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13 - Operative Hysteroscopy for Uterine Septum

from PART II - INFERTILITY EVALUATION AND TREATMENT

Published online by Cambridge University Press:  04 August 2010

By
Mohamed F. M. Mitwally  and
Mostafa Abuzeid
Edited by
Botros R. M. B. Rizk ,
Juan A. Garcia-Velasco ,
Hassan N. Sallam  and
Antonis Makrigiannakis
Botros R. M. B. Rizk
Affiliation:
University of South Alabama
Juan A. Garcia-Velasco
Affiliation:
Rey Juan Carlos University School of Medicine,
Hassan N. Sallam
Affiliation:
University of Alexandria School of Medicine
Antonis Makrigiannakis
Affiliation:
University of Crete
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Summary

INTRODUCTION

This chapter presents a comprehensive review of the reproductive problems that could be associated with uterine septum. We believe that this topic has significant amount of controversy regarding its diagnosis and treatment due to the paucity of comprehensive evidence-based data on female congenital anomalies, in particular uterine septum. This resulted in the lack of a consensus on how the presence of a uterine septum might affect female reproduction. We will discuss the available data aiming at providing a balanced appraisal that can help the reproductive medicine specialists to better counsel patients about their reproductive potentials when a uterine septum is discovered.

Development

During the embryo development, the uterus forms from fusion of the paramesonephric ducts (Müllerian ducts), which join in the midline around the “tenth” week of gestation to form the unified body of the uterus. In the absence of Müllerian-inhibiting substance, the Müllerian ducts develop into the uterus and fallopian tubes (and possibly the upper part of the vagina) (1–4). It is interesting to note that the Müllerian ducts can develop into two distinct types of tissue: the smooth muscle tissue of the uterus and the fibrous tissue of the cervix (3). We believe this explains the various structural subtypes of uterine septum when it comes to different proportion of fibrous and muscle structure, that is, some uterine septa may contain more fibrous (cervical differentiation) component, while others contain more muscular (uterine differentiation) component.

Keywords

hysterosalpingographylaparoscopymagnetic resonance imagingoperative hysteroscopyuterine septumultrasonographyreproductive problems
Type
Chapter
Information
Infertility and Assisted Reproduction , pp. 115 - 131
Publisher: Cambridge University Press
Print publication year: 2008

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References

Lin, PC, Bhatnagar, KP, Nettleton, GS et al. (2002). Female genital anomalies affecting reproduction. Fertil Steril. 78:899–915.CrossRefGoogle ScholarPubMed
Ulfelder, H, Robboy, SJ. (1976). The embryologic development of the human vagina. Am J Obstet Gynecol. 126:769–76.CrossRefGoogle ScholarPubMed
Mossman, HW. (1973). The embryology of the cervix. In (Blandau, RJ, Moghissi, K, (Eds.), The biology of the cervix. Chicago: University of Chicago Press, pp. 13–22.Google Scholar
Patton, PE. (1994). Anatomic uterine defects. Clin Obst Gynecol 37:705–21.CrossRefGoogle ScholarPubMed
Lee, DM, Osathanondh, R, Yeh, J. (1998). Localization of Bcl-2 in the human fetal Müllerian tract. Fertil Steril 70:135–40.CrossRefGoogle ScholarPubMed
McBean, JH, Brumsted, JR. (1994). Septate uterus with cervical duplication: a rare malformation. Fertil Steril 62:415–17.CrossRefGoogle ScholarPubMed
Ergun, A, Pabuccu, R, Atay, V et al. (1997). Three sisters with septate uteri: another reference to bidirectional theory. Hum Reprod 12:140–2.CrossRefGoogle ScholarPubMed
Balasch, J, Moreno, E, Martinez-Romans, S et al. (1996). Septate uterus with cervical duplication and longitudinal vaginal septum: a report of three new cases. Eur J Obstet Gynecol Reprod Biol 65:241–3.CrossRefGoogle ScholarPubMed
Muller, PP, Musset, R, Netter, A et al. (1967). Etat du haut appareil urinaire chez les porteuses de malformations uterines: etude de 133 observations. La Presse Med 75:1331–6.Google Scholar
March, C.M. (1990) Mullerian anomalies. Fertil News 24/1 Endocrine Fertil Forum 13:1–5.Google Scholar
Acien, P. (1997). Incidence of Müllerian defects in fertile and infertile women. Hum Reprod 12:1372–6.CrossRefGoogle ScholarPubMed
Nahum, GG. (1998). Uterine anomalies: how common are they, and what is their distribution among subtypes?J Reprod Med 43:877–87.Google ScholarPubMed
Byrne, J, Nussbaum-Blask, A, Taylor WS Rubin, A et al. (2000). Prevalence of Müllerian duct anomalies detected at ultrasound. Am J Med Genet 94:9–12.3.0.CO;2-H>CrossRefGoogle ScholarPubMed
Raga, F, Bauset, C, Remohi, J et al. (1997). Reproductive impact of congenital Müllerian anomalies. Hum Reprod 12:2277–81.CrossRefGoogle ScholarPubMed
Maneschi, F, Zupi, E, Marconi, D et al. (1995). Hysteroscopically detected asymptomatic Müllerian anomalies. J Reprod Med 40:684–8.Google ScholarPubMed
Ashton, D, Amin, HK, Richart, RM et al. (1988). The incidence of asymptomatic uterine anomalies in women undergoing transcervical tubal sterilization. Obstet Gynecol 72:28–30.Google ScholarPubMed
Simon, C, Martinez, L, Pardo, F et al. (1991). Müllerian defects in women with normal reproductive outcome. Fertil Steril 56:1192–3.CrossRefGoogle ScholarPubMed
Nasri, MN, Setchell, ME, Chard, T. (1990). Transvaginal ultrasound for the diagnosis of uterine malformations. Br J Obstet Gynecol 97:1043–5.CrossRefGoogle Scholar
Heinonen, PK. (1997). Reproductive performance of women with uterine anomalies after abdominal or hysteroscopic metroplasty or no surgical treatment. J Am Assoc Gynecol Laparosc 4:311–17.CrossRefGoogle ScholarPubMed
Grimbizis, GF, Camus, M, Tarlatzis, BC et al. (2001). Clinical implications of uterine malformations and hysteroscopic treatment results. Hum Reprod Update 7:161–74.CrossRefGoogle ScholarPubMed
Homer, HA, Cooke, TC, Li, ID. (2000). The septate uterus a review of management and reproductive outcome. Fertil Steril 73:1–14.CrossRefGoogle ScholarPubMed
Buttram, VC, Gibbons, WE. (1979). Muellerian anomalies: a proposed classification (An analysis of 144 cases). Fertil Steril 32:40–6.CrossRefGoogle Scholar
The American Fertility Society. (1988). The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Müllerian anomalies and intrauterine adhesions. Fertil Steril 49:944–55.
Fayez, JA. (1986). Comparison between abdominal and hysteroscopic metroplasty. Obstet Gynecol 68:399–403.CrossRefGoogle ScholarPubMed
Daly, DC, Maier, D, Soto-Albors, C. (1989). Hysteroscopic metroplasty: six years' experience. Obstet Gynecol 73:201–5.Google ScholarPubMed
March, CM. (1983). Hysteroscopy as an aid to diagnosis in female infertility. Clin Obstet Gynecol 26:302–12.CrossRefGoogle ScholarPubMed
Worthen, N, Gonzalez, F. (1984). Septate uterus: sonographic diagnosis and obstetric complications. Obstet Gynecol 64:345–85.CrossRefGoogle ScholarPubMed
Perino, A, Mencaglia, L, Hamou, J et al. (1987). Hysteroscopy for metroplasty of uterine septa: report of 24 cases. Fertil Steril 48:321–3.CrossRefGoogle ScholarPubMed
Dabirashrafi, H, Bahadori, M, Mohammad, K et al. Septate uterus: new idea on the histologic features of the septum in this abnormal uterus. Am J Obstet Gynecol 172:1.
Kupesic, S, Kurjak, A. (1998). Septate uterus: detection and prediction of obstetrical complications by different forms of ultrasonography. J Ultrasound Med 17(10):631–6.CrossRefGoogle ScholarPubMed
Kupesic, S. (2001). Clinical implications of sonographic detection of uterine anomalies for reproductive outcome. Ultrasound Obstet Gynecol 18:387–400.CrossRefGoogle ScholarPubMed
Exalto, N, Stappers, C, Raamsdonk, , Emanuel, MH. (2007). Gel instillation sonohysterography: first experience with a new technique. Fertil Steril 87:152–5.CrossRefGoogle ScholarPubMed
Carrington, BM, Hricak, H, Nuruddin, RN et al. (1990). Müllerian duct anomalies: magnetic resonance imaging evaluation. Radiology 176:715.CrossRefGoogle Scholar
Nicolini, U, Bellotti, M, Bonazzi, B et al. (1987). Can ultrasound be used to screen uterine malformations?Fertil Steril 47:89–93.CrossRefGoogle ScholarPubMed
Keltz, MD, Olive, DL, Kim, AH et al. (1997). Sonohysterography for screening in recurrent pregnancy loss. Fertil Steril 67:670–4.CrossRefGoogle ScholarPubMed
Soares, SR, Barbosa dos Reis, MMB, Camargos, AF. (2000). Diagnostic accuracy of sonohysterography, transvaginal sonography, and hysterosalpingography in patients with uterine cavity diseases. Fertil Steril 73:406–11.CrossRefGoogle ScholarPubMed
Jurkovic, D, Geipel, A, Gruboeck, K et al. (1995). Three-dimensional ultrasound for the assessment of uterine anatomy and detection of congenital anomalies: a comparison with hysterosalpingography and two-dimensional sonography. Ultrasound Obstet Gynecol 5:233–7.CrossRefGoogle ScholarPubMed
Jurkovic, D, Gruboeck, K, Tailor, A et al. (1997). Ultrasound screening for congenital uterine anomalies. Br J Obstet Gynaecol 104:1320–1.CrossRefGoogle ScholarPubMed
Abuzeid, OM, Sakhel, K, Abuzeid, MI. (2005). Diagnosis of various type of uterine septum in infertile patients. J Minim Invasive Gynecol 12(5 Suppl. 1).Google Scholar
Hartman, A. (2006). Uterine imaging—malformations, fibroids and adenomyosis, Thirty-Ninth Annual Postgraduate Program, Course 17 Reproductive Imaging—How to Improve the Outcome of Assisted Reproductive Technology, October 22, 2006, New Orleans, Louisana, sponsored by ASRM.Google Scholar
Kupesic, S, Kurjak, A. (1998). Diagnosis and treatment outcome of the septate uterus. Croat Med J 39:185–90.Google ScholarPubMed
Weinraub, Z, Maymon, R, Shulman, A et al. (1996). Three-dimensional saline contrast hysterosonography and surface rendering of uterine cavity pathology. Ultrasound Obstet Gynecol 8:277–82.CrossRefGoogle ScholarPubMed
Lev-Toaff, AS, Pinheiro, LW, Bega, G et al. (2001). Three-dimensional multiplanar sonohysterography. J Ultrasound Med 20:295–306.CrossRefGoogle ScholarPubMed
Ayida, G, Kennedy, S, Barlow, D et al. (1996). Contrast sonography for uterine cavity assessment: a comparison of conventional two-dimensional with three-dimensional transvaginal ultrasound: a pilot study. Fertil Steril 66:848–50.CrossRefGoogle ScholarPubMed
Toaff, ME, Lev-Toaff, AS. (1984). Communicating uteri: review and classification of two previously unreported types. Fertil Steril 41:661–79.Google ScholarPubMed
Abuzeid, M, Mitwally, MF, Ahmed, A et al. (2007). The prevalence of fimbrial pathology in patients with early stages of endometriosis. J Minim Invasive Gynecol 14:49–53.CrossRefGoogle ScholarPubMed
Abuzeid, MI, Sakhel, K, Khedr, M et al. (2003). The association of endometriosis and uterine septum. Hum Reprod Suppl. 1:P-610.Google Scholar
Kamm, ML, Beernik, HE. (1962). Uterine anomalies in habitual abortion and premature labor. Obstet Gynecol 20:713–18.Google ScholarPubMed
Greiss, FC, Mauzy, CH. (1961). Genital anomalies in women: an evaluation of diagnosis, incidence, and obstetric performance. Am J Obstet Gynecol 82:330–9.CrossRefGoogle ScholarPubMed
Lewis, BV, Brant, HA. (1966). Obstetric and gynecologic complications associated with Müllerian duct abnormalities. Obstet Gynecol 28:315–22.Google ScholarPubMed
Acien, P. (1993). Reproductive performance of women with uterine malformations. Hum Reprod 8:122–6CrossRefGoogle ScholarPubMed
Goldenberg, M, Sivian, E, Sharabi, Z et al. (1995). Reproductive outcome following hysteroscopic management of intrauterine septum and adhesions. Hum Reprod 10:2663–5.CrossRefGoogle ScholarPubMed
Homer, HA, Tin-Chiu, L, Cooke, ID. (2000). The septate uterus: a report of management and reproductive outcome. Fertil Steril 73:1–14.CrossRefGoogle Scholar
Gaucherand, P, Awada, A, Rudigoz, RC et al. (1988). Obstetrical prognosis of septate uterus: a plea for treatment of the septum. Eur J Obstet Gynecol Scand 54:109–12.CrossRefGoogle Scholar
Buttram, CV. (1983). Müllerian anomalies and their management. Fertil Steril 40:159–63.CrossRefGoogle ScholarPubMed
Heinonen, PK, Saarkisoski, S, Pystynen, P. (1982). Reproductive performance of women with uterine anomalies. Acta Obstet Gynecol Scand 61:157–62.CrossRefGoogle ScholarPubMed
Sorensen, SS, Trauelsen, AG. (1987). Obstetric implication of Müllerian anomalies in oligomenorrheic women. Am J Obstet Gynecol 156:1112–18.CrossRefGoogle Scholar
Fenton, AN, Singh, BP. (1952). Pregnancy associated with congenital abnormalities of the female reproductive tract. Am J Obstet Gynecol 63:744–8.CrossRefGoogle ScholarPubMed
Rock, JA, Jones, HW. (1977). The clinical management of the double uterus. Fertil Steril 28:798–806.CrossRefGoogle ScholarPubMed
Woelfer, B, Salim, R, Banerjee, S. (2001). Reproductive outcomes in women with congenital uterine anomalies detected by three-dimensional ultrasound screening. Obstet Gynecol 98(6):1099–103.Google ScholarPubMed
Lin, PC. (2004). Reproductive outcomes in women with uterine anomalies. J Womens Health (Larchmt) 13(1):33–9.CrossRefGoogle ScholarPubMed
Raga, F, Bauset, C, Remohi, J et al. (1997). Reproductive impact of congenital Müllerian anomalies. Hum Reprod 10:2277–81.CrossRefGoogle Scholar
Salim, DR, Regan, L, Woelfer, B et al. (2003). A comparative study of the morphology of congenital uterine anomalies in women with and without a history of recurrent first trimester miscarriage. Hum Reprod 18(1):162–6.CrossRefGoogle ScholarPubMed
Tomazevic, T, Ban-Frangez, H, Ribic-Pucelj, M et al. (2006). Small uterine septum is an important risk variable for preterm birth. Eur J Obstet Gynelcol 2006. [Epub ahead of print.]Google ScholarPubMed
Jermy, K, Oyelese, O, Bourne, T. (1999). Uterine anomalies and failed surgical termination of pregnancy: the role of routine preoperative transvaginal sonography. Ultrasound Obstet Gynecol 14:431–3.CrossRefGoogle ScholarPubMed
White, MM. (1960). Uteroplasty in infertility. Proc R Soc Med 53:1006.Google ScholarPubMed
Fedele, L, Dorta, M, Brioschi, D et al. (1989). Pregnancies in septate uteri: outcome in relation to site of uterine implantation as determined by sonography. AJR 152:781–4.CrossRefGoogle ScholarPubMed
Candiani, GB, Fedele, L, Zamferletti, D et al. (1983). Endometrial patterns in malformed uteri. Acta Eur Fertil 14:311–18.Google ScholarPubMed
Fedele, L, Bianchi, S, Marchini, M et al. (1996). Ultrastructural aspects of endometrium in infertile women with septate uterus. Fertil Steril 65:750–2.CrossRefGoogle ScholarPubMed
Pellerito, JS, McCarthy, SM, Doyle, MB et al. (1992). Diagnosis of uterine anomalies: relative accuracy of MR imaging, endovaginal sonography, and hysterosalpingography. Radiology 183:795–800.CrossRefGoogle ScholarPubMed
Zreik, TG, Troiano, RN, Ghoussoub, RA. (1998). Myometrial tissue in uterine septum. J Am Assoc Gynecol Laparosc 5:155–60.CrossRefGoogle Scholar
Hinckley, MD, Milki, A. (2004). 1000 office-based hysteroscopies prior to in vitro fertilization: feasibility and findings. JSLS 8:103–7.Google ScholarPubMed
Tulandi, T, Arronet, GH, McInnes, RA. (1980). Arcuate and bicornuate uterine anomalies and infertility, Fertil Steril 34:362–4.CrossRefGoogle ScholarPubMed
Sorensen, SS. (1981). Minor Mullerian anomalies and oligomenorrhea in infertile women. Am J Obstet Gynecol 140:636–44.CrossRefGoogle ScholarPubMed
Raga, F, Bonilla-Musoles, F, Blanes, J, Osborne, NG. (1996). Congenital Mullerian anomalies: diagnostic accuracy of three dimensional ultrasound. Fertil Steril 65:523–8.CrossRefGoogle ScholarPubMed
Abuzeid, M, Sakhel, K, Ashraf, M et al. (2005). The association between uterine septum and infertility. Fertil Steril 84(Suppl. 1): S472.CrossRefGoogle Scholar
Lavergne, N, Aristizabal, J, Zarka V, et al. (1996). Uterine anomalies and in-vitro fertilization: what are the results?Eur J Obstet Gynecol Reprod Biol 68:29–34.CrossRefGoogle ScholarPubMed
Kirsop, R, Porter, R, Torode, H et al. (1991). The role of hysteroscopy in patients having failed IVF/GIFT transfer cycles. Aust NZ J Obstet Gynaecol 31:263–4.CrossRefGoogle ScholarPubMed
Dicker, D, Ashkenazi, J, Dekel, A et al. (1996). The value of hysteroscopic evaluation in patients with preclinical in-vitro fertilisation abortions. Hum Reprod 11:730–1.CrossRefGoogle ScholarPubMed
Syrop, CH, Sahakian, V. (1992). Transvaginal sonography detection of endometrial polyps with fluid contrast augmentation. Obstet Gynecol 79:1041–3.Google ScholarPubMed
Marcus, S, Al-Shawaf, T, Brinsden, P. (1996). The obstetric outcome of in vitro fertilization and embryo transfer in women with congenital uterine malformation. Am J Obstet Gynecol 175:85–9.CrossRefGoogle ScholarPubMed
Testart, J, Plachot, M, Mandelbaum, J et al. (1992). World collaborative report on IVF/ET and GIFT; 1989 results. Hum Reprod 7:362–9.CrossRefGoogle Scholar
Olive, DL, Henderson, DY. (1987). Endometriosis and mullerian anomalies. Obstet Gynecol 69:412–15.Google ScholarPubMed
Ugur, M, Turan, C, Mungan, T et al. (1995). Endometriosis in association with Müllerian anomalies. Gynecol Obstet Invest 40:261–4.CrossRefGoogle ScholarPubMed
Fedele, L, Bianchi, S, Di Nola, G et al. (1992). Endometriosis and nonobstructive Müllerian anomalies. Obstet Gynecol 79:515–17.Google ScholarPubMed
Nawroth, F, Rahimi, G, Nawroth, C et al. (2006) Is there an association between septate uterus and endometriosis?Hum Reprod 2:542–4. [Epub ahead of print.]CrossRefGoogle Scholar
Leyendecker, G, Kunz, G, Herbertz, M et al. (2004). Uterine peristaltic activity and the development of endometriosis. Ann NY Acad Sci 1034:338–55.CrossRefGoogle ScholarPubMed
Ugur, M, Karakaya, S, Zorlu, G et al. (1995). Polycystic ovaries in association with Müllerian anomalies. Eur J Obstet Gynecol Reprod Biol 62(1):57–9.CrossRefGoogle ScholarPubMed
Noumoff, JS, Heyner, S, Farber, M. (1986). The malignant potential of congenital anomalies of the paramenonephric ducts. Sem Reprod Endocrinol 4:67–73.CrossRefGoogle Scholar
Heinonen, P. (2006). Reproductive surgery: complete septate uterus with longitudinal vaginal septum. Fertil Steril 85(3):700–5.CrossRefGoogle ScholarPubMed
Hirst, BC. The operative treatment of uterus subseptus or semipartus with a case report. Trans Obstet Soc Phila 1919:891–2.
Luikart, R. (1936). Technic of successful removal of the septum uterine septus and subsequent deliveries at term. Am J Obstet Gynecol 31:797–9.CrossRefGoogle Scholar
Rock, JA, Lippincott, JB. (1992). Surgery for anomalies of the Müllerian ducts. In Thompson, JD, Rock, JA, (Eds.) Te Linde's operative gynecology. Seventh Edition. Philadelphia, pp. 603–46.Google Scholar
Rizk, B (Ed.) (2008). Ultrasonography in reproductive medicine and infertilityCambridge: United Kingdom, Cambridge University Press, (in press).Google Scholar
Choe, KJ, Baggish, SM. (1992). Hysteroscopic treatment of septate uterus with neodymium-YAG laser. Fertil Steril 57:81–4.CrossRefGoogle ScholarPubMed
Daly, DC, Maier, D, Soto-Albors, C. (1989). Hysteroscopic metroplasty: six years experience. Obstet Gynecol 73:201–5.Google Scholar
Lin, BL, Iwata, Y, Miyamoto, N et al. (1987). Three contrast methods: an ultrasound technique for monitoring transcervical operations. Am J Obstet Gynecol 56:469–72.CrossRefGoogle Scholar
Mencaglia, L, Tantini, C. (1996). Hysteroscopic treatment of septate and arcuate uterus. Gynaecol Endosc 5:151–4.Google Scholar
Thompson, JP, Smith, RA, Welch, JS. (1966). Reproductive ability after metroplasty. Obstet Gynecol 28:363–8.Google ScholarPubMed
Acién, P. (1993). Reproductive performance of women with uterine malformations. Hum Reprod 8:122–6.CrossRefGoogle ScholarPubMed
Mitwally, MF, Casper, RF, Diamond, MP. (2005). The role of aromatase inhibitors in ameliorating deleterious effects of ovarian stimulation on outcome of infertility treatment. Reprod Bio Endocrinol 3:54.CrossRefGoogle ScholarPubMed
Daly, DC, Waiters, CA, Soto-Albors, CE et al. (1983). Hysteroscopic metroplasty: surgical technique and obstetric outcome. Fertil Steril 39:623.CrossRefGoogle ScholarPubMed
Valle, RF, Sciarra, JJ. Hysteroscopic treatment of the septate uterus. Obstet Gynecol 676:253–986.
March, CM, Israel, R. (1987). Hysteroscopic management of recurrent abortion caused by septate uterus. Am J Obstet Gynecol 156:834.CrossRefGoogle ScholarPubMed
Rock, JA, Roberts, CP, Hesla, JS. (1999). Hysteroscopic metroplasty of the class Va uterus with preservation of the cervical septum. Fertil Steril 72:942.CrossRefGoogle ScholarPubMed
Vercellini, P, Giorgi, O, Cortesi, I et al. (1996). Metroplasty for the complete septate uterus: does cervical sparing matter?J Am Assoc Gynecol Laparosc 3:509–14.CrossRefGoogle ScholarPubMed
Parsanezhad, ME, Alborzi, S. (2000). Hysteroscopic metroplasty: section of the cervical septum does not impair reproductive outcome. Int J Gynaecol Obstet 69:165–6.CrossRefGoogle Scholar
Parsanezhad, ME, Alborzi, S, Zarei, A et al. (2006). Hysteroscopic metroplasty of the complete uterine septum, duplicate cervix, and vaginal septum. Fertil Steril 85:1473–7.CrossRefGoogle ScholarPubMed
Candiani, GB, Vercellini, P, Fedele, L, et al. (1990). Repair of the uterine cavity after hysteroscopic septal incision. Fertil Steril 54:991.CrossRefGoogle ScholarPubMed
Nisolle, M, Donnez, J. (1996). Endoscopic treatment of uterine malformations. Gynaecol Endosc 5:155–60.Google Scholar
Fedele, L, Bianchi, S, Marchini, M et al. (1996). Residual uterine septum of less than 1 cm after hysteroscopic metroplasty does not impair reproductive outcome. Hum Reprod 11:727–9.CrossRefGoogle Scholar
Kormanyos, Z, Molnar, BG, Pal, A. (2006). Removal of a residual portion of a uterine septum in women of advanced reproductive age: obstetric outcome. Hum Reprod 4:1047–51.CrossRefGoogle Scholar
Grimbizis, G, Camus, M, Clasen, K et al. (1998). Hysteroscopic septum resection in patients with recurrent abortions or infertility. Hum Reprod 13:1188–93.CrossRefGoogle ScholarPubMed
Daly, DC, Maier, D, Soto-Albers, C. (1989). Hysteroscopic metroplasty: six years' experience. Obstet Gynecol 73:201–5.Google ScholarPubMed
Fedele, L, Arcaini, L, Parazzini, F et al. (1993). Reproductive prognosis after hysteroscopic metroplasty in 102 women: life table analysis. Fertil Steril 59:768–72.CrossRefGoogle ScholarPubMed
Jacobsen, IJ, DeCherney, A. (1997). Results of conventional and hysteroscopic surgery. Hum Reprod 12:1376–81.CrossRefGoogle ScholarPubMed
Preutthipan, S, Linasmita, V. (2001). Reproductive outcome following hysteroscopic treatment of the septate uterus: a result of 28 cases at Ramathibodi Hospital. J Med Assoc Thai 84:166–70.Google Scholar
Sentilhes, L, Sergent, F, Roman, H et al. (2005). Late complications of operative hysteroscopy: predicting patients at risk of uterine rupture during subsequent pregnancy. Eur J Obstet Gynecol Reprod Biol 120:134–8.CrossRefGoogle ScholarPubMed
Nisolle, L, Donnez, J. (1996). Endoscopic treatment of uterine malformations. Gyaecol Endosc 5;155–60.Google Scholar
Abuzeid, M, Mitwally, MFM. (2008). Modern evaluation and management of uterine septum. In Rizk, B, (Ed.) Ultrasonography in reproductive medicine and infertility. Cambridge: United Kingdom, Cambridge University Press, chapter 28, pp. 282–4.Google Scholar

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