Is Prophylactic Hysteroscopic Metroplasty for the Septate Uterus Justified?

Abstract

Background: A septate uterus is a relatively common Müllerian defect that has an impact on fertility; this effect has been debated. Operative hysteroscopy is the preferred method of treatment in patients with recurrent abortions or poor obstetric histories, but it has not yet been determined whether or not to perform prophylactic metroplasty when a septum is incidentally diagnosed in an otherwise healthy patient. Methods: This article reviews existing literature on the clinical significance of a septate uterus, its diagnosis, surgical treatment, and reproductive outcome after hysteroscopic metroplasty. Complications and the controversy surrounding this procedure are also discussed. Results: Available literature suggests that untreated Müllerian defects could impair pregnancy outcomes significantly. Hysteroscopic metroplasty is generally preferred over expectant management in patients with septate uteri and poor obstetrical histories. Conclusions: Although controversial, prophylactic metroplasty may be recommended for nulliparous patients with incidentally diagnosed uterine septa if there is unexplained infertility in patients>35 years of age and in whom assisted reproductive technologies are used. (J GYNECOL SURG 30:325)