Manual of Fertility Enhancing Hysteroscopy by Shikha Jain & Dattaprasad B. Inamdar

Author:Shikha Jain & Dattaprasad B. Inamdar
Language: eng
Format: epub
Publisher: Springer Singapore, Singapore

7.8.2 Uterine Septum

Uterine septum is the only Mullerian anomaly where hysteroscopy has a definite role in diagnosis and management. There is no doubt about the therapeutic effects of hysteroscopic metroplasty in patients with recurrent abortions and normal fertility. In patients with secondary infertility and recurrent spontaneous abortions, hysteroscopic metroplasty is applied as a treatment for their poor reproductive performance [25]. But the role of hysteroscopic septal resection as a prophylactic procedure is always debatable in patients presenting with primary unexplained infertility [14, 26].

Abdominal metroplasty by Jones and Tompkins technique for the incision of septum has been completely abandoned in favor of hysteroscopy, which has a much lower morbidity.

Timing of surgery: Best time to perform surgery is the postmenstrual or early follicular phase because the surrounding endometrium is thin and least vascular at this phase. Ostia which serve as important landmark are also clearly visible at this time.

Preoperative evaluation: Septal resection should be offered if there is history of poor reproductive performance rather than mere presence of a septate uterus [27]. Ideal candidates for surgery include women who had recurrent spontaneous abortions, a single second-trimester loss, or history of preterm delivery [28, 29].

Although few authors have tried pretreatment with gonadotropin-releasing hormone agonists to make the endometrium thin, there doesn’t seem to be any definitive role in improving the surgical outcome.

Instrumentation: Hysteroscope 30°, 4 mm (widely available), and 2.9 mm (preferred for office procedures) (Figs. 7.5 and 7.6).

Fig. 7.5Endovision system with xenon light source, camera, hysteromat with inflow and outflow tubes, and high-frequency, underwater electrosurgical unit

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