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The classification of uterine anomalies divides the uterine septum into complete (septate) or partial (subseptate) groups according, respectively, to whether the septum approaches the internal os or does not. The complete septum that divides both the uterine cavity and the endocervical canal may be associated with a longitudinal vaginal septum. Although surgery (hysteroscopy, alone or with laparoscopy), constitutes the gold standard for the diagnosis of uterine septum, various imaging tools including hysterosalpingography (HSG), ultrasonography, and magnetic resonance imaging (MRI) have great value in the diagnosis, with high levels of accuracy. In infertility patients it is believed that incidentally discovered uterine septum and even arcuate uterus should be corrected hysteroscopically prior to any infertility treatment to enhance reproductive outcome. While the hysteroscopic approach for surgical resection of uterine septum is safe and effective, the choice of surgical technique (using sharp scissors or electrocautery) is an operator preference.
Polycystic ovary syndrome (PCOS), characterized by ovulatory dysfunction and hyperandrogenism, is the most common cause of infertility in women. Ovarian function in infertile women with PCOS is characterized by disordered folliculogenesis and abnormal steroidogenesis. Clomiphene citrate is then the first-line active medical treatment. There has been a long-standing debate regarding the gonadotrophin of choice for ovarian stimulation in women with PCOS. Recent meta-analysis assessing the effect of (gonadotropin-releasing hormone) GnRH antagonists in assisted reproduction technologies (ART) concluded that GnRH antagonist protocol is a short and simple protocol with good clinical outcome. Metformin appears to improve reproductive function in some women with PCOS. More research is necessary to define the optimal place of IVF, the best ovulation induction protocol, the choice of gonadotropin, the use of GnRH analog, antagonist, and the impact of coadministration of metformin for anovulatory infertile PCOS patients subjected to IVF.
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