Skip to main content

Advertisement

Log in

Hysteroscopic metroplasty: reproductive outcome in relation to septum size

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Our aim is to determine if the reproductive performance after hysteroscopic resection of partial uterine septum was related to septum size.

Methods

The retrospective and comparative cohort study was conducted in a University-affiliated Hospital. A cohort of 112 non-parous patients was treated for a partial uterine septum. The septum size was evaluated by hysteroscopy and transvaginal 3-dimensional ultrasound. The patients were stratified into two groups: group 1 (85 women) with small partial uterine septum (≤2.5 cm) and group 2 (27 women) with large partial uterine septum (>2.5 cm). They were also divided according to their obstetrics history: 39 infertile women and 73 aborters. All underwent hysteroscopic metroplasty with a resectoscope with an equatorial semicircular loop cutting 0° with monopolar energy. All septa were almost completely removed and no complications occurred.

Results

The two groups of patients with small (group 1) and large (group 2) partial uterine septum were compared in the terms of reproductive history and performance before and after surgery. In the overall population the reproductive performance after surgery is greatly improved. No significant differences in reproductive performance were evident between patients with small and large partial uterine septa. The reproductive performance was also similar in infertile patients and in aborters.

Conclusions

This study demonstrates that hysteroscopic metroplasty in cases of partial uterine septum and infertility significantly improves the reproductive performance irrespectively of septum size and that reproductive performance is independent from previous obstetrics history.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Rock JA, Jones HWJ (1977) The clinical management of the double uterus. Fertil Steril 12:798–806

    Google Scholar 

  2. Raga F, Bauset C, Remohi J, Bonilla-Musoles F, Simón C, Pellicer A (1997) Reproductive impact of congenital Müllerian anomalies. Hum Reprod 12:2277–2281

    Article  CAS  PubMed  Google Scholar 

  3. Heinonen PK, Saarkisoski S, Pystynen P (1982) Reproductive performance of women with uterine anomalies. Acta Obstet Gynecol Scand 61:157–162

    Article  CAS  PubMed  Google Scholar 

  4. Grimbizis GF, Camus M, Tarlatzis BC, Bontis JN, Devroey P (2001) Clinical implications of uterine malformations and hysteroscopic treatment results. Hum Reprod Update 7:161–174

    Article  CAS  PubMed  Google Scholar 

  5. Saravelos SH, Cocksedge KA, Li T-C (2008) Prevalence and diagnosis of congenital uterine anomalies in women with reproductive failure: a critical appraisal. Hum Reprod Update 14:415–429

    Article  PubMed  Google Scholar 

  6. Ghi T, Casadio P, Kuleva M, Perrone AM, Savelli L, Giunchi S et al (2009) Accuracy of three-dimensional ultrasound in diagnosis and classification of congenital uterine anomalies. Fertil Steril 92:808–813

    Article  PubMed  Google Scholar 

  7. The American Fertility Society (1988) The American Fertility Society Classifications of Adnexal Adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Müllerian anomalies and intrauterine adhesions. Fertil Steril 49:944–955

    Google Scholar 

  8. Siegler AM, Valle RF (1988) Therapeutic hysteroscopic procedures. Fertil Steril 50:685–701

    CAS  PubMed  Google Scholar 

  9. Valle RF (1996) Hysteroscopic treatment of partial and complete uterine septum. Int J Fertil Menop S 41:310–315

    CAS  Google Scholar 

  10. Gubbini G, Di Spiezio Sardo A, Nascetti D, Marra E, Spinelli M, Greco E et al (2009) New outpatient subclassification system for American fertility society classes V and VI uterine anomalies. J Minimal Invasive Ginecol 16:554–561

    Article  Google Scholar 

  11. Merz E, Miric-Tesanic D, Bahlmann F, Weber G, Wellek S (1996) Sonographic size of uterus and ovaries in pre- and postmenopausal women. Ultrasound Obstet Gynecol 7:38–42

    Article  CAS  PubMed  Google Scholar 

  12. Paradisi R, Barzanti R, Natali F, Battaglia C, Venturoli S (2011) Hysteroscopic metroplasty in a large population of women with septate uterus. J Minim Invasive Gynecol 18:449–454

    Article  PubMed  Google Scholar 

  13. Venturoli S, Colombo FM, Vianello F, Seracchioli R, Possati G, Paradisi R (2002) A study of hysteroscopic metroplasty in 141 women with septate uterus. Arch Gynecol Obstet 266:157–159

    Article  CAS  PubMed  Google Scholar 

  14. Valle RF, Sciarra JJ (1986) Hysteroscopic treatment of the septate uterus. Obstet Gynecol 67:253–257

    Article  CAS  PubMed  Google Scholar 

  15. Grimbizis G, Camus M, Clasen K, Tournaye H, De Munck L, Devroey P (1998) Hysteroscopic septum resection in patients with recurrent abortion or infertility. Hum Reprod 13:1188–1193

    Article  CAS  PubMed  Google Scholar 

  16. Porcu G, Cravello L, D’Ercole C, Cohen D, Roger V, de Montgolfier R et al (2000) Hysteroscopic metroplasty for septate uterus and repetitive abortions: reproductive outcome. Eur J Obstet Gynecol Reprod Biol 88:81–84

    Article  CAS  PubMed  Google Scholar 

  17. Bakas P, Gregoriou O, Hassiakos D, Liapis A, Creatsas M, Konidaris S (2012) Hysteroscopic resection of uterine septum and reproductive outcome in women with unexplained infertility. Gynecol Obstet Invest 73:321–325

    Article  PubMed  Google Scholar 

  18. Mucowski SJ, Herndon CN, Rosen MP (2010) The arcuate uterine anomaly: a critical appraisal of its diagnostic and clinical relevance. Obstet Gynecol Surv 65:449–454

    Article  PubMed  Google Scholar 

  19. Fedele L, Bianchi S, Marchini M, Mezzopane M, Di Nola G, Tozzi L (1996) Residual uterine septum of less than 1 cm after hysteroscopic metroplasty does not impair reproductive outcome. Hum Reprod 11:727–729

    Article  CAS  PubMed  Google Scholar 

  20. Kormanyos Z, Molnar BG, Pal A (2006) Removal of a residual portion of a uterine septum in women of advanced reproductive age: obstetric outcome. Hum Reprod 21:1047–1051

    Article  PubMed  Google Scholar 

  21. Mollo A, De Franciscis P, Colacurci N, Cobellis L, Perino A, Venezia R et al (2009) Hysteroscopic resection of the septum improves the pregnancy rate of women with unexplained infertility: a prospective controlled trial. Fertil Steril 91:2628–2631

    Article  PubMed  Google Scholar 

  22. Nouri K, Ott J, Huber JC, Fisher EM, Stögbauer L, Tempfer CB (2010) Reproductive outcome after hysteroscopic septoplasty in patients with septate uterus—a retrospective cohort and systematic review of the literature. Reprod Biol Endocrinol 8:52

    Article  PubMed Central  PubMed  Google Scholar 

  23. Tonguc EA, Var T, Batioglu S (2011) Hysteroscopic metroplasty in patients with a uterine septum and otherwise unexplained infertility. Int J Gynecol Obstet 113:128–130

    Article  Google Scholar 

  24. Bosteels J, Weyers S, Puttemans P, Panayotidis C, Van Herendael B, Gomel V et al (2010) The effectiveness of hysteroscopy in improving pregnancy rates in subfertile women without other gynaecological symptoms: a systematic review. Hum Reprod Update 16:1–11

    Article  PubMed  Google Scholar 

  25. Dabirashrafi H, Bahadori M, Mohammad K, Alavi M, Moghadami-Tabrizi N, Zandinejad K et al (1995) Septate uterus: new idea on the histologic features of the septum in this abnormal uterus. Am J Obstet Gynecol 172:105–107

    Article  CAS  PubMed  Google Scholar 

  26. Blum M (1978) Comparative study of serum CAP activity during pregnancy in malformed and normal uterus. J Perinat Med 6:165–168

    Article  CAS  PubMed  Google Scholar 

  27. Sparac V, Kupesic S, Ilijas M, Zodan T, Kurjak A (2001) Histologic architecture and vascularisation of hysteroscopically excised intrauterine septa. J Am Assoc Gynecol Laparosc 8:111–116

    Article  CAS  PubMed  Google Scholar 

  28. Fedele L, Bianchi S, Marchini M, Franchi D, Tozzi L, Dorta M (1996) Ultrastructural aspects of endometrium in infertile women with septate uterus. Fertil Steril 65:750–752

    CAS  PubMed  Google Scholar 

  29. Golan A, Langer R, Neuman M, Wexler S, Segev E, David MP (1992) Obstetric outcome in women with congenital uterine malformations. J Reprod Med 37:233–236

    CAS  PubMed  Google Scholar 

  30. Tomaževič T, Ban-Frangež H, Ribič-Pucelj M, Premru-Sršen T, Verdenik I (2007) Small uterine septum is an important variable risk for preterm birth. Eur J Obstet Gynecol Reprod Biol 135:154–157

    Article  PubMed  Google Scholar 

  31. Grimbizis GF, Gordts S, Di Spiezio Sardo A, Brucker S, De Angelis C, Gergolet M et al (2013) The ESHRE/EGSE consensus on the classification of female genital tract congenital anomalies. Hum Reprod 28:2032–2044

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

Special thanks to Drs. Maria Teresa Iammarino and Alessandro Paccapelo, Statisticians of the Department of Clinical Medicine, University of Bologna, Bologna, Italy for their assistance in statistical analysis.

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Roberto Paradisi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Paradisi, R., Barzanti, R., Natali, F. et al. Hysteroscopic metroplasty: reproductive outcome in relation to septum size. Arch Gynecol Obstet 289, 671–676 (2014). https://doi.org/10.1007/s00404-013-3003-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-013-3003-9

Keywords

Navigation