What is a septate uterus? We asked an expert to explain

Recently we heard from one of our readers who wanted to share her difficult journey with us. Following multiple 5 failed pregnancies, our reader was diagnosed with a ‘septate uterus’

She was told that it was easily operated on and the surgery would likely have a positive affect on her ability to carry a child. So, she had the surgery, but then tragically could not fall pregnant. She was told IVF was her best option. She is now thrilled to say she is 7 weeks pregnant. She asked us to reach out to one of our experts, to help shed a bit of more light on her condition so that others can understand what it means to have a septate uterus.

So, we turned to Dr Bodri, gynaecologist and fertility expert at IVF Spain for his expertise and medical opinion:

What is a septate uterus?

A septate uterus is a particular type of congenital malformation of the womb where the normally triangular-shaped uterine cavity is divided by a more or less thick, vertical column of fibrous tissue and is separated in two smaller halves. It is one of the more common types of uterine malformations and is associated with adverse pregnancy outcomes such pregnancy loss, breech presentation, placental abruption and preterm delivery.

Did the septate uterus cause the miscarriages that our reader suffered?

Most likely this patient’s recurrent pregnancy losses were caused by her uterine malformation, although other infertility factors (advancing maternal age, D&C following repeated miscarriages) could also have additional negative effect on fertility.  

Why do you think our reader could not fall pregnant following surgery?

In some cases, following the hysteroscopic resection of a uterine septum intrauterine adhesions (scar tissue inside the uterine cavity) could form impeding the development of an adequate endometrial lining where a potential embryo could implant. That is why, a “second-look” hysteroscopy is required after the initial intervention to exclude formation of any post-operative adhesions.     

How common is a Septate uterus?

There are no exact statistics on the population prevalence of uterine malformations, but septate uterus is considered the most common type of congenital uterine malformation. It is also particularly relevant because its surgical correction is relatively easy and could completely eliminate the risk of adverse obstetric outcomes.

How do you get a Septate uterus?

The womb is formed during early foetal life from the fusion of the left and right müllerian ducts. Failure to fuse leads to a range of congenital uterine malformations resulting in a uterus that only has slight midline indentation (arcuate uterus – considered a normal variant), a partial or a complete uterine septum. In more severe cases the failure to fuse correctly leads to another type of malformation where the uterine bodies are become partially of completely separated in two diverging halves (didelphys, bicornuate or “heart-shaped” uterus). Because exact classification is extremely important before planning a surgical intervention, a thorough diagnostic workup including 3D ultrasound or saline infusion sonograph, magnetic resonance imaging or even diagnostic laparoscopy is warranted. Nowadays, non-invasive diagnostic techniques are often sufficient to correctly diagnose the type of uterine malformation involved.        

Can a Septate uterus cause pain?

A septate uterus does not necessarily cause pain in contrast to other types of uterine malformations where the evacuation of menstrual blood is partially or completely blocked (e.g. non-communicating hemi-uterus or transversal vaginal septum). 

Can a Septate uterus be fixed?

The resection of a uterine septum is performed with a hysteroscopic intervention. In contrast to thermocoagulation devices, cold scissors are preferred to cut the excess tissue of the septum to limit heat damage of the surrounding tissue and the risk of scar formation. After the intervention, a waiting period up to 6 months is recommended to achieve complete healing of the operated uterus. During in-vitro-fertilization treatment single embryo transfer is mandatory if the uterus was previously operated on.

Does a uterine septum cause infertility?

A septate uterus does not necessarily impedes getting pregnant; in fact, it is through repeated pregnancy losses that the condition is most often diagnosed, clinically. Conversely, removal of the uterine septum greatly improves expected obstetric outcome and could lead subsequently to a completely uncomplicated pregnancy and delivery.

Can you have a normal pregnancy with a Septate uterus?

It is unlikely that a normal term pregnancy could develop in uterus with a complete septum, and repeated late miscarriages or preterm deliveries are most frequently associated with this type of uterine malformation. In the context of fertility treatment, the surgical correction of a septate uterus is always recommended before embryo implantation. Often, when it is more urgent to undergo in-vitro fertilization resulting embryos could be cryopreserved first and the uterus could be operated later.

Thank you so much to the brilliant Dr Bodri, gynaecologist and fertility expert at IVF Spain for his expertise and medical opinion.

If you have any further questions, drop us a line at info@ivfbabble.com.

 

 

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