Original conceptual illustration, not patient anatomy, a procedural diagram or study data.
Should laparoscopy be added when a uterine septum is removed hysteroscopically? This question can mean two different things. One is whether the additional procedure improves the chance of pregnancy or live birth. The other is whether it helps investigate another pelvic problem or makes a particular operation safer. A study published in Frontiers in Reproductive Health on 18 September 2026 helps separate these questions. It does not justify cancelling an individually recommended procedure on the basis of a headline.
Its main finding is cautious: the researchers detected no statistically significant association between concomitant laparoscopy and the primary reproductive outcomes in their cohort. That is not proof that the approaches are equivalent, and it does not mean that laparoscopy has no role for any patient.
What was actually compared?
Lu and colleagues retrospectively reviewed patients who underwent hysteroscopic septum resection at a single centre in Chengdu between 2017 and 2024. Every woman in the final comparison had the septum resected. Some also underwent laparoscopy, used to view the outside of the uterus, monitor the extent of the incision and examine the pelvis.
The researchers initially identified 512 patients and included 361 in the final analysis. Exclusions included not undergoing resection, incomplete perioperative information, unavailable follow-up and other concomitant reproductive procedures. Hysteroscopy alone was performed in 241 women; 120 underwent hysteroscopy with laparoscopy. Median follow-up was 40 and 39 months, respectively.
This design matters. The study did not compare septum resection with no surgery. It therefore cannot tell us whether removing a septum improves the chance of a child for every woman diagnosed with one. Its question is narrower: what was associated with adding laparoscopy among women already undergoing hysteroscopic resection?
The outcomes and their denominators
At least one postoperative pregnancy occurred in 137 of 241 women after hysteroscopy alone, or 56.8%, compared with 73 of 120 after the combined approach, or 60.8%. At least one live birth occurred in 103 of 241 women, or 42.7%, and 47 of 120, or 39.2%, respectively. Neither difference was statistically significant.
These percentages describe women in each group over follow-up. They are not success rates per embryo transfer, per treatment cycle or per pregnancy. “At least one live birth” is also different from the total number of babies born. Keeping the denominator visible prevents a result from being mistaken for an individual treatment prediction.
The investigators adjusted for recorded characteristics including age, body mass index, reproductive history, infertility, surgical indication, calendar year, follow-up duration and septum classification. The main adjusted models likewise found no significant association between additional laparoscopy and pregnancy or overall live birth. Analyses of time to the first pregnancy and additional sensitivity analyses broadly supported the same picture.
In the model incorporating ESHRE/ESGE classification, the adjusted odds ratio was 0.82 for live birth (95% CI 0.47–1.44) and 1.27 for pregnancy (0.72–2.23). These are odds ratios (OR), not relative risks or direct changes in probability.
Adjustment makes an observational comparison more informative. It does not turn it into a randomised trial.
Why “not statistically significant” does not mean “the same”
A study may fail to detect a difference because there is little difference, because its estimates are imprecise or because features of the groups obscure a relationship. A confidence interval describes a range of results compatible with an estimate; a non-significant result does not demonstrate that the true difference is exactly zero. Establishing equivalence requires a different, explicitly justified question and analysis.
Here, clinicians chose whether to add laparoscopy. Their decision reflected anatomy, suspected pelvic abnormalities and intraoperative safety considerations. The women receiving the additional procedure may therefore have differed from those who did not in ways that were not fully recorded. This is confounding by indication: the reason for choosing a treatment can also be related to the outcome.
Information about endometriosis, adhesions, tubal status or anatomical complexity was not complete enough to remove every potential difference. Some postoperative management also differed between groups. Consequently, the study should not be converted into a simple ranking of a “better” and “worse” operation.
Safety is a separate question
Only three complications were recorded across the cohort. That is too few to establish equivalent perioperative safety. The absence of a detected difference cannot exclude a useful safety-monitoring role for laparoscopy in patients with complex anatomy or a higher surgical risk.
This distinction is important during counselling. A procedure might be proposed to clarify anatomy or monitor an incision, rather than because it is expected to increase pregnancy rates directly. Evidence about one objective does not automatically settle the other. A patient needs to know what the proposed intervention is intended to achieve in her particular case.
The study also cannot establish the biological mechanism of reproductive outcomes after resection. There was no nonsurgical comparison group and no assessment of local markers of endometrial receptivity. It would be inappropriate to claim that these results prove a specific regenerative or implantation-enhancing effect of surgery.
Missing measurements and exploratory findings
Septum depth could not be reliably recovered from every record. Its availability differed between the surgical groups and was associated with reproductive outcomes. Analyses limited to women with complete measurements therefore describe a selected subset, not necessarily the whole cohort.
One should not extract a single significant estimate from that subset and claim that laparoscopy causes poorer fertility outcomes. Selection related to missing data can influence an association. The authors explicitly caution about this issue, and the primary comparison should not be replaced by a more dramatic isolated subgroup finding.
The researchers also explored septum classification and depth. Some exploratory associations weakened after correction for multiple testing. Depth thresholds derived within this sample have not been externally validated for clinical decision-making. They should not become an online calculator of a patient’s chance of a child or a stand-alone rule for offering surgery.
Questions that can improve a consultation
The practical lesson is to make the purpose of the additional procedure explicit. “Doing more” is not a sufficient explanation. Equally, “this study did not show better fertility outcomes” is not a reason to ignore a separate diagnostic or safety indication.
Questions worth discussing include:
- What specific issue would additional laparoscopy address in my case?
- Is the aim to improve reproductive outcomes, clarify anatomy, investigate another condition or support surgical safety?
- How would the information obtained change the management plan?
- What are the individual risks, possible benefits and relevant alternatives?
These are suggested conversation prompts, not a validated checklist for deciding who should have surgery. An answer requires the patient’s history, imaging findings and proposed procedure. The findings should inform an assessment, not replace it.
The conclusion that the evidence supports
This retrospective cohort does not establish that routinely adding laparoscopy solely to improve reproductive outcomes provides that benefit. It also does not invalidate specific indications for pelvic assessment or intraoperative monitoring. Its single-centre design, clinician-selected treatment and incomplete information limit causal interpretation and generalisability.
For patients and clinicians, the useful conclusion is neither “always add laparoscopy” nor “never add it.” An additional procedure needs a clearly stated purpose and an individual explanation. The study helps frame that discussion while leaving important questions for prospective, standardised research.
Source and transparency
Lu Y, Su M, Yuan Q, He L. Association of concomitant laparoscopy with reproductive outcomes after hysteroscopic septum resection: a longitudinal cohort study. Frontiers in Reproductive Health, 18 September 2026. Full article and DOI.
The authors reported institutional/public and fellowship funding and declared no commercial or financial relationships constituting a potential conflict of interest. The article is available under CC BY. This educational explanation is based on the full text; it is not individual medical advice or an independent audit of patient-level data.