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. 2025 Oct 2.
doi: 10.1007/s10815-025-03652-w. Online ahead of print.

Congenital complex uterine anomalies carry complex complications: an evaluation of ART outcomes

Keizra Mecklai  1   2 , Emily Weidenbaum  3 , Elise Heisler  4   5 , David McCulloh  3 , M Elizabeth Fino  3 , Christopher Eswar  5 , Jennifer Blakemore  3
Affiliations

Congenital complex uterine anomalies carry complex complications: an evaluation of ART outcomes

Keizra Mecklai et al. J Assist Reprod Genet. .

Abstract

Purpose: To examine assisted reproductive technology (ART) outcomes in patients with congenital complex uterine anomalies (CUA) as well as the impact of surgical repair on these outcomes.

Methods: This retrospective cohort study analyzed 46 patients with CUA who underwent 130 embryo transfer cycles at a large academic fertility center from 2000 to 2024. Outcomes were compared between patients who underwent surgical repair and those who did not.

Results: The overall live birth and ongoing pregnancy rate after fresh or frozen embryo transfer was 36.9% (48/130). Cesarean section was the most common mode of delivery (61.7%). Pregnancy complications occurred in 38.3% of live births. Live birth and ongoing pregnancy rates did not differ significantly between patients with and without surgical repair (32.6% vs. 39.2%, p = 0.57).

Conclusions: Patients with complex uterine anomalies experience lower live birth rates compared to the center's average and face a high risk of pregnancy complications. Surgical repair of CUA does not significantly improve ART outcomes. Personalized counseling regarding goals and risks is crucial for CUA patients undergoing ART.

Keywords: Assisted reproductive technology; Bicornuate; Complex uterine anomalies; Didelphys; Embryo transfer; Müllerian anomalies; Reproductive surgery; Septum; Unicornuate; Uterine factor infertility.

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Conflict of interest statement

Declarations. Ethics approval: Performed with NYU IRB approval #13–00389. Conflict of interest: The authors declare no competing interests.

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