Open Journal of Obstetrics and Gynecology, 2012, 2, 262-264 OJOG
http://dx.doi.org/10.4236/ojog.2012.23054 Published Online September 2012 (http://www.SciRP.org/journal/ojog/)
Hysteroscopic septum resection in patients with recurrent
abortions and infertility
Davut Güven, Kadir Bakay*, Serkan Kuruoğlu, Ayşe Özdemir
Department of Obstetrics and Gynecology, 19 Mayis University School of Medicine, Samsun, Turkey
Received 15 May 2012; revised 20 June 2012; accepted 6 July 2012
ABSTRACT
Objective: The aim of this study was to assess the
achievement of pregnancy as well as the reproductive
outcome after hysteroscopic septum resection in wo-
men with recurrent abortions or infertility. Design:
retrospective, clinical trial. Setting: University hos-
pitals. Patient(s): Fourty women with a diagnosis of
uterine septum who had a history of pregnancy loss
or infertility. They were randomized into two groups.
Group I includes 18 infertile women and Group II
includes 22 recurrent miscarriage women. Interven-
tion(s): Hysteroscopic metroplasty was performed on
all patients in both groups. Result(s): 40 patients who
were diagnosed with a partial septate uteri had hys-
teroscopic septum resection and were divided into
two groups: Group I (18 patients) presented with
infertility and Group II (22 patients) with recurrent
abortions. The mean post-operative follow up period
was 24 months. Group I, 12 patients (66.6%) and
Group II, 17 patients (77.2%) achieved pregnancy,
with respective abortion rates of 2 (11.1%) and 4
(18.1%). Conclusion(s): Using hysteroscopy to per-
form metroplasty on septate uteri makes the pro-
cedure safer, easier, and less complicated. This pro-
cedure is recommended for all cases diagnosed with
an uterine septum.
Keywords: Hysteroscopy; Infertility; Recurrent
Aborti on ; Se ptum Re s ection
1. INTRODUCTION
Uterine Septum as an anomaly may be associated with
poor reproductive performance, including higher inci-
dence of abortion, premature delivery, and infertility.
Although the septum is usually restricted to the uterine
corpus, it may extend through the cervix and vagina. In
such cases visual inspection and pelvic examination
shows a complete longitudinal vaginal septum and cer-
vical duplication that is usually misdiagnosed as uterus
didelphys [1].
The main and absolute indication for the treatment of
patients with septate uteri is a reproductive history of
recurrent abortions or fetal loss. However, a group of
patients with septate uteri may present with infertility,
primary or secondary, and this will be discovered only
during the infertility work-up. Minimally invasive pro-
cedures have many benefits compared with traditional
procedures, including lower costs, shorter hospital stays,
and shorter recovery time. The development of operative
hysteroscopy has simplified the treatment of these mal-
formations, which were previously treated by laparotomy.
Surgical hysteroscopy is no longer performed with rigid
scissors attached to a channel. Today, these metroplasties
use monopolar instruments.
Bipolar instruments, which have been introduced more
recently, seem to be as effective and result in less mor-
bidity [2]. Hysteroscopic metroplasty in this group is
applied mainly as a prophylactic procedure to prevent
spontaneous abortions and complications during labour
[3].
2. MATERIAL AND METHODS
Fourty subfertile patients who underwent hysteroscopic
septum resection at the center for Department Obstetrics
and Gynecology of 19 Mayis University School of Me-
dicine between January 2005 and March 2009 were in-
cluded in the study. The diagnosis of uterin septum was
accomplished by performing transvaginal ultrasonogra-
phy after hysterosalpingography in all patients.
The hysteroscopic operation of the uterine septum was
scheduled in the early proliferative phase. The operation
was performed under general anaesthesia and laparo-
scopic control was not performed during operation.
Inclusion criteria were determined locally and con-
sisted of all patients with a complete or partial septate
uterus who had a history of at least one first-trimester or
second-trimester pregnancy loss and who had undergone
preoperative evaluation to exclude other causes of re-
*Corresponding author.

D. Güven et al. / Open Journal of Obstetrics and Gynecology 2 (2012) 262-264 263
productive failure. Two or more miscarriages in the last 2
years, premature delivery, no endocrine or other disor-
ders as in the previous group.
The cervix was dilated up to 9 mm and the uterine
cavity was distended with a non-conductive solution.
Fluid balance was reco rded in all patients. When a partial
uterin septum was present, resection was initiated at its
lower margin, after the tubal ostia had been visualized.
The resection continued upwards and was considered
complete when the area between the tubal ostia was
converted to a line. The hysteroscopic septum resection
was performed under general anaesthesia. Postopera-
tively, a second-look hysteroscopy and hysterosalpingo-
graphy was not deemed necessary instead patients were
reevaluated by transvaginal ultrasonography 2 months
after the operation.
3. RESULTS
The main reproductive history data are shown (before
septum resection) in Table 1. In the infertile Group I, 12
(66.6%) achieved pregnancy. 2 of the 12 pregnancies
(11.1%) ended in miscarriage; 1 (5.5%) ended as pre-
term delivery; 9 of the 18 pregnancies (50%) ended as
term deliveries, 6 (33.3%) of the infertile patients were
unable to become pregnant. In the recurrent abortion
Group II, 17 patients (77.2%) achieved pregnancy. 4
(18.1%) ended in miscarriage; 2 pregnancies (9%) ended
as pre-term delivery; 11 (64.7%) pregnancies ended as
term deliveries. 5 (22.7%) out of 22 patients did not
achieve pregnancy after hysteroscopic septum resection
(Table 2).
There were no operative complications such as uterine
perforation, hyponatremia, hemorrhage, bowel or bladder
injur in the study group.
4. DISCUSSION
Minimally invasive procedures have many benefits when
Table 1. Reproductive history before septum resection.
Group I (n: 18) Group II (n: 22)
Patients (n) 18 22
Age in year (mean ± SD) 27 ± 3 29 ± 5
Duration in infertility in a
year (mean ± SD) 5.2 ± 3.1 0
Pregnancies (n) 0 56
Abortions (n) 0 56 (100%)
Intra uterine fetal death (n) 0 2
Pre-term deliveries (n) 0 0
Term deliveries (n) 0 0
Table 2. Reproductive history after septum resection (the mean
period of follow up was 24 months).
Group I Group II Total
Patients (n) 18 22 40
Pregnant (n [%]) 12 (66.6%) 17 (77.2%)29 (72.5%)
Abortions (n [%]) 2 (11.1%) 4 (18.1%)6 (15.0%)
Intra uterine fetal death (n [%])0 0 0
Pre-term deliveries (n [%]) 1 (5.5%) 2 (9.0%) 3 (7.5%)
Healthy pregnancy (n [%]) 9 (50%) 11 (64.7%)20 (50%)
Non pregnant women 6 (33. 3%) 5 (22.7%)11 (28%)
compared with traditional procedures, including shorter
hospital stays, lower cost, and shorter recovery time.
Daly et al. (1989) reported that 7 (53.8%) out of 13 pa-
tients with infertility conceived after septum resection
and, more recently, Goldenberg et al. (1995) have ob-
served pregnancies after hysteroscopic metroplasty in 18
(54%) out of 34 patients with uterine septum and inferti-
lity.
Thus, the chance of conception in patients with septate
uteri and infertility seems to be similar to those of the
general infertile population either with or without septu m
resection. This may also be an indirect sign that uterine
septum is not an infertility factor in itself. However, the
treatment has a beneficial effect on pregnancy outcomes
[3]. Although congenital uterin e malformations are asso-
ciated with poor reproductive performance, each type
may have a different impact on reproduction [4]. Uni-
cornuate uterus and uterus didelphys seem to have a
similar effect on pregnancy outcome, since uterus didel-
phys may be considered as a symmetrical duplication of
a unicornuate uterus [4-6].
The performance of hysteroscopic metroplasty in pa-
tients with primary infertility is still a subject of debate,
with some groups recommending treatment and others
not. Generally treatment is considered in women in
whom assisted conception is being contemplated.
Considering that the procedure used in this study is
simple and without complications, this is probably justi-
fied, as the obstetric outcome in pregnant patients with a
uterin septum is worse [7].
S. Venturoli observed that, 141 patients who had a par-
tial uterine septum and had undergone hysteroscopic
metroplasty (class Vb, American Society for Reproduc-
tive Medicine, ASRM) were divided into two groups:
Group I (69 patients) presented with infertility and
Group II (72 patients) with recurrent abortions were ob-
served that after oper ation, 36 of Group I patients (5 2.1%)
and 38 of Group II patients (52.7%) achieved pregnancy,
with respective aborti o n rat es of 20% an d 25 % [8].

D. Güven et al. / Open Journal of Obstetrics and Gynecology 2 (2012) 262-264 264
5. CONCLUSION
Hysteroscopic septum resection is a minimally invasive
procedure and it appears to be related with a significant
improvement in achieving pregnancy in women with a
history of recurrent abortions. Traditional metroplasty is
well known to cause pelvic adhesions thus further com-
plicating the case.
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