Septate Uterus
Diagnosis & Treatment

Dr. Deepak Goenka, M.D
Director, Institute of Human Reproduction
IVF Specialist

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Septate Uterus is a birth defect (Mullerian Duct anomaly).
Normally uterine cavity is triangular in shape. But in cases of the septate uterus, a fibromuscular partition with poor vascularity runs down the middle of the uterus (i.e. the womb) and divides it into two small separate parts.

Two common types of the septate uterus are there:
Sub-septate uterus, in which a septum does not reach the cervix, and
complete septate uterus, in which the septum divides the whole uterine cavity.

Rarely septum can also reach up to the vagina resulting in two vaginas too. Sometimes this may be associated with defects of the kidney.

This is the most common birth defect of the uterus. It is seen in almost 5% female in the general population. But if we consider patients with infertility, it is seen in almost 10% of cases. And in cases of repeated abortions, it is seen in almost 15% of the cases. Whereas, in cases where both infertility and repeated abortions are seen, the septate uterus is seen in almost 25% of cases.

Diagnosis

Magnetic Resonance Imaging (MRI) and three-dimensional Trans Vaginal Sonography (3D TVS) are the gold standards for the diagnosis of the septate uterus. Hystero-salpingo-graphy (HSG) is never the right investigation to diagnose septate uterus as the fundus of the uterus cannot be visualized through it.

Many times this problem is diagnosed accidentally in young girls. The presence of this partition itself does not need any surgical intervention in these girls. In many cases, a female doesn’t even realize that there is something wrong or should say something different in her uterus and enjoys her whole life without any trouble.

But in a few females, this septate uterus can cause first and second-trimester abortions, preterm labor, abnormal labor, intrauterine growth restriction, and infertility.

Treatment

Only those females who experience problems due to septate uterus require treatment. There is no medical treatment for this condition and surgical treatment is always the best option.

There was a time, say 20-30 years back, the correction surgeries for the septum used to be an open surgery (laparotomy) where the abdomen, and the uterus, had to be opened.

But with the advancements in hysteroscopic surgeries, the treatment of the septate uterus (Hysteroscopic Metroplasty) has been much easier.

Now with the help of hysteroscopic scissors or an electric cutter, a surgeon can cut this septum and make the uterine cavity normal. In the majority of the cases, correction can be done in one sitting only. But in some cases, 2 or 3 sittings may be required.

This surgery may rarely be associated with complications like perforation of the uterus, intestine, or other important organs or fluid overload.

This surgery requires a set of very sophisticated instruments as well as a very skilled and experienced surgeon. At IHR, we are performing this surgery for the last 20 years with an excellent success rate.

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