Hysteroscopic Metroplasty

Current & Future role

Septate uterus is seen most frequently in women with reproductive wastage. Uterine anomalies are found in 1-2% of all women, in 4% of infertile women and in 10-15% of women who experience recurrent abortion

Recurrent pregnancy loss (RPL) is a profound personal tragedy to the couple seeking parenthood and form a great clinical challenge to their physician.

Diagnostic hysteroscopy is a possible main tool for the diagnosis and management of uterine cavity abnormalities. This is of particular importance in recurrent aborters

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The central portion of the septum is incised first and the fibroelastic band of tissue retracted with minimal bleeding. The dissection is carried cephalad until the septum was incised completely and the uterine cavity was apparantly normal.

Wide septa that do not allow simultaneous observation of the whole line of incision are reduced progressively with alternate lateral sections from the apex to the fundus according to the technique proposed by March & Israel

The resection is guided by laparoscopy in all cases to minimize the risk of complications. By keeping the amount of light introduced into the abdomen to a minimum, the position of the hysteroscope is observed by the laparoscopist through transillumination of the myometrium

Conjucated oestrogen is prescribed for 25 days to encourage endometrial proliferation. Follow up for 6-12 month is conducted to evaluate the pregnancy rate and duration. Follow up is done on monthly interval.

A cause-effect relationship between the septate uterus and infertility has still not been demonstrated clearly. The traditional concept is that uterine septum is not an indication for surgery in infertile women .

The wide use of hysteroscopy in management of cases of recurrent abortions has expanded its indications to involve what is called “prophylactic metroplasty” in infertile women with uterine septa.

Metroplasty seems to prevent breech delivery and to decrease the cesarean section rate, which are potential benefits

Hysteroscopic metroplasty seems to be a safe and effective method for solving pregnancy wastage caused by uterine septa but if other factors compromising fertility were present metroplasty does not increase fecundability, but may improve live birth rate.

We believe that the main indication for removal of a uterine septum is recurrent pregnancy loss.

However, If a septate uterus is revealed during infertility investigations, it is reasonable to consider prophylactic metroplasty during combined hysteroscopy-laparoscopy setting to prevent spontaneous abortion and labour complications in patients considering assisted reproduction .