Association of concomitant laparoscopy with reproductive outcomes after hysteroscopic septum resection: a longitudinal cohort study

Objective To evaluate whether concomitant laparoscopy during hysteroscopic uterine septum resection is associated with perioperative characteristics and postoperative reproductive outcomes, and to explore the prognostic roles of ESHRE/ESGE classification and septum depth. Methods This single-center retrospective cohort study included 361 patients who underwent hysteroscopic septum resection between 2017 and 2024. Of these, 241 underwent hysteroscopy alone and 120 underwent concomitant laparoscopy. Multivariable logistic regression was used to evaluate postoperative pregnancy, live birth, and miscarriage. Kaplan–Meier analysis and Cox regression were used to assess time to first postoperative pregnancy. Anatomical analyses included U2a/U2b classification and septum depth. Results Postoperative pregnancy rates were 56.8% and 60.8% in the hysteroscopy-only and concomitant-laparoscopy groups, respectively ( P  = 0.469), while live-birth rates were 42.7% and 39.2% ( P  = 0.517). After adjustment for clinical characteristics and ESHRE/ESGE classification, concomitant laparoscopy was not significantly associated with pregnancy (aOR, 1.27; 95% CI, 0.72–2.23) or live birth (aOR, 0.82; 95% CI, 0.47–1.44). Time to first pregnancy was also similar between groups (adjusted hazard ratio, 1.03; 95% CI, 0.75–1.41). U2b morphology, compared with U2a morphology, was not independently associated with pregnancy or live birth. Septum depth was not consistently associated with reproductive outcomes. Conclusion No statistically significant association was detected between concomitant laparoscopy and postoperative pregnancy, live birth, miscarriage, or time to first pregnancy. Laparoscopy should be selected according to pelvic indications, anatomical complexity, and intraoperative safety requirements rather than routinely used to improve reproductive outcomes.