Metroplasty in a Large Population of Women with Septate Uterus

Study Objective: To determine the reproductive outcome after hysteroscopic metroplasty in women with septate uterus. Design: Retrospective comparative single-center study (Canadian Task Force classification II-3). Setting: University-affiliated hospital. Patients: Two hundred forty-six patients with septate uterus undergoing hysteroscopic metroplasty between January 1998 and December 2007. The diagnosis was based on hysteroscopy and 3-dimensional ultrasonography. In the most cases laparoscopy was also available. The subjects were divided into 2 age-matched groups. Group I consisted of 108 women with unexplained infertility, and group 2 consisted of 138 women suffering from recurrent abortion. Interventions: Patients underwent hysteroscopic metroplasty by use of resectoscopy with an equatorial semicircular loop cutting at 0 degree with monopolar energy. All septa were completely removed without complications of bleeding, infection, risk of perforation, visceral injury, or uterine dehiscence during pregnancy. Measurement and Main Results: The 2 groups were compared in terms of reproductive performance in mean +/- SD follow-up of 37 +/- 18 months. In group 1,61 (56.5%) patients achieved pregnancy. Seventy-one pregnancies ensued, including I twin gestation. Fourteen of the 71 pregnancies (19.7%) ended in miscarriage. In group 2, 90 (65.3%) patients achieved pregnancy. One hundred twenty-nine pregnancies ensued, including 2 twin gestations. Forty-four of the 129 pregnancies (34.1%) ended in miscarriage. The 2 groups have no significant differences in terms of reproductive outcome after surgery, except for the number of abortions, which was higher in group 2 (p < .05). Conclusion: This study confirms that hysteroscopic metroplasty is a simple, safe, and rapid surgical procedure with no complications for achieving normal uterine architecture, which is peculiar to a good reproductive outcome. The use of an equatorial semicircular loop may give satisfactory and similar results to those obtained with Collin's loop. Journal of Minimally Invasive Gynecology (2011) 18, 449-454 (C) 2011 AAGL. All rights reserved.