Septate uterus in infertile patients: three dimensionale sonographic assessment, histology of septal tissue after hysteroscopic metroplasty and correlation to reproductive outcome

Abstract

OBJECTIVE: Septate uteri can cause early abortion and infertility but mechanisms have not been clearly established yet.The aim of this study was to assess by 3D TVS uterine septum dimensions, volume, morphology and vascularization and to correlate these findings to reproductive outcome and to the hystological features of uterine septa obtained by hysteroscopic metroplasty (HM).DESIGN: Reproductive outcome of patients with septate uterus undergoing 3D TVS and HM.MATERIALS AND METHODS: Sixty-five patients of reproductive age with septate uterus underwent 3D TVS. On the coronal view of the uterus, septal length, width, volume, echostructure and vascularization (Vascularisation Index-VI), were evaluated. The reproductive outcome of each patient was recorded and correlated to the 3D TVS features. Twenty of these patients underwent HM. At least two specimens of the septum were obtained for histological evaluation, to assess the amount of vessels, connective and muscle tissue.RESULTS: Of the 65 patients with septate uterus, 19 had repeated pregnancy loss, 5 had a preterm delivery, 4 had a term delivery and 36 primary infertility. The width of the septum was significantly larger in patients with recurrent abortion (31.6 + 6.10mm) than in those with primary infertility (25.6+7.12mm). 3D TVS showed a VI on septal volume (17.49 ±8.40 %) significantly higher in patient with term or preterm deliveries. Histology of the septum showed in 9 cases poor vessels amount, among which only one showed normal muscle tissue amount. In the 11 septa with normal vessels amount 3D TVS showed VI of the septum (17.49 ±8.40 %) significantly higher compared to the 9 cases with poor vessels amount (VI 1.83 ± 1.26%). The width of the septum was significantly lower in the fibrotic septa with poor vessels amount.CONCLUSIONS: 3D TVS can detect different types of uterine septa. The different morphology and histology of uterine septa suggest that pathogenesis of infertility in these patients is multifactorial and correlated to septal width and content. OBJECTIVE: Septate uteri can cause early abortion and infertility but mechanisms have not been clearly established yet.The aim of this study was to assess by 3D TVS uterine septum dimensions, volume, morphology and vascularization and to correlate these findings to reproductive outcome and to the hystological features of uterine septa obtained by hysteroscopic metroplasty (HM). DESIGN: Reproductive outcome of patients with septate uterus undergoing 3D TVS and HM. MATERIALS AND METHODS: Sixty-five patients of reproductive age with septate uterus underwent 3D TVS. On the coronal view of the uterus, septal length, width, volume, echostructure and vascularization (Vascularisation Index-VI), were evaluated. The reproductive outcome of each patient was recorded and correlated to the 3D TVS features. Twenty of these patients underwent HM. At least two specimens of the septum were obtained for histological evaluation, to assess the amount of vessels, connective and muscle tissue. RESULTS: Of the 65 patients with septate uterus, 19 had repeated pregnancy loss, 5 had a preterm delivery, 4 had a term delivery and 36 primary infertility. The width of the septum was significantly larger in patients with recurrent abortion (31.6 + 6.10mm) than in those with primary infertility (25.6+7.12mm). 3D TVS showed a VI on septal volume (17.49 ±8.40 %) significantly higher in patient with term or preterm deliveries. Histology of the septum showed in 9 cases poor vessels amount, among which only one showed normal muscle tissue amount. In the 11 septa with normal vessels amount 3D TVS showed VI of the septum (17.49 ±8.40 %) significantly higher compared to the 9 cases with poor vessels amount (VI 1.83 ± 1.26%). The width of the septum was significantly lower in the fibrotic septa with poor vessels amount. CONCLUSIONS: 3D TVS can detect different types of uterine septa. The different morphology and histology of uterine septa suggest that pathogenesis of infertility in these patients is multifactorial and correlated to septal width and content.