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13 - Operative Hysteroscopy for Uterine Septum

from PART II - INFERTILITY EVALUATION AND TREATMENT

Published online by Cambridge University Press:  04 August 2010

Botros R. M. B. Rizk
Affiliation:
University of South Alabama
Juan A. Garcia-Velasco
Affiliation:
Rey Juan Carlos University School of Medicine,
Hassan N. Sallam
Affiliation:
University of Alexandria School of Medicine
Antonis Makrigiannakis
Affiliation:
University of Crete
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Summary

INTRODUCTION

This chapter presents a comprehensive review of the reproductive problems that could be associated with uterine septum. We believe that this topic has significant amount of controversy regarding its diagnosis and treatment due to the paucity of comprehensive evidence-based data on female congenital anomalies, in particular uterine septum. This resulted in the lack of a consensus on how the presence of a uterine septum might affect female reproduction. We will discuss the available data aiming at providing a balanced appraisal that can help the reproductive medicine specialists to better counsel patients about their reproductive potentials when a uterine septum is discovered.

Development

During the embryo development, the uterus forms from fusion of the paramesonephric ducts (Müllerian ducts), which join in the midline around the “tenth” week of gestation to form the unified body of the uterus. In the absence of Müllerian-inhibiting substance, the Müllerian ducts develop into the uterus and fallopian tubes (and possibly the upper part of the vagina) (1–4). It is interesting to note that the Müllerian ducts can develop into two distinct types of tissue: the smooth muscle tissue of the uterus and the fibrous tissue of the cervix (3). We believe this explains the various structural subtypes of uterine septum when it comes to different proportion of fibrous and muscle structure, that is, some uterine septa may contain more fibrous (cervical differentiation) component, while others contain more muscular (uterine differentiation) component.

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Publisher: Cambridge University Press
Print publication year: 2008

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