Uterine Septum Removal Found to Improve Fertility and Pregnancy Outcome

A uterine septum is a congenital uterine anomaly that is, in essence, an embryologic remnant within the uterus that did not resorb away as it does in most women. According to a systematic review in 2011, of women in the general population, 2.3% have a uterine septum and there is a similar percentage of 3% in the subfertile population who have a uterine septum. Among women with recurrent pregnancy loss (RPL), 15% have a uterine septum.

Adverse effects of a uterine septum include subfertility, sporadic or recurrent pregnancy loss in the 1st or 2nd trimester, preterm labor and delivery, breech or transverse presentation of a fetus, and intrauterine growth restriction.

A uterine septum can be suspected by transvaginal sonogram (TVS) or hysterosalpingogram (HSG); however, these tests are not accurate enough to differentiate between bicornuate (heart-shaped), acruate (a variant of normal), or septate uterus. More accurate modalities such as pelvic Magnetic Resonance Imaging (MRI) or 3D sonography have been shown to be more reliable in terms of diagnosing a uterine septum.

The day surgery combination of hysteroscopy and laparoscopy is a gold standard for diagnosis, at which time the septum can be removed through the hysteroscope. In addition, since the presence of a uterine septum is a risk factor for the presence of endometriosis, the laparoscopic surgery provides an opportunity to diagnose and treat endometriosis in case the patient does have endometriosis as well. Intraoperative intrauterine stent placement and post-operative hormone regimens are aimed at minimizing postoperative intrauterine scar formation after septum removal. Miscarriage rates of greater than 60% prior to septum removal can be significantly reduced after septum removal based on existing data.