Uterine Vascularization Research Articles

EFFECTS OF A GONADOTROPIN-RELEASING HORMONE VACCINE ON OVARIAN CYCLICITY AND UTERINE MORPHOLOGY OF AN ASIAN ELEPHANT (ELEPHAS MAXIMUS)

This report describes the successful use of a gonadotropin-releasing hormone (GnRH) vaccine to suppress ovarian steroidogenic activity and to treat hemorrhage and anemia associated with reproductive tract pathology in a 59-year-old Asian elephant (Elephas maximus). The Repro-BLOC GnRH vaccine was administered subcutaneously as a series of 4 boosters of increasing dose from 3 to 30 mg of recombinant ovalbumin-GnRH fusion protein given at variable intervals after initial vaccination with 3 mg protein. Efficacy was confirmed over a year after initial vaccination based on complete ovarian cycle suppression determined by serum progestagen analyses. Estrous cycle suppression was associated with a significant increase in GnRH antibody binding and subsequent decrease in serum luteinizing hormone and follicle-stimulating hormone concentrations. Ultrasonographic examinations of the reproductive tract documented a reduction in uterine size and vascularity after immunization. The hematocrit level normalized soon after the initial intrauterine hemorrhage, and no recurrence of anemia has been detected. No substantive adverse effects were associated with GnRH vaccination. The results indicate that GnRH vaccination in elephants shows potential for contraception and management of uterine pathology in older elephants.

Impacts of linseed meal and estradiol-17β on cellularity, angiogenic and vasoactive factor mRNA expression, and vascularity of the uterus in ovariectomized ewes

Ilse, B. R., O'Neil, M. R., Lardy, G. P., Reynolds, L. P. and Vonnahme, K. A. 2012. Impacts of linseed meal and estradiol-17β on cellularity, angiogenic and vasoactive factor mRNA expression, and vascularity of the uterus in ovariectomized ewes. Can. J. Anim. Sci. 92: 297–306. The objective of the current study was to determine the estrogenic potential of the phytoestrogen secoisolariciresinol diglycoside (SDG) found in linseed meal (LSM) on uterine cell proliferation, vascularity, and angiogenic factor mRNA expression. Ovariectomized ewes (n=48) were fed a diet containing 12.5% LSM for 0, 1, 7, or 14 d and implanted with estradiol-17β (E2) for 0, 6, or 24 h before tissue collection. There was an interaction of LSM×E2 on uterine mass (grams; P=0.03; percentage change; P<0.003). Uterine mass increased (P≤0.02) after 24 h of E2 exposure on days 1, 7, and 14 of LSM feeding, with the greatest mass occurring in ewes exposed to E2 for 24 h and 1 d LSM feeding. Regardless of days fed LSM, after 24 h of E2 exposure uterine mass was greatest. The greatest percentage increase in uterine mass occurred in ewes exposed to E2 for 24 h and fed 1 d of LSM. Cell proliferation within the uterine luminal epithelium was greatest (P<0.01) with 24 h of E2 exposure compared with 0 h and 6 h. When expressed as the percentage change in uterine cell proliferation, feeding LSM for 14 d negated these effects. Only length of E2 exposure impacted vascularity with capillary number density at 6 h of E2 exposure being greater (P=0.02) than at 24 h. While mRNA expression of several angiogenic factors was influenced by E2, there was a LSM×E2 interaction (P≤0.03) only on vascular endothelial growth factor receptor 2 and fibroblast growth factor receptor 2C. It appears that growth and angiogenesis of E2 sensitive tissues may be influenced by the duration of LSM feeding.

Epigenetic regulation of trophoblast differentiation and antigen repertoire expression to ensure normal uterine vascularization and fetal growth

Epigenetic regulation of trophoblast differentiation and antigen repertoire expression to ensure normal uterine vascularization and fetal growth

Laparoscopic Hemihysterectomy in a 14-Year-Old Woman with a Blind Ended Rudimentary Horn

We present a case of a 14-year-old woman with dysmenorrhea since menarch, who was diagnosed by MRI of pseudo-unicornuate uterus, with a blind ended rudimentary contralateral cornis. no other genito-urinary anomalies were associated. We performed a laparoscopic hemihysterectomy, removing the right rudimentary horn, according to the recomendations of published data, and preventing damages to the functional uterus. Finally, we reconstructed the left unicornuate uterus together with the right Fallopian tube, and the other right pedicles. Patient is on her first week after surgery now, so we do not know how her medium or long term outcomes will be, but because right uterine artery and round ligament were not damaged, we asume there is no elevated risk of uterine prolapse or vascularization issues.

Effet du tabagisme sur l’implantation embryonnaire et la placentation précoce et facteurs influençant la toxicité tabagique sur la reproduction (Partie II)

Cigarette smoking is associated with lower fecundity rate, adverse reproductive outcomes and higher risk of IVF failure. Over the last decades, prevalence of smoking among women of reproductive age has increased. The aim of this work was first to focus on the knowledge of the effects of cigarette smoking on reproductive stages and particularly on implantation process and early placentation. Human clinical and experimental studies were analysed in order to find hypothesis and explanations for the effects observed. Then, our second aim was to analyse which factors could influence smoke effects. We observed that smoke compounds induce impairment of endometrial maturation, disturb angiogenesis and trophoblastic invasion. Cigarette compounds also impair uterine and endometrial vascularisation and myometrial relaxation. These effects lead to implantation failure in IVF and higher risk of miscarriage. Many factors influence the effects of cigarette smoke, as smoke behaviour, dose and duration of exposition. Sidestream is also damaging on reproductive function. Prenatal exposure leads to irreversible and deleterious effects on ovarian reserve. These observations need to be confirmed in order to improve health care in women of reproductive age.

Uterine and chorioallantoic angiogenesis and changes in the uterine epithelium during gestation in the viviparous lizard, niveoscincus conventryi (squamata: scincidae)

We used immunofluorescent confocal microscopy and scanning electron microscopy to quantify uterine vascularity and to describe uterine surface morphology during gestation in pregnant females of the lecithotrophic lizard Niveoscincus coventryi. As uterine angiogenesis and epithelial cell morphology are thought to be under progesterone control, we studied the effect of a progesterone receptor antagonist (mifepristone) on uterine and chorioallantoic microvasculature and features of the uterine epithelial surfaces. Although intussuceptive angiogenesis was observed in both, uterine and chorioallantoic, vascular beds during gestation, the only significant increases were in the diameters of the uterine vessels. An ellipsoid vessel-dense area grows in the mesometrial hemisphere of the developing conceptus, which parallels the expansion of the allantois to form the chorioallantoic placenta. Uterine surface topography changed during gestation. In particular, uterine blood vessels bulge over the luminal surface to form marked ridges on the uterine embryonic hemisphere, especially during the last stage of pregnancy, and ciliated cells are maintained in the embryonic and abembryonic hemispheres but disappear in both the mesometrial and antimesometrial poles. This distinct regionalization of uterine ridges and ciliated cells in the uterine surface and in the shape of the epithelial component of the chorion might be related to the function of both chorioallantoic and yolk sac placentae during gestation. There was no significant difference between females treated with or without mifepristone, which may be related to the partial function of mifepristone as a progestin antagonist and/or with the function and time of action of progesterone in the uterus during gestation in N. coventryi. Differences in the pattern of angiogenesis and uterine surface morphology during gestation among squamates may be related to the functional diversity of the uterine component of the different placentae and probably reflect its diverse evolutionary history.

Aplicação da ultrassonografia colorida doppler em programas de transferência de embriões equinos

Os programas comerciais de transferência de embriões em éguas existem por mais de três décadas e são hoje uma das biotécnias mais utilizadas na reprodução assistida de equinos. O exame ultrassonográfico nos períodos pré e pós-cobertura de doadoras de embriões, assim como a avaliação de receptoras no momento da inovulação é de vital importância para o êxito de um programa de transferência de embriões. A ultrassonografia Doppler é uma técnica não-invasiva que permite a avaliação em tempo real da hemodinâmica do trato reprodutivo de animais de grande porte. Por fornecer detalhes anatômicos e informações imediatas sobre a fisiologia do fluxo sanguíneo de tecidos e órgãos, o exame doppler permite a avaliação do potencial ovulatório de folículos e do status funcional de corpo lúteo e útero, além de ser uma técnica auxiliar para o diagnóstico de distúrbios na hemodinâmica do sistema reprodutivo. Alterações na perfusão sanguínea dos futuros folículos dominantes são detectáveis em diferentes fases de seu desenvolvimento, como na divergência folicular e no período pré-ovulatório. A partir dessas informações, é possível determinar o princípio da atividade sexual e o momento ideal para o início de tratamentos superovulatórios e indutores de ovulação, assim como o momento mais apropriado para a realização de coberturas de éguas doadoras de embriões. A avaliação através do modo-Doppler do corpo lúteo e útero de éguas receptoras é também um instrumento auxiliar para a seleção de animais com perfil sérico de progesterona e ambiente uterino adequados para a sobrevivência do embrião e manutenção da gestação. Essa técnica pode ser útil ainda ao se avaliar a interação concepto-maternal. Apesar da aplicabilidade da tecnologia doppler dentro de programas de transferência de embriões, novos estudos visando a determinar padrões de normalidade e posterior caracterização de distúrbios de fluxo sanguíneo de trato reprodutivo ainda se fazem necessários.

Paternal MHC expression on mouse trophoblast affects uterine vascularization and fetal growth

The mammalian fetus represents a semiallograft within the maternal uterus yet is not rejected. This situation is particularly pronounced in species with a hemochorial type of placentation, such as humans and rodents, where maternal tissues and blood are in direct contact with fetal trophoblast and thus potentially with paternal antigens. The main polymorphic antigens responsible for graft rejection are MHC antigens. In humans the trophoblast cells invading into the decidua have a unique pattern of MHC class I expression characterized by both classical (HLA-C) and nonclassical (HLA-G and HLA-E) molecules. Whether such an unusual MHC repertoire on the surface of trophoblast is a conserved feature between species with hemochorial placentation has not been resolved. Here we demonstrate, using a range of methods, that C57BL/6 mouse trophoblast predominantly expresses only one MHC class I antigen, H2-K, at the cell surface of giant cells but lacks expression of nonclassical MHC molecules. Antigenic disparity between parental MHCs affects trophoblast-induced transformation of the uterine vasculature and, consequently, placental and fetal gowth. Maternal uterine blood vessels were more dilated, allowing for increased blood supply, in certain combinations of maternal and paternal MHC haplotypes, and these allogeneic fetuses and placentas were heavier at term compared with syngeneic controls. Thus, maternal-fetal immune interactions are instrumental to optimize reproductive success. This cross-talk has important implications for human disorders of pregnancy, such as preeclampsia and fetal growth restriction.

Administration of Thyroxine Affects the Morphometric Parameters and VEGF Expression in the Uterus and Placenta and the Uterine Vascularization but does Not Affect Reproductive Parameters in Gilts During Early Gestation

The aim of this study was to evaluate the effects of thyroxine administration on morphometric parameters, expression of vascular endothelial growth factor (VEGF) and vascularization in the uterus and placenta and reproductive parameters in gilts at 70 days of gestation. At 150 days of age, i.e., before first heat, 20 gilts were randomly divided into two experimental groups: treated (n=10) and control (n=10). The treated group received a daily dose of 400 μg of L-thyroxine (T(4)) in their diet until slaughter and the control group received only typical meals. Before artificial insemination, blood was collected to determine plasma total T(4). The gilts were inseminated in the second oestrus and slaughtered at 70 days of gestation. The foetal thyroid follicular epithelium height, number, size and weight of foetuses; foetal myogenesis, corpora lutea number, embryonic mortality rate, uterine weight, placental weight and placental fluid volume were measured. Histomorphometric and immunohistochemical analysis of uterus and placenta were determined. The averages of all variables were compared by the Student's t-test. The gilts treated with thyroxine showed significant increase of plasma total T(4). At 70 days of gestation, the heights of the trophoblastic epithelium, endometrial epithelium and endometrial gland epithelium were significantly higher in the group treated with T(4). The expression of cytoplasmatic and nuclear VEGF in trophoblastic cells and the number of blood vessels per field in endometrial stroma were significantly higher in the gilts treated with T(4). No other significant differences between groups were obtained with respect to other parameters (p>0.05). We conclude that oral administration of T(4) up to 70 days of pregnancy in gilts affects the morphometric parameters, the expression of placental VEGF and the uterine vascularization but does not affect reproductive parameters in gilts during early gestation.

Ovarian Stimulation Affects the Levels of Regulatory Endometrial NK Cells and Angiogenic Cytokine VEGF

Endometrial NK cells play a critical role in uterine vascularization producing angiogenic factors. Impact of ovarian stimulation on endometrial expression of NK cells and VEGF in normal fertile oocyte donors and the effect of endometrial injury treatment on these parameters have been investigated. Endometrial tissue was obtained from oocyte donors during natural and stimulated cycles. NK cell subsets were measured by flow cytometry. VEGF was determined by ELISA and flow cytometry. Endometrial angiogenic parameters were determined by ultrasound Doppler. Local injury was induced by scratching endometrial tissue previous to implantation window. Ovarian stimulation decreased endometrial levels of NK cells and vascularization index but increased VEGF levels. Local injury normalized only the CD56(+) NK cell count. Hormonal therapy for ovarian stimulation may be associated with poor endometrial vascularization. Local injury before the implantation window seems not to influence endometrial angiogenic parameters altered by ovarian stimulation.

A comparison of endometrial and subendometrial vascularity assessed by three-dimensional ultrasonography and power Doppler angiography between healthy fertile women and women with unexplained primary recurrent miscarriage

We compared the characteristics of endometrial-subendometrial vascularity 7 days after ovulation of a natural cycle by transvaginal three-dimensional ultrasonography and power Doppler angiography between 88 patients with unexplained recurrent miscarriage and 46 healthy fertile women. Endometrial vascularization index, flow index, and vascularization flow index, as well as subendometrial vascularization index and vascularization flow index, were reduced significantly in the group with unexplained recurrent miscarriage.

Assesment of changes in uterine and subendometrial blood flows: the use of prediction outcome in IVF cycles

OBJECTIVE: The aim of this study is to evaluate the relationship between uterine Doppler flow and endometrial and subendometrial blood flows and uterine receptivity during IVF cycles. DESIGN: This is a prospective observational study which is conducted at Zekai Tahir Burak Women's Health Research and Education Hospital, Reproductive Endocrinology Clinic. MATERIALS AND METHODS: Sixty-eight patients from our infertility programme were recruited for this prospective observational study, after giving informed consent. Eight of them were excluded because of total fertilization failure (5 patients) and no sperm extraction in TESE (3 patients). A color Doppler ultrasound examination performed on the day of hCG injection and midluteal phase. Pulsatility and resistance indices of uterine vessels, and vascularization and flow endometrial and subendometrial region were assumed. No Doppler study was done on the endometrium in midluteal phase. RESULTS: There were no significant differences in the age of patients, BMI of patients, duration of infertility,cycle lenght or total number of embryos transferred between women who became pregnant (n =16) and those who did not (n = 44). There were no difference in mean endometrial thickness between the two groups on hCG day and 5-6days after embryo transfer. Mean uterine arterial resistance index (RI) and Pulsatility Index (PI) values were not significantly different in both group on hCG day but both indices were significantly lower in the pregnant than in the non-pregnant group in mudluteal phase (p=0.05 and 0.016, respectively). Also no significant differences were found between the two groups in subendometrial blood flow. CONCLUSION: Patients undergoing IVF-ICSI and embryo transfer, Doppler ultrasound examination of the uterine artery and subendometrial blood flow on hCG day do not discriminate between cycles resulting in conceived and non-conceived but especially low mean PI of uterine artery in 5-6 days after ET can predict pregnancy.

Transvaginal color Doppler study of uterine artery: Is there a role in chronic pelvic pain?

To determine the value of transvaginal color Doppler study of uterine artery and investigate the differences in blood flow of uterine artery among women with chronic pelvic pain (CPP). A total of 50 female patients were recruited. The study group consisted of 25 women with CPP of possible gynecological origin. Twenty-five women without CPP made a control group. All women were examined using transvaginal color Doppler ultrasonogram after negative finding of pelvic examination. The mean pulsality index (PI) and resistant index (RI) of the uterine arteries were recorded and compared. The mean ages were 36.6 ± 10.6 and 32.0 ± 6.7 years in the study group and control group, respectively. The duration of pain ranges from 6-48 months (mean, 14.8). The mean PI and RI values of the uterine arteries in patients with CPP were significantly lower than in the control group; PI = 2.12 ± 0.78, 2.76 ± 0.84 and RI = 0.79 ± 0.19, 0.89 ± 0.05, respectively (P < 0.05). Doppler flow indices demonstrated significant increase of uterine arteries vascularization in CPP women related to pelvic causes. Transvaginal ultrasound with noninvasive Doppler study could be a useful primary investigation for CPP women, especially when financial resource is an issue.

Three-dimensional power Doppler study of changes in uterine vascularity after absorbable cervical tourniquet during open myomectomy

To evaluate the effect of an absorbable polyglactin tie (i.e., cervical tourniquet) on postoperative uterine artery blood flow using three-dimensional (3D) power Doppler. Forty-four patients with symptomatic uterine myomas warranting surgical treatment were randomized to either receive absorbable cervical tourniquets group 1 or not group 2. Resistance index, pulsatility index, and peak systolic velocity of the uterine artery as well as 3D power Doppler study of uterine vascularity in terms of VI, FI, vascularization flow index (VFI) were performed preoperatively and at 1 and 3 months, postoperatively. Estimated myoma and uterine volume, operative time were compared in both groups. No significant difference in the characteristics of myomas, regarding number, size, and location of the largest myoma, between the two studied groups. No significant differences between the two groups for uterine artery RIs, PIs, and PSV at 1 and 3 months, postoperatively. The myometrial VI, FI and VFI in the study group were comparable to those in the control group. No sequential change in FI was noted in either group. Absorbable cervical tourniquet during open myomectomy did not compromise uterine perfusion as evaluated by 3D power Doppler study.

Uterine Fundal Blood Supply from an Aberrant Left Ovarian Artery Originating from the Inferior Mesenteric Artery: Implications for Uterine Artery Embolization

A 46-year-old Cambodian woman with a history of adenomyosis underwent a uterine artery embolization procedure to control her menorrhagia. Aortography revealed a left ovarian artery originating from the inferior mesenteric artery (IMA) supplying a large portion of uterine vascularity. Based on recognition of this variant, the ovarian artery was embolized without compromising flow to the IMA to achieve the best chance for success.

Evolution of viviparity and uterine angiogenesis: vascular endothelial growth factor (VEGF) in oviparous and viviparous skinks

During pregnancy, uterine vasculature of live-bearing lizards proliferates to support embryonic growth and development. Vascular endothelial growth factor (VEGF) is the most potent of a suite of growth factors responsible for uterine vascularization in mammals. We have sequenced VEGF mRNA transcripts expressed in the uterus of oviparous and viviparous Australian skinks, and compared uterine VEGF expression in nonreproductive and late-reproductive Saiphos equalis, a fossorial viviparous skink. VEGF sequences differed between phylogenetic groups of skinks, rather than oviparous and viviparous skinks. Two transcripts were identified in the uterus of each species that had the same splice sites as human VEGF(165) and VEGF(189). A third transcript, found only in uterine and testis tissue from S. equalis, had the same splice sites as human VEGF(111). This is the first natural expression of VEGF(111), previously found only in human cultured cells subjected to environmental stress. All the three VEGF transcripts identified showed higher expression in uterus from late-reproductive S. equalis than nonreproductive females. The different angiogenic properties of VEGF transcripts provide a mechanism that may produce the variety of placental complexities observed in viviparous skinks. The presence of VEGF(111) in S. equalis may be an opportunity to investigate the function of this unique transcript in a whole animal system.

Effects of pentoxifylline on uterine blood flow, and placental and fetal development in young and aged mares with endometrosis

Uterine fibroids are the most common cause of solid pelvic tumours, occurring in 20–30% of fertile women and presenting clinical complications that seriously affect women's health. They commonly cause severe symptoms, such as heavy, prolonged menstrual bleeding and anaemia. The study of microscopic and macroscopic vascular aspects of uterine fibroids is important for understanding the clinical manifestations of uterine fibroids, for predicting the effectiveness of alternative treatments to surgery, i.e. uterine artery embolization, for improving surgery outcomes and for carrying out a differential diagnosis with other benign conditions, e.g. adenomyosis, or malignancy, e.g. leiomyosarcoma, and to develop new therapeutic approaches. In this review, current knowledge of how the vascular network and angiogenesis are implied in the formation of uterine fibroids and in the pathogenesis of related symptoms is explored, and evidence on the role of ultrasound in evaluating fibroid vascularization is summarized. This review combines anatomical, morphological and biomolecular information related to angiogenic mechanisms with diagnostic and clinical information, highlighting the various interconnections. Uterine and fibroid vascularization need further investigation to gain a deeper understanding of the pathogenetic elements that lead to the formation of uterine fibroids and their clinical manifestations.

Septate Uterus: Three Dimensional Ultrasound Assessmnt of Septal Morphology, Volume and Vascularity and Correlation to Reproductive Outcome

Study Objective: The septate uterus presents an important decrease of live birth rate. The mechanisms by which septate uteri cause early pregnancy loss and infertility have not been established. Evaluation of septate uterus is quite easy by means of transvaginal three-dimensional (3D TVS) ultrasound. The purpose of this study was to assess by 3D TVS uterine septum dimensions, volume, morphology and vascularization and to correlate these features to reproductive outcome.

OC15.03: Three dimensional sonographic assessment of septate uterus: correlation between morphology, volume and vascularity of the septum and reproductive outcome

The septate uterus is associated with a decreased live birth rate. The mechanisms by which septate uteri cause early pregnancy loss and infertility have not been completely established yet. Evaluation of septate uterus is quite easy by means of transvaginal three-dimensional (3D TVS) ultrasound. The aim of this study was to assess by 3D TVS uterine septum dimensions, volume, morphology and vascularization and to correlate these features to reproductive outcome. Patients of reproductive age with a septate uterus underwent 3D TVS. On 3D TVS coronal view of the uterus, septal length and width, volume, echostructure and vascularization by means of the Vascularisation Index (VI), were evaluated. The number of pregnancies and the reproductive outcome of each patient were recorded and correlated to the previous mentioned 3D TVS features. Among 65 patients with septate uterus, 19 had a recurrent pregnancy loss, 5 had a preterm delivery, 4 had a term delivery and 36 presented with primary infertility. The width of the septum was significantly larger in patients with recurrent abortion (31.6 + 6.10mm) compared to those with primary infertility (25.6 + 7.12mm). 3D TVS showed that vascularization expressed as VI calculated on septal volume (17.49 ± 8.40%) was significantly higher in patients with term or preterm deliveries 3D TVS allows detection of different types of uterine septa. The different morphology of uterine septa suggests that the pathogenesis of infertility in these patients is multifactorial, and perhaps the reproductive outcome can be correlated to septal width and structure.

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

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.