Impact of hysteroscopy on pregnancy outcomes in women with endometriosis-associated infertility undergoing their first frozen-thawed embryo transfer: a retrospective cohort study.

Background: 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. Methods: 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 ( Results: 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%, Conclusion: 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. Trial registration: This is a retrospective cohort study.