Surgical treatment of uterine septum to improve reproductive outcomes — resect or not?

Fertile Battle

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VOLUME 116, ISSUE 2, P298-305

Authors:

Ruben Alvero, M.D., Richard O. Burney, M.D., M.Sc., Arian Khorshid, M.D., Brindha Saravanabavanandhan, M.D., Bruce D. Pier, M.D., Kendal F. Rosalik, D.O., William D. Schlaff, M.D. 

Abstract:

CON: The case against uterine septum surgery to improve reproductive outcomes

PRO: The case for uterine septum surgery to improve reproductive outcomes

Read the full text here. 

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. 

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Go to the profile of Pandiyan  Natarajan
about 1 month ago

Uterine anomalies are often incidental findings.

Uterine anomalies remain an unproven cause of Infertility. In the era before ultrasound, CT and MRI it was often an incidental finding at Caesarean section or at Hysterosalpingography or Laparoscopy. Surgical corrections like Unification did not yield gratifying results and often produced more problems than they tried to solve.

Uterine Septum has been blamed for recurrent miscarriage. The evidence for this remains inconclusive. If the septum is avascular, the embryo fails to implant and is lost before the next periods. A thick vascular septum may support implantation but not further growth and may lead to miscarriage.

Uterus being a muscular, expansile organ, and the septum being a compressible structure, septum is unlikely to be the cause of recurrent miscarriage. Most first trimester miscarriage are due to chromosomal & genetic defects & uterine anomalies are often incidental findings.

The onus for providing greater evidence rests with the group advocating surgery. As things stand today, data is inadequate to implicate uterine  anomalies as causative factors in Infertility or recurrent miscarriage. The only reasonably convincing evidence seems to be for Cervical Incompetence, which often leads to Recurrent second trimester painless miscarriage & which may be due to inadvertent cervical dilation & not just uterine anomaly. 

In conclusion, the mere presence of an uterine anomaly is not a pointer to a cause. Often the cause effect remains unestablished. More evidence is need before surgical intervention.

Professor Dr Pandiyan Natarajan,

Professor and Head of the Department of Andrology and Reproductive Medicine,

 Chettinad Super Speciality Hospital,

 Chettinad Academy of Research and Education,

Kelambakkam, Chennai,

Tamil Nadu, India- 603103.