One-step outpatient diagnosis and treatment of European Society of Human Reproduction and Embryology and European Society for Gynaecological Endoscopy class U1 and U2 congenital Müllerian anomalies

Research question: What is the feasibility and efficacy of a one-step outpatient diagnosis and treatment of class U1 and U2 congenital Müllerian anomalies? Design: Prospective, observational, non-pharmacological study conducted at the University of Naples Federico II, Italy. A total of 100 patients (aged 18-45 years) with a diagnosis of dysmorphic or septate uterus (class U1 or U2, according to the ESHRE-ESGE classification), and either a history of long-standing unexplained infertility, recurrent pregnancy loss, or both, were included. Outpatient three-dimensional pre-operative transvaginal ultrasonographic (3D-TVS-US) examination, see-and-treat hysteroscopy and immediate post-surgery 3D-TVS-US were carried out in a single access. Two months later, 3D-TVS-US and outpatient hysteroscopy were carried out again. A comparison with a historical cohort of 100 consecutive patients treated with traditional multi-step approach was also carried out. Results: The excellent feasibility of the one-step approach has been reported: at 2 months' follow-up using 3D-TVS-US, statistically significant (P < 0.001, all) improvement of morphology and volume of the uterine cavity after metroplasty was observed. Only six patients (50% of those with a complete septate uterus) required a second surgical step. This one-step approach has shown the same efficacy but differences in indirect costs and time from first diagnosis (P < 0.001) to the restoration of the uterine cavity, compared with the multi-step approach. Conclusion: The results support the safety, tolerability and efficacy of one-step approach in diagnosing and treating uterine malformation in a single outpatient visit, and is, therefore, a time-saving treatment for a patient looking to achieve pregnancy.