Andrology-Open Access
Open Access

Improve the Chance of Fertilization, the Uterine Septum Eliminated

Ahmed Ragab^{* *}Correspondence: Ahmed Ragab, Department of Reproductive Medicine, Cairo University, Giza, Egypt, Tel: 1009800611, Email:

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Introduction

The study indicating a link between a septate uterus and infertility or miscarriage is nearly entirely made up of retrospective studies, and the one RCT that was conducted failed to find a meaningful connection. The alleged link between a spectated uterus and early pregnancy loss is a major factor affecting surgical management in reproductive medicine.

Recurrent Pregnancy Loss (RPL) is reported to be caused by congenital uterine defects in 10% to 15% of instances in the retrospective literature, whereas only 20% to 25% of women with septate uteri report RPL. Also, it has been shown by data that a septate uterus increases the chance of malpresentation. A comprehensive evaluation that is typically standardised is performed on a woman who appears with unexplained infertility to a reproductive fertility expert. Laboratory testing, taking into account the male factor, calculating ovarian reserve, and evaluating the uterine cavity and tubal patency are all included in the workup. The diagnosis of uterine septum may prompt the healthcare provider and patient to consider rapid excision in the absence of any other obvious risk factors, although the supporting data for this approach are insufficient.

According to observational studies, infertility in women with other unexplained infertility decreased after hysteroscopic septum excision. In individuals with otherwise unexplained infertility, septum resection was associated with an overall pregnancy rate of 63% and a live birth rate of 50%, according to the most current published meta-analysis of these studies. The most recent and largest cohort study, which included 257 women and had an average follow-up time of 46 months, did not discover any appreciable variations in the rates of live births, spontaneous pregnancy losses, preterm births, or malpresentations between women with primary infertility who underwent septum resection and those whose pregnancies were treated expectantly. Among women whose pregnancies were expectantly managed, the rates of live birth and pregnancy loss were 60% and 45%, respectively, and 53% and 40% for women who underwent septum resection.

The findings of several prospective, nonrandomized cohort studies evaluating the same outcomes have also been inconsistent.

After resection, pregnancy and live birth rates improved according to three studies, with one finding a dose dependent link between the size of the removed septum and the number of previous miscarriages.

Description

A third trial that examined women who had never experienced a miscarriage was unable to show any appreciable change in their outcomes following resection. In these trials, the overall rates of pregnancy and live birth varied greatly, from 40% to 80% and from 30% to 80%, respectively. Just released an RCT on the effectiveness of uterine septum excision.

Years were spent recruiting 80 women for this multicenter, international trial, who were then randomised to get hysteroscopic septum excision. A live birth of a foetus with a gestational age of 24 weeks or more within 12 months following randomization was the primary outcome.

Continuation of pregnancy (including difficulties such malpresentation), pregnancy loss, clinical pregnancy, and premature birth were among the secondary outcomes. Regardless of whether intention to treat or per protocol analyses were carried out, there were no statistically significant differences between the two groups in any outcome.

Uterine perforation only occurred once in the septum resection group.

The trial's small sample size prevented it from being powered to assess the varied impacts of infertility or to identify subtle changes in outcomes. Although there is no defined procedure for the precise surgical technique, hysteroscopic excision is the first-line treatment for uterine septum. This is partly because clinical manifestations can differ greatly in terms of the extent, size, thickness, symmetry, muscularity, and vascularity of the septum.

Conclusion

Studies frequently lump all uterine septa together or do not follow a standard procedure for imaging methods and diagnostic standards for study inclusion, which makes it difficult to determine whether specific uterine septa types have a negative impact on reproductive outcomes and whether surgical repair is actually beneficial.