Reproductive outcome after hysteroscopic septoplasty in patients with septate uterus - a retrospective cohort study and
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Reproductive outcome after hysteroscopic septoplasty in patients with septate uterus - a retrospective cohort study and systematic review of the literature Review
Kazem Nouri1, Johannes Ott1, Johannes C Huber1, Eva-Maria Fischer1, Lucija Stögbauer1 and Clemens B Tempfer*2
Abstract Background: Septate uterus, one of the most common forms of congenital uterine malformations, negatively affects female reproductive health. Methods: In a retrospective cohort study, we evaluated the reproductive outcome after hysteroscopic septoplasty in 64 women with septate uterus and primary or secondary infertility. We performed a systematic review of studies evaluating the reproductive outcome after hysteroscopic septoplasty. Results: Sixty-four women underwent hysteroscopic septoplasty. In 2/64 (3%) women, intraoperative uterine perforation occurred. Complete follow-up was available for 49/64 (76%) patients. Mean follow-up time was 68.6 +/- 5.2 months. The overall pregnancy rate after hysteroscopic septoplasty was 69% (34/49). The overall life birth rate (LBR) was 49% (24/49). The mean time interval between surgery and the first life birth was 35.8 +/- 22.5 months. Including our own data, we identified 18 studies investigating the effect of septoplasty on reproductive outcome in 1501 women. A pooled analysis demonstrated that hysteroscopic septoplasty resulted in an overall pregnancy rate of 60% (892/1501) and a LBR of 45% (686/1501). The overall rate of intra- and postoperative complications was 1.7% (23/1324) and the overall rate of re-hysteroscopy was 6% (79/1324). Conclusions: In women with septate uterus and a history of infertility, hysteroscopic septoplasty is a safe and effective procedure resulting in a pregnancy rate of 60% and a LBR of 45%. Background Septate uterus, i.e. an incompletely septated uterus or uterus subseptus, is one of the most common forms of congenital uterine malformations [1]. The incidence of congenital uterine malformations has been reported to be as high as 3-4% in the general female population [2,3] and to be significantly higher in patients with infertility and recurrent pregnancy loss [3,4]. Septate uterus results from incomplete resorption of the paramesonephric muellerian ducts during the first trimester of pregnancy. The absorption of the septum normally initiates at the level of the uterine cervix and continues upwards in the direction of the uterine fundus. * Correspondence: [email protected] 2 Department of Gynecology and Gynecologic Oncology, Medical University of
Vienna, Vienna, Austria Full list of author information is available at the end of the article
Depending on the size of the septum, the uterine cavity may be affected only partially, as in case of an incomplete septate uterus, or it may be divided into two separate components including two cervices and eventually a vaginal septum, as in case of a complete septate uterus. A uterine septum affects female reproductive health in three ways: (i) obstetric complications, (ii) recurrent miscarriag
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