Objective To evaluate the reproductive performance after hysteroscopic metroplasty performed for hypoplastic uterus.

Design Crossover study (15 patients) and descriptive analysis (14 patients).

Setting Tertiary care university hospital.

Population Twenty-nine women (mean age: 31.4 years; range: 27–38.5 years) with a hypoplastic malformed uterus and a history of primary infertility and/or recurrent abortion and/or preterm delivery were included in this study. Fourteen women suffered from primary infertility and 15 women had previous pregnancies. Twenty-three women had been exposed to diethylstilboestrol in utero.

Methods Women underwent hysteroscopic metroplasty between January 1996 and May 1999.

Main outcome measures Rate of pregnancies and live births, anatomical results.

Results The mean follow up was 40 months (range: 13–67 months). Twenty-one women (72.4%) experienced 30 pregnancies. Thirteen women gave birth to 16 live infants. At the time of the follow up, four women were pregnant in the second trimester. Compared with previous pregnancies, the rate of deliveries increased from 3.8% to 63.2%. No complications occurred during metroplasty. The hysteroscopic anatomical results were good in all cases.

Conclusions Our results suggest that hysteroscopic metroplasty, with its simplicity and minimal post-operative sequelae, seems to be an operation of choice in women with a hypoplastic malformed uterus and a history of severe infertility and/or recurrent pregnancy loss.