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Septate uteri are the most prevalent congenital uterine anomaly in infertile women. Women with septate uteri have reduced conception rates and increased risks of first-trimester miscarriage, preterm birth and malpresentation at delivery. The prevalence of arcuate uteri in infertile women is almost identical to that of the general/fertile population. Acquired uterine abnormalities described in the chapter include endometrial polyps, intrauterine adhesions, and uterine fibroids. Hysteroscopic myomectomy is now considered the gold standard treatment for submucosal fibroids. Abdominal myomectomy remains the routine approach for most surgeons faced with multiple or large intramural fibroids. For appropriately trained surgeons, a laparoscopic approach may be adopted. Hysteroscopic resection of submucosal fibroids before IVF treatment is recommended. Although subfertile women who have otherwise asymptomatic fibroids may benefit from a myomectomy procedure, this approach should be individualised given the absence of any good randomised controlled trials (RCT) in this area.
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