abdou 2018 [12]

Randomized non-blinded trial

56 women with secondary infertility

Hysteroscopic resection of uterine niche

The clinical pregnancy rate was significantly higher (p = 0.001) in the group of women who had hysteroscopic surgery when compared with the expectant management group (75% vs. 32.1% respectively)

Cohen 2020

[9]

Retrospective cohort study

Thirty-two women attempted and failed to conceive spontaneously, and seven women underwent IVF treatment and failed.

Hysteroscopic niche resection

One year after the hysteroscopic resection, 18 women conceived (14 spontaneously and four following IVF), leading to a cumulative pregnancy rate of 46.15%. Among the women who failed to conceive after at least two IVF cycles before the hysteroscopic resection, 42.8% conceived following surgery (three women out of seven)

Tsuji 2022 [45]

Retrospective cohort study

70 women with secondary infertility

Hysteroscopic niche resection

Among the 70 women, 49 women (70%) became pregnant after hysteresopic surgery.

Calzolari 2019 [29]

Retrospective cohort study

16 women with secondary infertility

Operative hysteroscopy

9/16 women (56%) became pregnant within 12 months of isthmoplasty.

Istvan 2017 [46]

Retrospective clinical study (No traditional design as cohort)

15 women with secondary infertility

Hysteroscopy-guided laparoscopic isthmoplasty

80% (n = 12/15) became pregnant within 24 months of the treatment.

Szafarowska 2021 [31]

Prospective cohort study

44 women with secondary infertility

Operative hysteroscopy

52% (n = 13/25) of women who

underwent operative hysteroscopy and became pregnant compared to 26% (n = 5/19) of women who underwent diagnostic hysteroscopy, but the result is not statistically significant.

Karampelas 2021 [32]

Retrospective case series

12 women with secondary infertility

Laparoscopic niche repair

The success rate for surgery to improve secondary infertility is 83.3%, with 10 out of 12 cases showing improvement.

Piriyev 2022 [22]

Retrospective cohort study

28 women with fertility desire have Isthmocele

Prophylactic laparoscopic niche repair

Laparoscopic correction of the Isthmocele increased myometrial thickness from 2 mm to 8.7 mm (average values). This represents an increase in myometrial thickness of 335%.

Donnez 2017 [36]

Prospective case series

18 women with secondary infertility

Laparoscopic niche repair

Among the 18 women with infertility, eight (44%) became pregnant and delivered healthy babies by cesarean section at 38–39 weeks of gestation.

Chuqing 2023 [35]

Retrospective cohort study

55 women with secondary infertility

Hysteroscopic niche resection

There was a significantly higher live birth rate (p = 0.04) and pregnancy rate (p = 0.01) in the HNR group compared to the expectant management group.

Tsuji 2020 [23]

Retrospective cohort study

38 women with secondary infertility

Hysteroscopic niche resection

Twenty-seven women (71%) became pregnant (pregnant group), while 11 (29%) did not (non-pregnant group).

Schepker 2014 [27]

Retrospective cohort study

Six women with secondary infertility

A microsurgical uterus reconstruction was performed by mini-laparotomy.

Post-operatively, three women (60%) became pregnant naturally. One no longer wished to become pregnant, and another patient planned to become pregnant by assisted reproductive therapy.

Shapira 2019 [30]

Retrospective cohort study

26 women with secondary infertility

Hysteroscopic niche resection

Of the 26 women who had infertility, 19 attempted to conceive spontaneously after CSD excision. Ten women (52.6%) conceived, and nine delivered at least once (47.36%).

Tanimura 2015 [13]

Retrospective cohort study

22 women with secondary infertility

Hysteroscopic repair/ Laparoscopic and hysteroscopic repair

Fourteen of the 22 women (63.6%) who were followed up for ≥ one year after surgery achieved pregnancy. RMT ≥ 2.5 mm with the straight uterus or uterus ante flexion underwent hysteroscopic repair, while RMT ≤ 2.5 mm with uterus retroflection underwent combined laparoscopic and hysteroscopic repair. Pregnancies occurred in all four women (100%) who underwent hysteroscopic surgery and in 10 of the 18 women (55.6%) who underwent laparoscopic surgery.

Zhang X 2016 [47]

Prospective cohort study

32 women with fertility desire

Laparoscopic niche repair

All 32 women who desired fertility underwent laparoscopy; 12 (37.5%) became pregnant after this procedure.

Zhang D 2018

[48]

Retrospective cohort study

43 women with fertility desire

Transvaginal repair/Laparoscopic repair

Conception rates for the two groups (Transvaginal repair/Laparoscopic repair) were similar among women who desired fertility.