{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T06:04:26Z","timestamp":1790229866270,"version":"4.1.0"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012165","name":"Key Technologies Research and Development Program","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100012165","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008410","name":"Shanghai Municipal Population and Family Planning Commission","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100008410","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Endometriosis is associated with infertility, adverse assisted reproductive outcomes, and a high prevalence of intrauterine pathologies. Lesions such as endometrial polyps and chronic endometritis may impair endometrial receptivity and embryo implantation. Although hysteroscopy is the gold standard for diagnosing and treating intrauterine lesions, its value before the first frozen embryo transfer (FET) in women with endometriosis-related infertility remains uncertain. This study evaluated whether hysteroscopic surgery before the first FET improved pregnancy outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This single-center retrospective cohort study consecutively enrolled 220 infertile women with endometriosis undergoing their first FET at the Reproductive Medicine Center of the Shanghai Changzheng Hospital between January 1, 2021, and May 31, 2025. Patients were divided into hysteroscopy (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009180) and non-hysteroscopy (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200940) groups according to whether they underwent hysteroscopic evaluation and treatment before FET. Baseline characteristics and pregnancy outcomes were compared. To reduce imbalance, 1:1 propensity score matching (PSM) was performed, primarily based on embryo attributes, yielding 40 patients per group. Primary outcomes were clinical pregnancy and live birth rates.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Both before and after PSM, the hysteroscopy group exhibited higher clinical pregnancy rates than the non-hysteroscopy group [pre-PSM: 65.56% vs. 42.50%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05; post-PSM: 67.50% vs. 42.50%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05]. The live birth rate was also higher in the hysteroscopy group both before and after PSM [pre-PSM: 55.56% vs. 35.00%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05; post-PSM: 55.00% vs. 35.00%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;gt;\u20090.05], although the post-PSM difference did not reach statistical significance. After PSM, the hysteroscopy group also showed a significantly higher biochemical pregnancy rate than the non-hysteroscopy group [75.00% vs. 52.50%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05]. No significant differences were found in miscarriage rate, preterm birth rate, or multiple pregnancy rate between the two groups after matching. Hysteroscopic evaluation revealed a high incidence of intrauterine abnormalities among patients with endometriosis, with lesion rates of 82.78% before PSM and 87.50% after PSM.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Intrauterine lesions, particularly endometrial polyps and chronic endometritis, are highly prevalent in endometriosis-related infertility. Hysteroscopic surgery before the first FET was associated with a higher clinical pregnancy rate. Given the high lesion prevalence, hysteroscopic evaluation before the first FET may be considered in these patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>This is a retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1849361","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T05:43:59Z","timestamp":1790228639000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of hysteroscopy on pregnancy outcomes in women with endometriosis-associated infertility undergoing their first frozen-thawed embryo transfer: a retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Yujie","family":"He","sequence":"first","affiliation":[{"name":"Center for Reproductive Medicine, Shanghai Changzheng 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China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhijun","family":"Jin","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Shanghai Changzheng Hospital","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ningxia","family":"Sun","sequence":"additional","affiliation":[{"name":"Center for Reproductive Medicine, Shanghai Changzheng Hospital","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"9716","DOI":"10.1073\/pnas.1507931112","article-title":"Molecular and preclinical basis to inhibit PGE2 receptors EP2 and EP4 as a novel nonsteroidal therapy for endometriosis","volume":"112","author":"Arosh","year":"2015","journal-title":"Proc Natl Acad Sci U S 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