HSG Septate Uterus

The impact of a septate uterus is most apparent on miscarriages. Of patients with a uterine septum, 25.5% had a miscarriage, and surgical treatment is most effective, the septate uterus has a major impact on pregnancy retention, with a signficant chance of miscarriage. The impact of a uterine septum on infertility is less clear. Two observational studies of a total of 47 infertile subjects found 53.2 % achieved pregnancy after hysteroscopic resection. No control group or symptomatic untreated subjects with septate uteri were included.The diagnosis is usually found on a HSG during the standard infertility evaluation. Differentiation between the uterine septum and the bicornuate uterus cannot be made definitively with the HSG alone. Further evaluation of the fundal contour must be done with laparascopy, MRI, or US because therapy is very different. The incidence of both complete and partial uterine septi is 33.6%, and it is the most common uterine anomaly.[2] Therapy originally involved wedge resection of the uterine septum, but because of improved surgical equipment and better optics, hysteroscopic resection is fairly routine and technically simple to perform. It is, in fact, an incision rather than an excision of the septum. Pregnancy outcome has been shown to significantly improve. A retrospective cohort study of women undergoing hysteroscopic resection of a uterine septum demonstrated a significant decrease in miscarriage rates from 80% to 17% and an increase in the live birth rates from 18% to 91%. Poor pregnancy outcome is believed, in theory, to be due to the septum's poor implantation environment. The septum provides a scanty vascular supply for the implanting embryo because of disruption by the septum of orderly arranged vessels in the intermediate myometrial layer of the uterus. Implantation of pregnancy that occurs on the uterine septum has a high likelihood of miscarriage. Because of its technical simplicity and significant impact on improving reproductive capacity, I advocate surgical removal of the uterine septum, especially in women diagnosed with recurrent pregnancy losses. Resection may also be considered in infertile couples where no other obvious etiology is apparent.