Reproductive outcomes after surgical correction of congenital obstructive genital tract anomalies: A systematic review and quantitative pooled analysis of published data

Abstract

Congenital obstructive genital tract anomalies are rare but clinically significant causes of menstrual outflow obstruction, endometriosis, and subfertility. Surgical correction aims to restore reproductive potential, yet evidence to guide counselling on fertility and pregnancy outcomes remains fragmented. To synthesise and pool published data on fertility, obstetric, and neonatal outcomes following surgical correction of congenital obstructive anomalies, comparing outcomes across anomaly types to inform individualised counselling. A systematic review was conducted. PubMed, Emcare, CINAHL, and Scopus were searched from inception to May 2025. Studies reporting reproductive outcomes after surgical correction of imperforate hymen, transverse vaginal septum, OHVIRA-spectrum, functional non-communicating uterine horns, or cervicovaginal atresia were included. Data were extracted independently and pooled by anomaly type. Study quality was assessed using Joanna Briggs Institute tools. Ninety-six studies (41 case reports, 41 case series, and 14 retrospective cohorts) were contributed 634 fertility-related events. Infertility rates were low following imperforate hymen (8.0%) and OHVIRA-spectrum anomalies (18.2%), intermediate in functional rudimentary horns (21.2%), and high following transverse vaginal septum (52.6%) and cervicovaginal atresia (55.4%). Among achieved pregnancies, livebirth rates exceeded 80%. Preterm birth occurred in 23.7% of pregnancies and did not differ significantly by anomaly type. Caesarean delivery was frequent (55.9%), particularly after cervicovaginal reconstruction (97.6%). Birthweight was lower following cervicovaginal atresia repair, with higher rates of small-for-gestational-age infants. Gestational hypertensive disorders were associated with co-existing renal agenesis. Reproductive outcomes after surgical correction are generally favourable but vary substantially by anomaly type. These findings support individualised counselling and targeted antenatal surveillance.