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3 results

  • 23A - All Infertile Women with a Uterine Septum Should Have a Surgical Removal

  • from Section III - The Best Policy
  • Edited by Roy Homburg, Adam H. Balen, Robert F. Casper
  • Book:
    50 Big Debates in Reproductive Medicine
    Published online:
    25 November 2021
    Print publication:
    16 December 2021, pp 122-123

  • Summary

    A uterine septum is a congenital abnormality that has been associated with poor reproductive outcome that can be readily corrected by hysteroscopic surgery. For this debate article we argue that all women with a uterine septum should have hysteroscopic septal resection before undergoing any fertility treatment. A uterine septum is a congenital uterine anomaly arising from the failure of canalisation of the uterus during embryological development. Uterine septa are more prevalent in women with a history of pregnancy loss, but not infertility alone, and are associated with an increased risk of first and second trimester miscarriage and preterm birth [1,2]. Diagnosis is straightforward with three-dimensional ultrasound. Adequate assessment of uterine morphology requires concurrent imaging of the external and internal controls of the uterus. Three-dimensional ultrasound facilitates such views and is safer and more acceptable to women than surgical assessment with hysteroscopy and laparoscopy which are required to see the internal and external fundal contours.

  • Chapter 12 - Adjuvant therapy to increase implantation rates

  • Edited by David K. Gardner, University of Melbourne, Botros R. M. B. Rizk, University of South Alabama, Tommaso Falcone
  • Book:
    Human Assisted Reproductive Technology
    Published online:
    16 May 2011
    Print publication:
    31 March 2011, pp 119-126

  • Summary

    This chapter examines the evidence and methods of uterine cavity evaluation and the structural abnormalities that may compromise in vitro fertilization (IVF) success. The gold standard method for the evaluation of the uterine cavity is direct visualization with hysteroscopy. One of the most commonly encountered uterine cavity abnormalities is endometrial polyps. Müllerian anomalies are structural developmental abnormalities of the female reproductive system. The American Society for Reproductive Medicine (ASRM) staging system classifies these abnormalities into hypoplastic/agenesis, unicornuate, didelphus, bicornuate, septate, arcuate, and DES-related. Uterine septae form from incomplete absorption of the intervening tissue as the two Müllerian ducts fuse. The arcuate uterus occurs when there is a mild extension from the uterine fundus caudally. Myomas are the most common benign tumor of the female reproductive system. Finally, the chapter describes a comprehensive diagnostic and treatment algorithm for patients with Asherman's syndrome (AS).

  • 35 - Congenital Uterine Malformations and Reproduction

  • from PART II - INFERTILITY EVALUATION AND TREATMENT
  • Edited by Botros R. M. B. Rizk, University of South Alabama, Juan A. Garcia-Velasco, Hassan N. Sallam, Antonis Makrigiannakis, University of Crete
  • Book:
    Infertility and Assisted Reproduction
    Published online:
    04 August 2010
    Print publication:
    15 September 2008, pp 327-331

  • Summary

    This chapter discusses the congenital uterine malformations and their reproductive implications. Patients with congenital absence of the vagina usually lack the uterus as well. Imperforate hymen and transverse vaginal septum are vertical fusion anomalies. Double uterus, septate uterus and unicornuate uterus are obstructive lateral fusion anomalies. In strassman procedure a transverse fundal incision is made in case of a bicornuate uterus and the two uterine cavities are unified. In Tompkins procedure for septate uteri a median bivalve is made and no tissue is excised. The two cavities are opened and unified. In Jones procedure which is usually reserved for the wide septum, a wedge resection of the septum is done and the uterine cavities are unified. In uterus didelphys, there is duplication of the uterus, cervix, and vagina. Fertility of women with didelphic uterus was comparatively good. Patients with congenital uterine malformations undergoing IVF have a good pregnancy rate.