{"paper_id":"47dee2a8-77ad-4706-865c-87cd456d66e2","body_text":"Fertility Outcomes after Novel or Traditional Transvaginal Niche Repair in Women with Uterine Niche | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Fertility Outcomes after Novel or Traditional Transvaginal Niche Repair in Women with Uterine Niche Jie Xu, wei xia, xiaoya zhao, yang wang, jinglan liu, qunying cai, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9225832/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Introduction: This study investigates whether traditional transvaginal niche repair (Traditional VNR) or a hysteroscopy-assisted novel transvaginal niche repair technique (Novel VNR) provides superior fertility outcomes. Our goal is to inform surgical decision-making for women with a uterine niche who desire conception. Materials and Methods: This prospective cohort study was conducted at the International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University, China (May 2019–May 2023). Women diagnosed with a uterine niche who desired fertility and underwent either Traditional or Novel VNR were included. The primary outcome was live birth rate within 24 months after surgery. Secondary outcomes included clinical pregnancy rate, miscarriage rate, ectopic pregnancy rate, intraoperative and postoperative complications, pregnancy and neonatal outcomes, and postoperative anatomical changes in the niche measured by MRI. Inverse probability treatment weighting (IPTW) was applied to minimize baseline differences and improve comparability between the two groups. Results: A total of 120 women were enrolled (61 Traditional VNR; 59 Novel VNR). After IPTW, all variables achieved balance between the two groups, and subsequent analyses were conducted based on the weighted data. Both procedures significantly increased residual myometrial thickness (both p < 0.001). Kaplan-Meier analysis showed that the cumulative live birth rate at 24 months was significantly higher in the Novel VNR group than in the Traditional VNR group (58.62% vs. 45.76%, p < 0.001). Similarly, the cumulative pregnancy rate was greater in the Novel VNR group (68.97% vs. 57.63%, p < 0.001). The time to conception was shorter following Novel VNR (283.33 ± 31.33 days vs . 447.06 ± 43.68 days, p = 0.003). Multifactorial interaction analysis identified age (≥ 35 years) and secondary infertility as independent factors modulating the benefit of Novel VNR ( p = 0.018 and 0.048, respectively). Conclusions: In women with a uterine niche who wish to conceive, Novel VNR may improve cumulative pregnancy and live birth rates compared with Traditional VNR, while both achieve similar outcomes in anatomical restoration. Furthermore, the Novel VNR, allowed for a notably shorter interval from surgery to pregnancy, may be preferred for women aged ≥ 35 years or those with secondary infertility seeking earlier pregnancy. Niche Traditional transvaginal niche repair Hysteroscopy-assisted novel transvaginal niche repair Live birth Fertility outcome Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 22 Apr, 2026 Editor invited by journal 30 Mar, 2026 Editor assigned by journal 29 Mar, 2026 Submission checks completed at journal 29 Mar, 2026 First submitted to journal 25 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-9225832\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":633454838,\"identity\":\"d62ab3fe-c543-4503-abd1-4d816b50c26a\",\"order_by\":0,\"name\":\"Jie Xu\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Shanghai Jiao Tong University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Jie\",\"middleName\":\"\",\"lastName\":\"Xu\",\"suffix\":\"\"},{\"id\":633454839,\"identity\":\"5a415b8e-636e-450a-b175-f498face7da0\",\"order_by\":1,\"name\":\"wei xia\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Shanghai Jiao Tong University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"wei\",\"middleName\":\"\",\"lastName\":\"xia\",\"suffix\":\"\"},{\"id\":633454840,\"identity\":\"767fc06d-11e8-4c52-8d8e-05c1fb379e80\",\"order_by\":2,\"name\":\"xiaoya zhao\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Shanghai Jiao Tong University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"xiaoya\",\"middleName\":\"\",\"lastName\":\"zhao\",\"suffix\":\"\"},{\"id\":633454841,\"identity\":\"741d881e-0666-47fe-8c5b-01960ad28836\",\"order_by\":3,\"name\":\"yang wang\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Shanghai Jiao Tong University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"yang\",\"middleName\":\"\",\"lastName\":\"wang\",\"suffix\":\"\"},{\"id\":633454842,\"identity\":\"416ccec0-c6c0-435d-8183-c7db30feb040\",\"order_by\":4,\"name\":\"jinglan liu\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Shanghai Jiao Tong University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"jinglan\",\"middleName\":\"\",\"lastName\":\"liu\",\"suffix\":\"\"},{\"id\":633454843,\"identity\":\"f8046f2a-bf11-4d7f-8cec-5bec74a787f6\",\"order_by\":5,\"name\":\"qunying cai\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"International Peace Maternity \\u0026 Child Health Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"qunying\",\"middleName\":\"\",\"lastName\":\"cai\",\"suffix\":\"\"},{\"id\":633454844,\"identity\":\"e99b21b1-450c-4328-aa4a-06198f17da64\",\"order_by\":6,\"name\":\"qian zhu\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Shanghai Jiao Tong University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"qian\",\"middleName\":\"\",\"lastName\":\"zhu\",\"suffix\":\"\"},{\"id\":633454845,\"identity\":\"8de3da27-aedd-4ea1-8265-81ecdac30049\",\"order_by\":7,\"name\":\"jian zhang\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyElEQVRIiWNgGAWjYBACNiBmZqiQ4LE/3tj44APxWs7YyDCcOdxsOINYm5gZ29JsGG6kt0lzEKOcT7o78XMB22EexpkPG6QZGOzkdBsIOUzm7GbpGTyHeZilExuMCxiSjc0OENIikbuNmUfiMA8bUEvyDIYDiduI02JwmIdH8mDDYR7itSSk8UhIMDY2E6cF5BeeAzY8BjyJzYwzDIjwi/zs3o2fef9J2BuwH3/+40OFnRxBLQwSKDwDQsoxtYyCUTAKRsEowAIAVlw8zhIU6wIAAAAASUVORK5CYII=\",\"orcid\":\"\",\"institution\":\"Shanghai Jiao Tong University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"jian\",\"middleName\":\"\",\"lastName\":\"zhang\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2026-03-25 17:08:58\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-9225832/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-9225832/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":108492826,\"identity\":\"e4ff0733-112b-4cf0-b0e0-9a2432d2bd1f\",\"added_by\":\"auto\",\"created_at\":\"2026-05-05 09:58:44\",\"extension\":\"pdf\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1705651,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9225832/v1_covered_d8623028-e7c8-4c35-81d4-80a515696806.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Fertility Outcomes after Novel or Traditional Transvaginal Niche Repair in Women with Uterine Niche\",\"fulltext\":[],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":false,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":true,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":true,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-pregnancy-and-childbirth\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"prch\",\"sideBox\":\"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/prch/default.aspx\",\"title\":\"BMC Pregnancy and Childbirth\",\"twitterHandle\":\"@BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Niche, Traditional transvaginal niche repair, Hysteroscopy-assisted novel transvaginal niche repair, Live birth, Fertility outcome\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-9225832/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-9225832/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003eIntroduction:\\u003c/p\\u003e \\u003cp\\u003eThis study investigates whether traditional transvaginal niche repair (Traditional VNR) or a hysteroscopy-assisted novel transvaginal niche repair technique (Novel VNR) provides superior fertility outcomes. Our goal is to inform surgical decision-making for women with a uterine niche who desire conception.\\u003c/p\\u003e \\u003cp\\u003eMaterials and Methods:\\u003c/p\\u003e \\u003cp\\u003eThis prospective cohort study was conducted at the International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University, China (May 2019\\u0026ndash;May 2023).\\u003c/p\\u003e \\u003cp\\u003eWomen diagnosed with a uterine niche who desired fertility and underwent either Traditional or Novel VNR were included. The primary outcome was live birth rate within 24 months after surgery. Secondary outcomes included clinical pregnancy rate, miscarriage rate, ectopic pregnancy rate, intraoperative and postoperative complications, pregnancy and neonatal outcomes, and postoperative anatomical changes in the niche measured by MRI. Inverse probability treatment weighting (IPTW) was applied to minimize baseline differences and improve comparability between the two groups.\\u003c/p\\u003e \\u003cp\\u003eResults:\\u003c/p\\u003e \\u003cp\\u003eA total of 120 women were enrolled (61 Traditional VNR; 59 Novel VNR). After IPTW, all variables achieved balance between the two groups, and subsequent analyses were conducted based on the weighted data. Both procedures significantly increased residual myometrial thickness (both \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). Kaplan-Meier analysis showed that the cumulative live birth rate at 24 months was significantly higher in the Novel VNR group than in the Traditional VNR group (58.62% vs. 45.76%, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). Similarly, the cumulative pregnancy rate was greater in the Novel VNR group (68.97% vs. 57.63%, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). The time to conception was shorter following Novel VNR (283.33\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;31.33 days \\u003cem\\u003evs\\u003c/em\\u003e. 447.06\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;43.68 days, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.003). Multifactorial interaction analysis identified age (\\u0026ge;\\u0026thinsp;35 years) and secondary infertility as independent factors modulating the benefit of Novel VNR (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.018 and 0.048, respectively).\\u003c/p\\u003e \\u003cp\\u003eConclusions:\\u003c/p\\u003e \\u003cp\\u003eIn women with a uterine niche who wish to conceive, Novel VNR may improve cumulative pregnancy and live birth rates compared with Traditional VNR, while both achieve similar outcomes in anatomical restoration. Furthermore, the Novel VNR, allowed for a notably shorter interval from surgery to pregnancy, may be preferred for women aged\\u0026thinsp;\\u0026ge;\\u0026thinsp;35 years or those with secondary infertility seeking earlier pregnancy.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Fertility Outcomes after Novel or Traditional Transvaginal Niche Repair in Women with Uterine Niche\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-05-04 10:13:59\",\"doi\":\"10.21203/rs.3.rs-9225832/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2026-04-22T20:18:09+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2026-03-30T09:25:52+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2026-03-30T02:34:47+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2026-03-30T02:34:29+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Pregnancy and Childbirth\",\"date\":\"2026-03-25T17:04:42+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-pregnancy-and-childbirth\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"prch\",\"sideBox\":\"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/prch/default.aspx\",\"title\":\"BMC Pregnancy and Childbirth\",\"twitterHandle\":\"@BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"e5902302-4d80-457e-93ce-346f91bef7b9\",\"owner\":[],\"postedDate\":\"May 4th, 2026\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-05-04T10:13:59+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-05-04 10:13:59\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-9225832\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-9225832\",\"identity\":\"rs-9225832\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}