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23A - All Infertile Women with a Uterine Septum Should Have a Surgical Removal

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from Section III - The Best Policy

Published online by Cambridge University Press:  25 November 2021

Roy Homburg
Affiliation:
Homerton University Hospital, London
Adam H. Balen
Affiliation:
Leeds Centre for Reproductive Medicine
Robert F. Casper
Affiliation:
Mount Sinai Hospital, Toronto
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Summary

A uterine septum is a congenital abnormality that has been associated with poor reproductive outcome that can be readily corrected by hysteroscopic surgery. For this debate article we argue that all women with a uterine septum should have hysteroscopic septal resection before undergoing any fertility treatment. A uterine septum is a congenital uterine anomaly arising from the failure of canalisation of the uterus during embryological development. Uterine septa are more prevalent in women with a history of pregnancy loss, but not infertility alone, and are associated with an increased risk of first and second trimester miscarriage and preterm birth [1,2]. Diagnosis is straightforward with three-dimensional ultrasound. Adequate assessment of uterine morphology requires concurrent imaging of the external and internal controls of the uterus. Three-dimensional ultrasound facilitates such views and is safer and more acceptable to women than surgical assessment with hysteroscopy and laparoscopy which are required to see the internal and external fundal contours.

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Publisher: Cambridge University Press
Print publication year: 2021

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References

Chan, YY, Jayaprakasan, K, Zamora, J, Thornton, JG, Raine-Fenning, N, Coomarasamy, A. The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systematic review. Hum Reprod Update. [Internet] 2011;17(6):761–71. Available from: www.ncbi.nlm.nih.gov/pubmed/21705770.CrossRefGoogle ScholarPubMed
Chan, YY, Jayaprakasan, K, Tan, A, Thornton, JG, Coomarasamy, A, Raine-Fenning, NJ. Reproductive outcomes in women with congenital uterine anomalies: a systematic review. Ultrasound Obs Gynecol. [Internet] 2011;38(4):371–82. Available from: www.ncbi.nlm.nih.gov/pubmed/21830244.Google ScholarPubMed
Valle, RF, Ekpo, GE. Hysteroscopic metroplasty for the septate uterus: review and meta-analysis. J Minim Invasive Gynecol. [Internet] 2013;20(1):2242. Available from: www.ncbi.nlm.nih.gov/pubmed/23312243.CrossRefGoogle ScholarPubMed

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