Literature Review Article
Hysteroscopic resection of the septum improves the pregnancy rate of women with unexplained infertility: a prospective controlled trial. Mollo, A., De Franciscis, P., Colacurci NCobellis, L., Perino, A., Venezia, R., Alviggi ,C., De Placido, G. Fertility & Sterility. 2009 June; 91(6): 2628-31.
Dr. John Preston Parry, M.D., M.P.H.
The authors posed the question as to whether hysteroscopic septum resection improves both fecundability and fecundity in patients with otherwise unexplained infertility. This prospective controlled trial enrolled 44 women with uterine septae and otherwise unexplained infertility in the metroplasty arm and 132 women with unexplained infertility and no uterine septum served as controls. All enrollees had regular menses and BMIs ranging from 18 to 28. In the 12 months of follow-up, 38.6% of metroplasty patients spontaneously conceived and 34.1% had a pregnancy that resulted in a live birth compared to 20.4% and 18.9% respectively in the control arm. Both the differences in fecundability and fecundity were statistically significant. The authors conclude that, all other things being equal in the setting of otherwise unexplained infertility, patients with a uterine septum that undergo metroplasty will have a higher pregnancy and live birth rate than patients with unexplained infertility and without a septum. The authors note that ideally all enrollees would have had uterine septae and that they would have been randomized to treatment or non-treatment, but they did not believe this to be ethically acceptable, given the association between uterine septae and pregnancy loss.
Dr. Meike Uhler, M.D.
This is a very interesting study as there are a number of IVF programs that advocate hysteroscopic evaluation of the uterine cavity prior to IVF as a way to maximize pregnancy outcome. While it would be difficult to perform this type of study in the U.S. (12 months of expectant management following septal resection), the study does raise the intriguing possibility of a link between a uterine septum and infertility. Limitations of the study are small patient numbers in the treatment group, non-randomization (not ethically feasible), and no clear description of septal size or how the septum was diagnosed (i.e. length of extension of septum into the cavity). Further study in this area is certainly warranted.
The above review and commentary on this article were written by SRS members. Publication of these summaries does not reflect endorsement of any particular procedure or treatment. Views expressed in these summaries do not necessarily reflect the views of SRS or ASRM.